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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Your stage, day to day

In short

This section has one page for each stage of chronic kidney disease (CKD) and for each kind of treatment. Find yours in the tables below, using your latest eGFR or the treatment you have now. Stages are labels for risk and planning, not a countdown: CKD leads to kidney failure only in some people, and treatment can slow it (NIDDK). Each page says what changes at that stage, the numbers that matter, what to do this week, and when to get help.

These pages are written for adults. Children and teenagers with kidney disease should be cared for by a pediatric kidney team, and some adult advice, such as limiting protein, does not apply to them (KDIGO 2024, practice points 3.3.1.4 and 5.1.2).

Find your page

Not on dialysis: use your eGFR

Your eGFR (estimated glomerular filtration rate) is on your blood test report. It is measured in mL/min/1.73 m². The stage is set by results that last more than 3 months, not by one test (KDIGO 2024).

Your eGFR Stage Your page
90 or more, with signs of kidney damage (such as albumin in the urine) G1 Stages G1 and G2
60–89, with signs of kidney damage G2 Stages G1 and G2
45–59 G3a Stage G3a
30–44 G3b Stage G3b
15–29 G4 Stage G4
under 15 G5 Stage G5 without dialysis (also for comprehensive conservative care)

On treatment: use your treatment

You are… Your page
on hemodialysis at a dialysis center In-center hemodialysis
on hemodialysis at home (standard, short daily or overnight) Home hemodialysis
on peritoneal dialysis (CAPD by hand, or APD with a night cycler) Peritoneal dialysis
being assessed for, or waiting for, a kidney or pancreas-kidney transplant Before a kidney transplant and your current stage or dialysis page
living with a kidney or pancreas-kidney transplant After a kidney transplant
choosing not to have dialysis Stage G5 without dialysis

Choosing between treatments is covered in Choosing a treatment (NIDDK: choosing a treatment).

Your numbers

The second part of your stage: albumin in the urine

Your stage also has an "A" number from the urine albumin-to-creatinine ratio (UACR). Risk rises with both numbers, so "G3a A3" is higher risk than "G3b A1" (KDIGO 2024). See CKD stages and UACR.

Category UACR
A1 (normal to mildly raised) under 30 mg/g
A2 (moderately raised) 30–300 mg/g
A3 (severely raised) over 300 mg/g
Category UACR
A1 (normal to mildly raised) under 3 mg/mmol
A2 (moderately raised) 3–30 mg/mmol
A3 (severely raised) over 30 mg/mmol

Your own risk number (KFRE)

From stage G3 on, your team can work out your personal chance of needing dialysis or a transplant with the Kidney Failure Risk Equation (KFRE). That number, not the stage alone, sets the timing of the next steps (KDIGO 2024, recommendation 2.2.1 and practice points 2.2.1–2.2.3):

Your KFRE result What it is used for
3–5 % or more over 5 years seeing a kidney specialist (nephrologist)
more than 10 % over 2 years joining a kidney care team (diet, medicines, education and social support)
more than 40 % over 2 years learning about treatments, planning dialysis access, transplant referral

KFRE may not be valid at G1 and G2, so it is not used there (KDIGO 2024, practice point 2.2.4).

Starting numbers by stage

These are the same starting points the app uses for "Suggest targets" (Targets and warnings). They are worked out for a 70 kg (154 lb) adult with type 1 diabetes.

Starting points, not your prescription

These numbers are typical starting points from guidelines. Your nephrologist, diabetes team and renal dietitian set your own numbers from your blood tests, urine output and medicines, and change them as your labs change. If your lab report or your team says something different, they win.

Stage Protein per kg (for 70 kg) Potassium mg ¹ Phosphorus mg ² Sodium mg Fluid mL Energy per kg (for 70 kg) Calcium mg ³
G1–G2 0.8–1.0 g/kg (56–70 g) ≤ 4,000 ≤ 1,000 < 2,000 no set limit 30 kcal/kg (about 2,100 kcal) ≤ 1,000
G3a 0.8 g/kg (about 56 g) ≤ 4,000 ≤ 1,000 < 2,000 no set limit 30 kcal/kg (about 2,100 kcal) ≤ 1,000
G3b 0.8 g/kg (about 56 g) ≤ 3,500 ≤ 1,000 < 2,000 no set limit 30 kcal/kg (about 2,100 kcal) ≤ 1,000
G4 0.8 g/kg (about 56 g) ≤ 3,000 ≤ 1,000 < 2,000 no set limit 30 kcal/kg (about 2,100 kcal) ≤ 1,000
G5, no dialysis 0.8 g/kg (about 56 g) ≤ 2,500 ≤ 900 < 2,000 no set limit 30 kcal/kg (about 2,100 kcal) ≤ 1,000
Hemodialysis 1.0–1.2 g/kg (70–84 g) ≤ 2,500 ≤ 1,000 < 2,000 1,500 ⁴ 30 kcal/kg (about 2,100 kcal) ≤ 1,000
Peritoneal dialysis 1.0–1.2 g/kg (70–84 g) ≤ 3,500 ≤ 1,000 < 2,000 2,000 ⁴ 30 kcal/kg (about 2,100 kcal) ≤ 1,000

¹ A review ceiling, not a prescription: only restrict potassium if your blood potassium is high; your care team sets the number. ² Used when blood phosphate runs high; phosphate additives count most (see the Phosphorus page). ³ Total from food, supplements and calcium-based binders. ⁴ Hemodialysis: 1,000 mL plus your measured urine output (1,500 mL assumes about 500 mL of urine). Peritoneal dialysis: set from your urine output and ultrafiltration.

Protein: with diabetes, never below 0.8 g/kg before dialysis (ADA 2026 Rec 11.3; KDIGO 2022 and 2024). Without diabetes, KDOQI 2020 allows 0.6–0.8 g/kg only under close clinical supervision. "Per kg" means per kg of a reference weight your team chooses; the 70 kg column is an example. Energy: KDOQI 2020 gives 25–35 kcal/kg; on peritoneal dialysis subtract the calories absorbed from the dialysis fluid (often 400 or more a day).

What to do

These apply at every stage:

  • Find your latest eGFR and UACR and write them down, with the date.
  • Open your stage page above and read its "What to do" list.
  • Treat every low blood glucose straight away. Potassium or fluid limits never delay it (ADA 2026 §6; Treating a low).
  • Keep glucagon at home and teach someone how to use it (ADA 2026 §6).
  • Ask your team for a written sick-day plan (Sick days).
  • Never eat star fruit or drink its juice, at any stage. It contains a toxin that failing kidneys cannot clear (NKF).
  • Keep one up-to-date medicine list (Your medicine list).
  • Put your stage, dialysis days and targets into the app (First setup).

Examples

  • "My eGFR went from 47 to 43. Am I worse?" Results move from test to test. KDIGO says a change of more than 20 % on a later test is more than normal variation (KDIGO 2024, practice point 2.1.3). 47 to 43 is a change of about 9 %. Ask your team which stage they use for you.
  • "I have been G3b for six years." That can happen: CKD leads to kidney failure only in some people (NIDDK). The stage tells you what to check and plan for. Your KFRE tells you how fast things are likely to change.

Ask your care team

  1. Which stage do you use for me, G and A?
  2. What is my KFRE, and when will you work it out again?
  3. Which page of this handbook fits me best right now?
  4. Which of the starting numbers above apply to me, and what are my own numbers?

Get help now if…

Call 911 (or your local emergency number)

Chest pain, severe breathlessness or not being able to lie flat, fainting, new confusion or a seizure, a low the person cannot treat themselves (give glucagon, then call), or possible diabetic ketoacidosis (DKA): blood ketones of 3.0 mmol/L or more, or any ketones with vomiting, deep fast breathing or fruity breath. With kidney failure, DKA can come with lower ketone readings, so the signs count too (2024 consensus). Full list: Get help now.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.