What are the stages of chronic kidney disease and what do they mean?
Chronic kidney disease (CKD) is classified into five stages based on how well the kidneys filter waste from the blood, measured by the estimated glomerular filtration rate (eGFR). Each stage guides a different treatment approach — from lifestyle changes in early stages to dialysis or transplant in advanced disease. S.L. Raheja Hospital in Mumbai provides specialised nephrology services across all stages of CKD.
Tip: CKD often has no symptoms in its early stages. Routine blood and urine tests are the only reliable way to detect it early.
| Stage | eGFR (mL/min/1.73m²) | Kidney Function |
|---|---|---|
| Stage 1 | 90 or above | Normal or high, with kidney damage markers present |
| Stage 2 | 60–89 | Mildly reduced |
| Stage 3a | 45–59 | Mildly to moderately reduced |
| Stage 3b | 30–44 | Moderately to severely reduced |
| Stage 4 | 15–29 | Severely reduced |
| Stage 5 | Below 15 | Kidney failure (end-stage renal disease) |
What are the symptoms of each stage of CKD?
Symptoms vary significantly by stage. Early CKD is largely silent; noticeable symptoms typically emerge in stages 3 and beyond as waste accumulates in the blood.
- Stage 1 & 2: Usually no symptoms. Kidney damage is detected only through urine protein (proteinuria) or imaging abnormalities.
- Stage 3: Fatigue, fluid retention (swelling in ankles or feet), changes in urination frequency, mild anaemia, and early blood pressure elevation.
- Stage 4: Increased fatigue, decreased appetite, nausea, difficulty concentrating, worsening swelling, and bone pain due to mineral imbalance.
- Stage 5 (Kidney Failure): Severe breathlessness, persistent nausea and vomiting, confusion, muscle cramps, very little or no urine output, and itching from toxin build-up.
Warning: Sudden swelling, breathlessness, or confusion in a known CKD patient requires immediate medical attention — do not wait for a scheduled appointment.
How is chronic kidney disease treated at each stage?
Treatment at S.L. Raheja Hospital in Mumbai is tailored to the patient's CKD stage, underlying cause, and overall health. The goal at every stage is to slow progression and manage complications.
- Stage 1 & 2 — Protect and monitor: Control blood pressure and blood sugar (key drivers of CKD), reduce dietary sodium, avoid nephrotoxic medications (e.g. certain NSAIDs), and schedule regular kidney function tests.
- Stage 3 — Slow progression: Medications to manage blood pressure (often ACE inhibitors or ARBs), treatment of anaemia with iron or erythropoiesis-stimulating agents, phosphate and potassium dietary restrictions, and referral to a nephrologist if not already under specialist care.
- Stage 4 — Prepare for renal replacement: All stage 3 measures continue. The nephrologist begins planning for dialysis or transplant, including patient education, vascular access creation (for haemodialysis), and transplant evaluation.
- Stage 5 — Renal replacement therapy: Haemodialysis, peritoneal dialysis, or kidney transplantation. Palliative/conservative management is an option for patients who choose not to pursue dialysis.
Patients with CKD often have overlapping conditions. The nephrology team at S.L. Raheja Hospital coordinates with endocrinology for diabetes management and with diabetes care specialists, since diabetic nephropathy is one of the most common causes of CKD in India.
At what stage of CKD do you need dialysis?
Dialysis is typically initiated at Stage 5 CKD, when the eGFR falls below 15 mL/min/1.73m², or earlier if the patient develops life-threatening complications such as severe fluid overload, uncontrolled high potassium (hyperkalaemia), or uraemic symptoms that cannot be managed medically.
The decision is not based on eGFR alone. A nephrologist considers:
- Severity of uraemic symptoms (nausea, confusion, pericarditis)
- Fluid balance and blood pressure control
- Nutritional status and rate of kidney function decline
- Patient preference and overall clinical picture
Starting dialysis too early carries its own risks; starting too late can be dangerous. This is why regular nephrology follow-up from Stage 3 onwards is important — so the timing decision is planned, not reactive.
Tip: If dialysis is anticipated, vascular access (arteriovenous fistula) should ideally be created months in advance — not as an emergency. Discuss this with your nephrologist at Stage 4.
What diet should you follow for CKD, especially at stage 3?
Diet is a cornerstone of CKD management. Specific restrictions depend on blood test results, but the following general principles apply at Stage 3 and beyond. Always follow the guidance of your nephrologist and a renal dietitian — individual requirements vary.
| Nutrient | General Guidance for Stage 3 CKD |
|---|---|
| Sodium | Limit to help control blood pressure and fluid retention; avoid processed and packaged foods |
| Potassium | Restrict only if blood potassium is elevated; avoid high-potassium foods (bananas, tomatoes, potatoes) if advised |
| Phosphorus | Limit dairy, nuts, cola drinks, and processed foods with phosphate additives |
| Protein | Moderate intake; excessive protein accelerates kidney decline, but too little causes malnutrition — a dietitian should set the target |
| Fluids | Usually not restricted at Stage 3 unless swelling or high blood pressure is present; restriction becomes important at Stage 5 |
How quickly does CKD progress, and can stage 3 kidney disease be reversed?
CKD is generally not reversible, but its progression can often be significantly slowed — and in some cases stabilised — with appropriate treatment. True reversal (restoration of lost nephrons) is not possible with current medicine, but some patients with Stage 3 CKD maintain stable kidney function for many years.
Rate of progression depends on:
- Underlying cause — diabetic nephropathy and hypertensive nephropathy tend to progress faster without tight control
- Blood pressure management — sustained high blood pressure accelerates decline
- Proteinuria — higher protein in urine correlates with faster progression
- Adherence to medications and dietary guidance
- Smoking, obesity, and recurrent urinary tract infections
On average, eGFR declines by 1–2 mL/min/1.73m² per year in the general population, but this varies widely. Some patients with well-controlled Stage 3 CKD show minimal decline over a decade; others progress to Stage 5 within a few years. Regular monitoring every 3–6 months allows the care team to detect acceleration early.
When should you see a nephrologist for CKD?
Consult a nephrologist — not just a general physician — if any of the following apply:
- eGFR below 60 mL/min/1.73m² on two separate tests at least 90 days apart
- Persistent protein or blood in the urine without a clear urological cause
- Blood pressure that remains difficult to control despite two or more medications
- Rapid decline in kidney function (eGFR drop of more than 5 mL/min/1.73m² in one year)
- Diabetes or hypertension with any sign of kidney involvement
- Swelling in the legs, face, or around the eyes that does not resolve
- Unexplained anaemia, bone pain, or persistent fatigue in a patient with known kidney disease
S.L. Raheja Hospital in Mumbai offers nephrology consultations at its Mahim West facility. Use the booking form on this page to schedule an appointment, or reach out via email at info@rahejahospital.com.
Book a nephrology consultation at S.L. Raheja Hospital
Use the booking form on this page, or email us at info@rahejahospital.com