Treating Kidney Disease: Stages, Options & Advances

How kidney disease is identified and classified

Diagnosing kidney problems relies on a mix of laboratory tests, urine studies, and imaging. Blood tests that measure creatinine and blood urea nitrogen (BUN) allow clinicians to calculate the estimated glomerular filtration rate (eGFR), which reflects how effectively the kidneys clear waste. Urinalysis looks for protein, blood, and other signals of renal damage. Ultrasound or CT scans can expose structural problems, stones, obstructions, or anatomic abnormalities that contribute to kidney dysfunction.

Once abnormal findings are confirmed, clinicians stage chronic kidney disease (CKD) by eGFR values. Stages range from 1 (normal or high eGFR with signs of kidney damage) through 4 (severe reduction in function) to stage 5, also called end-stage renal disease (ESRD), when kidney replacement therapy is typically needed. Staging guides treatment choices, monitoring frequency, and prognosis.

Core treatment strategies by stage

Treatment depends on the underlying cause and how advanced the kidney damage is. Early-stage care focuses on preserving function and managing conditions that accelerate decline, while later-stage care may require dialysis or transplantation.

• Lifestyle and risk-factor control: Dietary changes (reducing sodium, moderating protein and potassium as advised), regular physical activity, maintaining a healthy weight, and stopping smoking are foundational. These steps slow progression and improve cardiovascular health, which is critical because heart disease is a major risk for people with CKD.

• Medications: Blood pressure control is a cornerstone of therapy; ACE inhibitors or ARBs are often used to reduce proteinuria and protect the kidneys. Glycemic control in people with diabetes lowers the risk of worsening renal disease. Newer agents such as SGLT2 inhibitors have demonstrated benefits for slowing kidney function decline in both diabetic and non-diabetic patients. Other drugs may treat anemia, bone-mineral disorders, electrolyte imbalances, or complications from reduced kidney function.

• Targeting the root cause: Identifying and treating the primary driver of damage—such as autoimmune disease, obstruction, recurrent infections, or metabolic conditions—is essential. For some causes, immunosuppressive treatment or surgical intervention may be required.

• Kidney replacement therapy: When kidney function reaches levels that cannot sustain health (usually stage 5), replacement options include dialysis or transplantation. Hemodialysis filters blood through a machine and is commonly performed at centers several times per week. Peritoneal dialysis uses the patient’s peritoneum as a filter and can be done at home, offering greater flexibility for some people. Kidney transplantation, when feasible, offers the best long-term quality of life for many patients but involves surgery and lifelong immunosuppression.

Managing symptoms and complications

CKD can produce a range of symptoms and secondary problems that require focused management. Fluid buildup causes swelling, which may be controlled through fluid limits, dietary salt restriction, and diuretics. Anemia related to reduced erythropoietin production may be treated with iron supplementation and erythropoiesis-stimulating agents when indicated.

Dietary adjustments are important: many patients need individualized guidance to balance protein needs against the risk of accelerating kidney decline while also controlling sodium, potassium, and phosphorus. Consulting a renal dietitian helps create a practical, nutrient-sufficient plan.

Routine monitoring of blood pressure, blood glucose in people with diabetes, electrolytes, hemoglobin, and bone-mineral markers is essential. Preventing and promptly treating infections is also important because advanced kidney disease can impair immune defenses.

Practical costs and planning

Cost disclaimer: These estimates are approximate and vary by country, facility, insurance coverage, and individual circumstances. Discuss financial and insurance options with your care team.

New and evolving therapies

Research continues to expand the therapeutic toolkit for kidney disease. SGLT2 inhibitors, initially developed for diabetes, now have evidence supporting kidney-protective effects in a broader patient population. Dialysis technology is improving, with more portable and efficient devices under development that could increase convenience and quality of life.

Longer-term innovations include bioartificial kidney devices that combine filtration with living renal cells, regenerative medicine approaches using stem cells or tissue engineering to repair damaged tissue, and precision or personalized medicine strategies that tailor interventions to a patient’s genetic and molecular profile. Many of these approaches remain experimental or in early clinical trials, so widespread availability may be years away.

What patients can expect

Early detection and a proactive plan can slow progression and reduce complications. Care typically involves a team: primary care providers, nephrologists, dietitians, pharmacists, and when needed, surgeons and transplant specialists. Regular follow-up, adherence to medication and diet recommendations, vaccination, and prompt attention to infections or new symptoms all contribute to better outcomes.

This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.