Understanding the 5 Stages of Chronic Kidney Disease (CKD)

Asian Institute of Nephrology and Urology | Dec 09, 2025

People don’t usually think about kidneys until a doctor brings them up during routine tests, and suddenly the word “chronic” changes the whole tone of the conversation. Some feel completely normal and are shocked to learn their kidneys have been struggling silently for years. Others know something feels “off” but can’t explain it; they push through work, family, long days, and assume it’s just stress. Kidney disease isn’t dramatic at first, which might be why people miss early warnings until they become too loud to ignore. Understanding what is going on can make the experience less frightening and more manageable, especially once you realize there are ways to slow things down.

What Exactly Is Chronic Kidney Disease?

Chronic Kidney Disease (CKD) is a long-term condition in which the kidneys gradually lose their ability to filter waste, balance electrolytes, and regulate essential functions such as blood pressure and red blood cell production. By definition, CKD is diagnosed when there is kidney damage or a reduced glomerular filtration rate (GFR) that persists for more than three months.

What makes CKD particularly challenging is that this decline happens slowly and silently. In the early stages, the kidneys compensate remarkably well, so most people feel completely normal. Symptoms of kidney disease often appear only when the damage has already progressed; one reason CKD is called a “silent” disease. Some people hear “CKD” and immediately worry about dialysis, but kidney decline usually happens slowly, not overnight. Identifying these stages early allows for timely interventions, lifestyle changes, and treatments that can delay progression and protect remaining kidney function.

What are the Symptoms of a Kidney Problem?

There isn’t a single universal warning, because many people develop chronic kidney disease (CKD) without any noticeable symptoms in the beginning. However, one of the earliest changes some people experience is persistent fatigue. Not the regular, “I stayed up late” kind, but a drained feeling that hangs around. Following are some of the common symptoms of kidney disease:

• Persistent fatigue or tiredness
  A deeper, ongoing exhaustion caused by toxin build-up or early anaemia.
• Swelling in the feet, ankles, or hands
  Fluid retention due to reduced kidney function.
• Puffiness around the eyes, especially in the morning
  Often an early clue that the kidneys are leaking protein.
• Dry, itchy skin
  Happens when waste products accumulate in the blood or when mineral balance is affected.

Because these symptoms are subtle and overlap with everyday issues, the safest way to detect kidney problems early is through simple blood (creatinine, eGFR) and urine tests rather than waiting for symptoms to appear.

How Do Chronic Kidney Disease Symptoms Appear?

Chronic Kidney Disease progresses slowly, and early symptoms are often subtle. For many, symptoms of kidney disease are almost like background noise. Nothing feels dramatic but something feels “off”, which is why CKD can go unnoticed for years. As kidney function declines, symptoms typically appear in stages:

Early or Mild Symptoms

• Increased urination at night (nocturia)
• Fatigue or sleep that doesn’t feel refreshing
• Mild swelling around the eyes

Progressing Symptoms

• Nausea or loss of appetite
• Restless legs or numbness in the feet
• Difficulty concentrating

Advanced Symptoms

• Noticeable swelling in the legs, feet, or hands
• Worsening fatigue due to anaemia
• Persistent itching
• Significant loss of appetite

The strange part is how ordinary these things sound, which is why they’re often ignored. Because these symptoms overlap with conditions like diabetes, heart disease, and high blood pressure, it’s often difficult to identify CKD based on symptoms alone. Regular blood and urine tests remain the most reliable way to detect kidney disease early.

What Causes Chronic Kidney Disease?

Chronic Kidney Disease usually develops due to long-standing conditions that damage the kidneys slowly over many years. The two most common causes are:

• Diabetes – High blood sugar damages the filters (glomeruli) and is responsible for nearly 40–45% of CKD cases worldwide.
• High Blood Pressure – Uncontrolled hypertension weakens and narrows the kidney’s blood vessels, accounting for another 20–25% of cases.

(Source: Saudi Journal of Kidney Diseases and Transplantation)

Other important causes include:

• Genetic conditions, such as Polycystic Kidney Disease (PKD)
• Autoimmune diseases, including lupus nephritis
• Chronic glomerulonephritis
• Long-term use of painkillers and certain medications (e.g., NSAIDs)
• Repeated kidney infections (pyelonephritis)
• Prolonged urinary obstruction, caused by kidney stones, prostate enlargement, or structural abnormalities

While lifestyle choices influence many risk factors, CKD often results from years of silent, cumulative damage. Understanding the cause helps shape chronic kidney disease treatment. Patients shouldn’t blame themselves, because CKD often results from years of silent damage before anyone even knew it existed.

The 5 Stages Of Chronic Kidney Disease, Explained

Chronic Kidney Disease is classified into five stages using a measurement called eGFR (estimated Glomerular Filtration Rate); the number that reflects how much blood the kidneys filter each minute. Doctors look closely at these numbers, but for most people, they’re simply a way to understand how well their kidneys are functioning.

Stage 1: eGFR ≥ 90 (Normal kidney function with early signs of damage)

Kidney function appears normal, but there may be evidence of kidney damage such as protein leakage in the urine, structural abnormalities, or known risk factors like diabetes or hypertension. Most people feel completely well and only discover changes through routine health checks.

Stage 2: eGFR 60–89 (Mild decrease in kidney function)

The kidneys are still functioning reasonably well, and symptoms are uncommon. This is the stage where early changes in urine tests may appear. Doctors often focus on controlling blood pressure, blood sugar, and lifestyle factors, because targeted care here can significantly slow disease progression.

Stage 3a and 3b: eGFR 45–59 (3a) / 30–44 (3b)

This is the stage where CKD becomes more noticeable. Patients may begin experiencing fatigue, swelling in the legs or feet, muscle cramps, or changes in urination patterns. Stage 3b carries a higher risk of complications such as anaemia, bone-mineral disorders, and electrolyte imbalances. Regular follow-ups become essential.

Stage 4: eGFR 15–29 (Severely reduced kidney function)

Symptoms often become more prominent—loss of appetite, persistent swelling, sleep issues, or worsening fatigue. Doctors begin discussing future treatment options, including dialysis or kidney transplant evaluation, so patients are medically and emotionally prepared well in advance.

Stage 5: eGFR < 15 (Kidney failure)

At this stage, the kidneys are no longer able to support the body’s needs. Dialysis or kidney transplantation becomes necessary to maintain life. Even so, every individual’s journey with CKD is unique. With proper care, symptom management, and lifestyle support, many patients maintain stability for long periods.

How Is CKD Diagnosed?

Chronic Kidney Disease is diagnosed through a combination of tests repeated over time, because kidney function must show persistent changes, not just a one-time abnormal result. Doctors typically use:

Blood tests

1. To measure serum creatinine and calculate the estimated Glomerular Filtration Rate (eGFR), which indicates how well the kidneys filter blood.
2. To assess electrolyte levels, such as sodium and potassium.

Urine tests

1. Urine Albumin-to-Creatinine Ratio (ACR) to check for protein leakage, one of the earliest signs of kidney damage.
2. Routine urine analysis to detect infections or abnormalities.

Blood pressure measurement

High blood pressure is both a cause and consequence of kidney disease, so monitoring it is essential for diagnosis and staging.

Imaging tests (Ultrasound or CT scan)

Used when doctors suspect structural problems, blockages, stones, or congenital abnormalities.

A diagnosis of CKD is made when these tests show reduced kidney function or evidence of kidney damage that persists for at least three months. It’s rarely a dramatic, one-day diagnosis; it’s a careful, data-driven conclusion.

Chronic Kidney Disease Treatment Options

Treatment depends on the stage, cause, and the patient’s overall health. The goal is not to reverse existing kidney damage but to slow progression, manage complications, and protect the kidney function that remains.

Blood Pressure Control

Medications such as ACE inhibitors or ARBs are often used because they protect the kidneys and reduce protein leakage. Good blood pressure control is one of the most effective ways to slow CKD progression.

Managing Underlying Conditions

When diabetes or hypertension is the cause, strict control of blood sugar and blood pressure becomes central to treatment.

Treating Complications

Many people with CKD develop anemia, bone-mineral imbalances, or electrolyte disturbances. Treating anemia can reduce constant fatigue, while managing calcium–phosphate balance protects bone health.

Dietary Modifications

As kidney function declines, diet becomes more tailored; typically focusing on reducing sodium, moderating protein, and balancing potassium and phosphorus intake.

Dialysis or Kidney Transplant Evaluation

Dialysis is recommended not simply at Stage 5, but when the kidneys can no longer maintain fluid, electrolyte, and toxin balance, or when symptoms become difficult to manage. Early preparation ensures smoother transition if needed.

Good chronic kidney disease treatment focuses on protecting what kidney function remains rather than trying to undo what’s already lost. At this stage, we at AINU Hospitals ensure that every patient receives carefully designed care supported by advanced nephrology technology and expert specialists.

Lifestyle Changes That Help

Lifestyle isn’t a cure, but it influences how fast CKD progresses.

• Lowering salt helps with swelling and blood pressure.
• Your doctor may recommend adjusting protein intake so the kidneys don’t work as hard.
• Exercise doesn’t need to be intense; walking daily can be enough.
• Staying hydrated matters, though not everyone should drink the same amount.
• Getting enough sleep gives the body time to repair and regulate key functions.
• Managing stress helps keep blood pressure and inflammation under control.
• Avoiding smoking protects blood vessels and slows CKD progression.

Managing CKD isn’t a perfect, disciplined routine, it’s a series of small decisions made repeatedly, even on tired days.

Why Early Kidney Care Matters and How AINU Hospitals Helps

At AINU Hospitals, we believe that understanding kidney health early can change a patient’s entire journey. Many people overlook small symptoms, but with the right guidance, problems can be identified long before they become serious. We offer advanced diagnostics, experienced nephrologists, and supportive care that helps patients feel informed rather than overwhelmed. Our goal is simple: help people protect their kidney function with clarity, timely intervention, and compassionate treatment. By combining modern technology with human-centered care, we ensure that every patient receives attention that genuinely makes a difference in their daily life and long-term health.

When Should You See A Kidney Specialist?

Anyone with abnormal tests, swelling, persistent fatigue, changes in urination, or difficult-to-control blood pressure should see a specialist. Early visits don’t mean the condition is severe; they simply provide better monitoring and clarity. Doctors can help patients make sense of chronic kidney disease symptoms, answer confusing questions, and plan long-term care. Waiting until symptoms are overwhelming makes everything harder. This is exactly where we at AINU step in, offering timely guidance and comprehensive evaluation so patients never feel lost or unsupported.

Conclusion

Kidney disease doesn’t announce itself in big ways, which is why so many people learn about it late. Understanding symptoms of kidney disease and recognizing how slowly the condition can move gives people a chance to respond instead of panic. CKD can’t always be reversed, but it can often be slowed, and that makes a real difference in daily life. People don’t lose control overnight. They adapt, learn, adjust treatment, and keep going.