Stages of Chronic Kidney Disease

Kidney disease is divided into five stages, each of which calls for different tests and treatments.

Using the Glomerular Filtration Rate (GFR) to Determine Stages of Kidney Disease

Glomerular filtration rate (GFR) is the best measure of kidney function. It is the number used to figure out a person’s stage of kidney disease. A math formula using the person’s age, race, gender and serum creatinine is used to calculate GFR. A doctor will order a blood test to measure the serum creatinine level. Creatinine is a waste product that comes from muscle activity. When kidneys are working well they remove creatinine from the blood. As kidney function slows, blood levels of creatinine rise.

The following are the five stages of CKD, and the GFR for each stage:

  • Stage 1 — Normal or high GFR (GFR > 90 ml/min)
  • Stage 2 — Mild CKD (GFR = 60-89 ml/min)
  • Stage 3 — Moderate CKD (GFR = 30-59 ml/min)
  • Stage 4 — Severe CKD (GFR = 15-29 ml/min)
  • Stage 5 — End stage CKD (GFR <15 ml/min)

At stage 5, dialysis or a kidney transplant is needed.

Read more about each stage below:

Stage 1 and Stage 2 Kidney Disease

In stage 1 and stage 2 CKD, there are often few symptoms. Early CKD is usually diagnosed when the following conditions are present:

  • High blood pressure
  • Higher-than-normal levels of creatinine or urea in the blood
  • Blood or protein in the urine
  • Evidence of kidney damage in an MRI, CT scan, ultrasound or contrast x-ray
  • A family history of polycystic kidney disease (PKD)

Stage 3 Kidney Disease

In stage 3 CKD, anemia (a shortage of red blood cells) and/or early bone disease may appear. These may be treated to help the patient feel their best and help reduce problems down the road.

Stage 4 Kidney Disease

When CKD has progressed to stage 4, it's time to begin preparing for dialysis and/or a kidney transplant. If GFR falls below 30, most people need to see a kidney disease specialist (called a nephrologist). The kidney doctor will talk about treatments for kidney failure, including dialysis and kidney transplant. A GFR below 15 indicates that one of these treatments is necessary.

Stage 5 Kidney Disease

A person with stage 5 CKD has end stage renal disease (ESRD), with a GFR of 15 ml/min or less. At this advanced stage of kidney disease the kidneys have lost nearly all their ability to do their job effectively, and eventually dialysis or a kidney transplant is needed to live.

People diagnosed with Stage 5 CKD will need to see a nephrologist immediately. The doctor will help decide which treatment is best for the patient — hemodialysis, peritoneal dialysis or kidney transplant — and will recommend a vascular access for dialysis. A nephrologist will develop an overall care plan and manage the patient's healthcare team.

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