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Chronic Kidney Disease: Stages, Progression & Preservation

CKD is often silent until advanced. Early detection and intervention, mainly controlling blood pressure and diabetes, can significantly slow progression and prevent dialysis.

Written by Suman Konda, PharmD, Clinical Pharmacist · Based on peer-reviewed sources · Editorial policy · Not medical advice

Last updated: · How we check our content

Global prevalence
~10% of population
Most common causes
Diabetes (40%) and hypertension (25%)
eGFR <15
Kidney failure: replacement therapy needed
SGLT2 inhibitors
Slow CKD progression by ~40%

CKD Staging and Management

CKD StageeGFRKey Actions
G1≥90 (+ kidney damage markers)Treat cause; BP <130/80; annual monitoring
G260–89Same; lifestyle; address CVD risk
G3a45–59Nephrology if rapid decline; anaemia screen; bone disease screen
G3b30–44Nephrology referral; avoid nephrotoxic drugs; prepare patient for RRT discussion
G415–29Pre-dialysis planning; vascular access creation; transplant referral
G5<15Dialysis or kidney transplant; conservative care if chosen
Chronic kidney disease stages by eGFRThe six eGFR categories used to stage chronic kidney disease.Kidney function stages by eGFRmL/min/1.73m². G1 and G2 only count as kidney disease with evidence of damageStageeGFRMeaningG1≥90Normal †G260–89Mildly reduced †G3a45–59Mild to moderateG3b30–44Moderate to severeG415–29Severely reducedG5<15Kidney failure† G1 and G2 are only kidney disease if urine or imaging also shows damage. eGFR 90+ with a normal urine test is normal.
Scroll sideways to see the whole diagram
eGFR categories used to stage chronic kidney disease.
What the chart shows. Kidney function is graded by eGFR from G1 at 90 or above down to G5 below 15. An important qualification: the top two grades are not by themselves chronic kidney disease. G1 and G2 only count as kidney disease when there is also evidence of damage, such as albumin in the urine, blood in the urine, or a structural abnormality on imaging, and the finding has persisted for at least three months. An eGFR of 95 with a normal urine test is a normal result, not stage G1. From G3a downwards the reduction in filtration is itself sufficient. Stage is also only half the picture, because the same eGFR carries a materially higher risk of progression when albumin is leaking, which is why an albumin-to-creatinine ratio is measured alongside.

What causes kidney disease?

The two most common causes of CKD worldwide are diabetes (diabetic nephropathy) and high blood pressure (hypertensive nephropathy). Together, they account for about 60–70% of all CKD cases. Other causes include:

  • Glomerulonephritis: inflammation of the kidney filtering units
  • Polycystic kidney disease (genetic)
  • Repeated urinary tract infections
  • Kidney stones causing obstruction
  • Long-term use of NSAIDs (ibuprofen, naproxen) or certain antibiotics
  • Lupus and other autoimmune conditions

Symptoms of kidney disease

CKD is often called a "silent disease" because early stages have no symptoms. Later stages cause:

  • Swelling in the feet, ankles and legs (fluid retention)
  • Puffy face, especially around the eyes in the morning
  • Fatigue and weakness (anaemia from low EPO production)
  • Decreased urine output or foamy urine (proteinuria)
  • Itchy skin (uraemic pruritis)
  • Nausea, loss of appetite, metallic taste in the mouth
  • Shortness of breath (fluid in lungs)
  • High blood pressure that's difficult to control

Why eGFR Alone Is Half the Picture

Staging kidney disease by eGFR is so familiar that people assume it is the whole assessment. It is not, and the reason is one of the largest pieces of evidence in kidney medicine.

A collaborative meta-analysis pooled data on 105,872 people with albumin-to-creatinine ratio measured and over 1.1 million with urine dipstick results. It found that eGFR and albuminuria predict mortality independently of one another, and that their effects multiply rather than overlap.2 Two people with identical eGFR can carry very different risk depending on how much albumin is leaking into their urine.

Two findings are worth stating plainly. Risk was flat across eGFR between about 75 and 105, then climbed as eGFR fell below that — so a mildly reduced number is not automatically alarming. And albuminuria rose with risk without any threshold: there was no level below which it stopped mattering.2 Compared with a very low ratio, all-cause mortality was around 20% higher at 1.1 mg/mmol and roughly doubled at 33.9.2

The person most often missedSomeone with a normal eGFR and albumin in the urine has kidney disease, and their risk is raised. If your kidney check consisted of a creatinine and nothing else, the albuminuria half was not measured. This is exactly why modern staging uses both, and why a urine albumin-to-creatinine ratio belongs alongside the blood test rather than as an optional extra.

It is also why treatment decisions do not follow from eGFR alone. Albuminuria is what several kidney-protective drugs are chosen to reduce, and a falling ACR is evidence that treatment is doing its job even when eGFR moves very little.

What Slows CKD Progression?

InterventionEffectDrug/Target
BP controlMost important modifiable factorTarget <130/80; ACEi or ARB for proteinuric CKD
SGLT2 inhibitors~40% reduction in CKD progression + mortalityEmpagliflozin, dapagliflozin: now first-line for CKD
Protein restrictionMild benefit in advanced CKD<0.8 g/kg/day — dietitian-guided
Avoidance of NSAIDsNSAIDs reduce renal blood flow: avoidEspecially in CKD G3–5
Smoking cessationReduces CKD progression and CVD riskEssential
Contrast Dye RiskIodinated contrast used in CT scans can acutely worsen kidney function (contrast nephropathy) in advanced CKD (G3b+). Ensure your radiology team knows your eGFR. They may use alternative imaging or pre-hydrate you.
Do I need dialysis with CKD stage 3?
No. Most people with CKD G3 never need dialysis. Stage 3 CKD requires monitoring and lifestyle modification to slow progression. Dialysis is typically considered only when eGFR falls below 10–15 mL/min.
What does protein in urine mean for CKD?
Proteinuria (raised ACR) indicates kidney damage and predicts faster progression. Even small amounts (ACR >3 mg/mmol) significantly increase CKD progression and cardiovascular risk. ACE inhibitors reduce proteinuria.
Can CKD be reversed?
Some acute causes of reduced eGFR (dehydration, UTI, NSAIDs) are reversible. True CKD with structural damage cannot be reversed. However, progression can be dramatically slowed with optimal management.
What anaemia is associated with CKD?
Normocytic normochromic anaemia from reduced erythropoietin production. Starts in G3b–4. Treated with ESAs (erythropoiesis-stimulating agents, such as darbepoetin) + IV iron to maintain Hb 100–120 g/L.

ICD-10-CM diagnosis codes

CKD is coded by stage, which is based on eGFR:

ICD-10-CM codeDescription
N18.1Chronic kidney disease, stage 1
N18.2Chronic kidney disease, stage 2 (mild)
N18.30Chronic kidney disease, stage 3 unspecified
N18.4Chronic kidney disease, stage 4 (severe)
N18.5Chronic kidney disease, stage 5
N18.6End stage renal disease

Codes shown are from the current ICD-10-CM classification (FY2026) and are provided for general reference. Clinical coding is performed by trained coders using the full medical record.

References

The clinical information on this page is based on peer-reviewed sources indexed in PubMed, the biomedical literature database of the US National Library of Medicine.

  1. Grams ME, Coresh J, Matsushita K, et al.. Estimated glomerular filtration rate, albuminuria, and adverse outcomes: an individual-participant data meta-analysis. JAMA. 2023;330(13):1266-1277. doi:10.1001/jama.2023.17002 · PMID 37787795
  2. Chronic Kidney Disease Prognosis Consortium. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375(9731):2073–81. PMID 20483451 · doi:10.1016/S0140-6736(10)60674-5

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Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.