CKD Stages Explained: Understanding Chronic Kidney Disease from Stage 1 to 5

Chronic kidney disease (CKD) affects an estimated 17% of India’s population — roughly 24 crore people. Yet most patients don’t know their CKD stage, what it means, or when they need to take action.

Understanding your CKD stage is the single most important step in slowing kidney damage and avoiding dialysis. This guide explains each stage in plain language, what your eGFR and creatinine numbers actually mean, and what you should be doing at every stage.

What Is CKD?

Chronic kidney disease means your kidneys have been damaged and cannot filter blood as effectively as they should. The damage is usually gradual — happening over months or years — and is most commonly caused by:

• Diabetes (diabetic nephropathy) — the #1 cause in India
• High blood pressure (hypertensive nephrosclerosis) — the #2 cause
• Glomerulonephritis — inflammation of the kidney’s filtering units
• Polycystic kidney disease — inherited condition causing kidney cysts
• Obstructive uropathy — kidney stones or prostate enlargement blocking urine flow

CKD is staged based on your eGFR (estimated Glomerular Filtration Rate) — a blood test that measures how well your kidneys filter waste.

The 5 Stages of CKD

Stage	eGFR (mL/min)	Kidney Function	What It Means
Stage 1	90+	Normal or high	Kidney damage present but function is normal. Often detected by protein in urine.
Stage 2	60-89	Mildly reduced	Mild loss of function. Usually no symptoms. Detected through blood/urine tests.
Stage 3a	45-59	Mild-to-moderate	Waste products begin accumulating. You may start feeling fatigued.
Stage 3b	30-44	Moderate-to-severe	Anaemia, bone disease, and electrolyte imbalances become common.
Stage 4	15-29	Severely reduced	Preparation for dialysis or transplant should begin. Symptoms are noticeable.
Stage 5	Below 15	Kidney failure	Dialysis or kidney transplant is needed to survive.

Stage 1: Kidney Damage with Normal Function (eGFR 90+)

At this stage, your kidneys are filtering normally, but there is evidence of damage — usually detected through:

• Protein in urine (proteinuria or albuminuria)
• Blood in urine (haematuria)
• Abnormal kidney imaging (ultrasound showing structural changes)

What to do at Stage 1:

• Control blood sugar if diabetic (HbA1c below 7%)
• Control blood pressure (target: below 130/80 mmHg)
• Start an ACE inhibitor or ARB if you have proteinuria (these protect kidneys)
• Stop smoking — it accelerates kidney damage
• Annual kidney function monitoring (eGFR + urine albumin)

Most Stage 1 patients never progress to dialysis if they manage diabetes and blood pressure aggressively.

Stage 2: Mild Reduction (eGFR 60-89)

Kidney function is mildly reduced. Most patients feel completely normal. This stage is often discovered incidentally during routine blood tests.

What to do at Stage 2:

• Everything from Stage 1, plus:
• See a nephrologist for baseline assessment
• Start dietary modifications: moderate protein intake (0.8 g/kg/day)
• Monitor kidney function every 6 months
• Review all medications — avoid NSAIDs (ibuprofen, diclofenac) which damage kidneys

Stage 3: The Critical Window (eGFR 30-59)

This is where most patients are diagnosed. Stage 3 is split into 3a and 3b because the clinical picture changes significantly.

Stage 3a (eGFR 45-59): You may notice fatigue, mild swelling in ankles, or changes in urine frequency. Blood tests may show early anaemia and elevated phosphorus.

Stage 3b (eGFR 30-44): Symptoms become more noticeable. Anaemia worsens, bone mineral metabolism is disrupted, and dietary restrictions become important.

What to do at Stage 3:

• Regular nephrologist visits (every 3 months)
• Dietary changes for CKD — limit potassium, phosphorus, and sodium
• Treat anaemia with EPO and iron as prescribed
• Phosphate binders to protect bones
• Avoid nephrotoxic drugs — no over-the-counter painkillers without asking your nephrologist
• Discuss AV fistula creation if eGFR is trending toward 30

Stage 3 is your best opportunity to slow progression. Patients who control blood pressure, blood sugar, and proteinuria at this stage can delay dialysis by years — or avoid it entirely.

Stage 4: Severe Reduction (eGFR 15-29)

At Stage 4, kidney failure is approaching. Symptoms include:

• Persistent fatigue and weakness
• Nausea, loss of appetite
• Swelling in legs and face
• Difficulty concentrating
• Itching
• Muscle cramps, especially at night
• Changes in urination (more or less than usual)

What to do at Stage 4:

• Intensive nephrologist management (monthly visits)
• Prepare for renal replacement therapy:
  • AV fistula creation — should be done 6 months before anticipated dialysis start
  • Kidney transplant evaluation — living donor workup should begin now
  • Home hemodialysis training — if you’re a candidate
• Strict dietary management — work with a renal dietitian
• Erythropoietin for anaemia, vitamin D supplementation, phosphate binders

Do not wait for Stage 5 to plan. The patients who do best on dialysis are those who start with a mature AV fistula and a prepared treatment plan.

Stage 5: Kidney Failure (eGFR Below 15)

Your kidneys can no longer sustain life without support. You need either:

• Hemodialysis — typically 3 sessions per week at a dialysis centre
• Home hemodialysis — more frequent, shorter sessions at home
• Peritoneal dialysis — fluid-based dialysis through the abdomen
• Kidney transplant — the best long-term option if eligible

Starting dialysis is not a failure. It is a treatment that keeps you alive and functional while you wait for a transplant or manage your condition long-term.

At Renacare, our nephrologists help you choose the right modality based on your medical history, lifestyle, and preferences. Every patient gets an individualised treatment plan — not a one-size-fits-all protocol.

Understanding Your eGFR and Creatinine

eGFR is calculated from your serum creatinine, age, sex, and race. It estimates how many millilitres of blood your kidneys filter per minute.

Creatinine is a waste product from muscle metabolism. Healthy kidneys filter it out efficiently. As kidney function drops, creatinine rises.

Creatinine (mg/dL)	Approximate eGFR	What It Suggests
0.7-1.2	90+	Normal kidney function
1.5-2.0	45-60	Stage 3 CKD
2.5-3.5	20-35	Stage 4 CKD
5.0-8.0	8-15	Stage 5 — dialysis range
10.0+	Below 5	Urgent dialysis needed

Note: These are approximations. eGFR depends on age, sex, and muscle mass. Always use the lab-calculated eGFR, not creatinine alone.

When Should You See a Nephrologist?

• Creatinine above 1.5 mg/dL (or rising trend)
• eGFR below 60
• Protein in urine (even with normal creatinine)
• Family history of kidney disease
• Diabetes or hypertension with any kidney abnormality

Early nephrology referral is the single biggest factor in slowing CKD progression. Our clinical team at Renacare includes nephrologists with DM and DrNB qualifications from India’s top medical institutions.

Find a Renacare centre near you | Book a nephrology consultation

---

Reviewed by Dr. Swapnil Y Gajway, MD, DrNB (Nephrology) — Director Nephrology, Renacare CKDR