CKD Evolution: The Stages of Chronic Kidney Disease

The human body’s kidneys aren’t usually paid much attention to.

Most people think that the only function of our “bean-shaped bags” is to filter the assortment of waste products and excess nutrients from the bloodstream - separating these materials into urine, and then passing them out of the body.

Understand this, though: the kidneys do more than that. The role our kidneys play in the bodies overall process is a great one.

Major functions of the kidneys include:

  • Helping keep various salts and chemicals in the blood at the right level
  • Helping control blood pressure – This is done partly through the amount of water excreted from the body through urine and partly through the creation of hormones that help control blood pressure.
  • Creation of erythropoietin, a hormone that stimulates the bone marrow to create red blood cells

Now, imagine how life would be like when your kidneys stop to perform all of these functions...

Without healthy, fully-functional kidneys, your body will suffer and health complications will start to emerge.

At present, the usual causes of Chronic Kidney Disease (CKD) are: diabetes, untreated high blood pressure, & ageing kidneys.

The Symptoms

Now, this is where it gets tricky. Usually, people who have stage 1 - 3 CKD (meaning mild to moderate levels) don’t feel any kind of uneasiness. Kidney disease symptoms usually emerge at advanced levels of CKD such as that with stage 4 and above.

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In severe CKD conditions, patients may experience:

  • Muscle cramps
  • Weight loss
  • Difficulty in concentration
  • Poor appetite
  • Dry and itchy skin
  • Swollen feet and ankles due to fluid retention
  • Puffiness around the eyes

Moreover, when your kidneys start to decline, nutrient imbalance between calcium, phosphate and other chemicals can be observed which may result to tiredness and bone fractures.

The Stages of Chronic Kidney Disease

Since symptoms are unlikely to appear on its initial stage, people who have CKD might learn about the disease through a random blood test result from other diseases like diabetes and high blood pressure.

Once CKD has been confirmed, an eGFR (estimated Glomerular Filtration Rate) blood test is performed to measure the level of the chemical creatinine present in the blood.

Creatinine is a breakdown product of the muscles, and is usually cleared away from the blood by your kidneys. A damaged kidney will reduce the filtering of this chemical, thus increasing creatinine level in the blood.

It is important to note that GFR is calculated based on factors like age and sex. Meaning, people of similar ages but with different genders might still get different results.

Stage 1

GFR reading may show ‘normal kidney function’ on Stage 1. However, it is important to consider that your kidneys are already damaged in this case.

The presence of blood / protein in your urine, for instance, is an indication of abnormal or inflamed kidneys. GFR will read 90+.

If not for a random blood test from diabetes and high blood pressure, persons with Stage 1 CKD may be aware of their condition through:

  • Blood / protein in the urine
  • Indication of kidney damage during an MRI, CT scan, ultrasound, or contrast X-ray
  • Higher creatinine level or urea in the blood

Stage 2

Mildly reduced kidney function is already observed here, and you are already known to have some sort of kidney damage. GFR reads 60-89.

(Take note, however, that people who have the same GFR reading but have no known kidney damage or disease are not considered to have CKD.)

Stage 3

Stage 3 is associated with moderately reduced kidney function without necessarily having known kidney damage or disease.

An ageing kidney, for instance, may be characterized with moderately reduced function even without specific damage or disease. GFR reads 45-59 for CKD Stage 3(A) and 30-44 for CKD Stage 3(B).

Symptoms of kidney disease that may show up on Stage 3 include:

  • Sleeping problems – Stage 3 CKD patients may experience itchiness, and muscle cramps that make them unable to sleep.
  • Fatigue – Stage 3 patients may experience tiredness as a result of anemia.
  • Urine color changes – Foamy urine is an indication of the presence of protein in the urine while brown, dark orange, or red if the urine contains blood.
  • Edema – Since Stage 3 is characterized by a moderately reduced kidney function, the kidneys are slowly losing its ability to regulate the amount of water that stays inside the body. This results in visible swelling in some parts of your body like lower legs, hands or face.

A patient on the 3rd Stage of CKD must constantly consult his / her nephrologist (kidney doctor) for regular monitoring of kidney disease progress.

Usually, nephrologists would recommend patients to a dietitian who will take charge of the patient’s meal plans. This is when we often see the link between chronic kidney disease and diet.

Remember that stage 3 CKD requires delicate dieting to maintain a balanced amount of needed nutrients inside the body. Thus, patient and dietitian should work hand-in-hand to create a meal plan that is both healthy and delicious.

Stage 4

This stage entails severely reduced kidney functions with or without kidney disease. GFR reads 15-29. Most likely, Stage 4 CKD patients will need to undergo dialysis or kidney transplant in the near future.

In addition to the kidney disease symptoms experienced during Stage 3, Stage 4 may also have the following:

  • Concentration problems – Problems in focusing to tasks like reading can occur.
  • Change in taste – Foods which previously taste good may now taste metallic.
  • Loss of appetite – Because of the metallic taste of foods, patients can lose their appetite.
  • Nausea – Vomiting plus nauseous feeling can occur.
  • Uremic breath – Due to increased amount of urea in the blood, uremic or bad breath can develop.
  • Nerve problems – Numbness in your toes may be experienced.

Stage 5

Sometimes called as the End-Stage Kidney Failure or Established Renal Failure. GFR reads less than 15.

In this stage, your kidneys are no longer capable of taking out waste fluid from the body. This results to a buildup of toxins in the blood. Some other functions, like regulating blood pressure and producing hormones for red blood cell formation, are no longer performed as well.

Patients diagnosed with stage 5 CKD must, without exception, see a Nephrologist immediately. He/she will help decide the treatment best for them (either hemodialysis, peritoneal dialysis, or kidney transplant).

It’s important to take note that fluctuations or changes on your GFR reading are natural. As long as your GFR is not progressing worse, the average value remains the most important point of reference.


Chronic kidney disease is a trickster. It strikes without your knowledge, and makes you aware of it only if it has already progressed to a more serious level.

And so, to help you get started with fighting kidney disease progression, sign up for a FREE eBook below!

So, how did you find out you have kidney disease? Let us know in the comments section.

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