Chronic Kidney Disease Stages and Symptoms: A Stage-by-Stage Guide

By Anna Curran, RN, BSN, PHN · Last reviewed October 2026

There are five chronic kidney disease stages, and each one is based mostly on your eGFR, a blood test that shows how well your kidneys filter. Stages 1 and 2 usually cause no symptoms at all. Symptoms tend to show up in stage 3 or later, and they can be easy to mistake for other problems.

Knowing your stage helps you understand your lab results, ask better questions and spot changes early. Here is what each stage means and what you might notice along the way.

How Chronic Kidney Disease Stages Are Measured

Your stage is set mainly by your eGFR (estimated glomerular filtration rate). It is calculated from a blood test for creatinine plus your age and sex. Higher is better.

Your care team also looks at your urine albumin-to-creatinine ratio (UACR). This urine test checks for albumin, a protein that leaks out when the kidney filters are damaged. Lower is better.

Doctors group UACR into three levels:

A1: under 30 mg/g (normal to mildly increased)
A2: 30 to 300 mg/g (moderately increased)
A3: over 300 mg/g (severely increased)

So your full result may look like “stage 3a, A2.” The higher your UACR, the higher your risk of CKD getting worse and of heart problems, even at the same eGFR. If you are new to these tests, our guide on what is chronic kidney disease explains them in more detail.

One more thing to know: an eGFR can dip for a short time after an illness, dehydration or certain medicines. CKD is diagnosed when changes last 3 months or more.

The Stages at a Glance

Stage	eGFR	Kidney function
1	90 or higher	Normal, with signs of damage
2	60 to 89	Mildly decreased
3a	45 to 59	Mildly to moderately decreased
3b	30 to 44	Moderately to severely decreased
4	15 to 29	Severely decreased
5	Below 15	Kidney failure

Stage 1 and Stage 2: Early CKD

In stage 1, your eGFR is 90 or higher. In stage 2, it is 60 to 89. To be called CKD at these stages, there must be another sign of kidney damage, such as albumin in the urine or a structural problem seen on an ultrasound.

Symptoms: Usually none. Most people feel completely normal.

These stages are often found by chance, during routine lab work or a checkup for diabetes or high blood pressure. This is the best time to find CKD, because there is the most kidney function left to protect.

Stage 3: Moderate CKD

Stage 3 is split in two:

Stage 3a: eGFR 45 to 59
Stage 3b: eGFR 30 to 44

This is the most common stage for people to learn they have CKD. As filtering slows, problems like high blood pressure, anemia and bone and mineral changes become more likely.

Possible symptoms: Many people still have none. When symptoms do appear, the National Kidney Foundation lists:

Feeling tired or weak
Urinating more or less often than usual
Itchy or dry skin
Nausea
Loss of appetite
Losing weight without trying
Swelling in the hands or feet

The American Kidney Fund notes that with treatment and healthy changes, many people in stage 3 never move on to stage 4 or 5.

Stage 4: Severe CKD

In stage 4, eGFR is 15 to 29. The kidneys are working at a much lower level, and waste and fluid are more likely to build up.

Possible symptoms include those of stage 3, plus:

Swelling in the legs, ankles, feet or hands
Muscle cramps or aches
Trouble concentrating
Trouble sleeping
Shortness of breath
Foamy urine

This is often when your care team starts talking with you about options in case your kidneys fail. Planning early gives you time to learn, ask questions and make choices that fit your life.

Stage 5: Kidney Failure

Stage 5 means an eGFR below 15. The kidneys are close to failing or have failed. This is also called end-stage kidney disease.

Possible symptoms listed by NIDDK and the National Kidney Foundation include:

Nausea, vomiting and poor appetite
Severe tiredness
Itching
Urinating much less, or not at all
Swelling and shortness of breath from fluid buildup
Muscle cramps
Trouble thinking clearly

Treatment options at this stage include dialysis, a kidney transplant or conservative care that focuses on comfort and symptom control without dialysis. The right choice depends on your health, your wishes and the support you have at home.

Why Early CKD Often Has No Symptoms

It surprises many people that their kidneys can be damaged while they feel fine. In the early stages, the kidneys still filter enough waste and fluid to keep the body running. Problems only become noticeable when function drops much lower.

When early symptoms do appear, they are often vague. Feeling tired, itchy or not hungry can have many causes. MedlinePlus notes that many people are not diagnosed until they have lost most of their kidney function.

That is why testing matters. If you have diabetes, high blood pressure, heart disease or a family history of kidney failure, ask your provider about checking your eGFR and UACR. NIDDK advises yearly testing for people with diabetes.

When to Call Your Doctor

Call your provider soon if you have CKD, or are at risk for it, and you notice:

New or worse swelling in your feet, ankles, legs, hands or face
Foamy or bubbly urine that keeps happening
A change in how often you urinate or how much
Ongoing nausea, poor appetite or weight loss you cannot explain
New itching, muscle cramps or trouble sleeping
More tiredness than usual
Home blood pressure readings that are higher than your target
Sudden weight gain, which can be a sign of fluid buildup

Also call before you take any new over-the-counter pain reliever or supplement. Some can harm the kidneys or raise potassium.

When to Call 911 or Go to the ER

Call 911 or go to the emergency room right away if you have:

Chest pain or pressure
Trouble breathing or shortness of breath that is severe or getting worse, especially when lying down
A racing, pounding or irregular heartbeat
Sudden muscle weakness or numbness, or tingling with any of the signs above
Little or no urine for a day, along with feeling very ill
Confusion, extreme drowsiness or a seizure
Vomiting that will not stop

The National Kidney Foundation warns that a fast rise in blood potassium can be life-threatening. It can cause palpitations, chest pain and shortness of breath. People with CKD are at higher risk, so these symptoms need emergency care, not a wait-and-see approach.

Frequently Asked Questions

Can you go back to an earlier stage of CKD?

Your eGFR can go up and down a bit from test to test, so your stage label may shift. But long-lasting kidney damage usually cannot be undone. The goal of treatment is to keep your numbers as stable as possible.

How fast does CKD move through the stages?

It is different for everyone. Some people stay in the same stage for many years. The cause of your CKD and how well blood pressure and blood sugar are controlled make a big difference. Learn more in how to slow chronic kidney disease.

How often should my labs be checked?

It depends on your stage and your UACR. People in later stages, or with higher albumin levels, usually need tests more often. Ask your provider how often you should have your eGFR and UACR checked.

Does my stage change what I can eat?

It can. Limits on sodium, protein, potassium, phosphorus and fluids depend on your stage and your lab results. See our guide to a chronic kidney disease diet and ask about meeting with a kidney dietitian.

The Bottom Line

Chronic kidney disease stages run from 1 to 5, based mostly on your eGFR, with your urine albumin adding important detail. Early stages usually cause no symptoms, so testing is the only way to know. Symptoms like swelling, tiredness and changes in urination tend to appear later. Know your numbers, report new symptoms to your provider and call 911 for chest pain, severe shortness of breath or an irregular heartbeat.