Chronic kidney disease (CKD): signs, tests, stages and dialysis

Your two kidneys, each about the size of a fist, filter your blood. They remove waste and extra water as urine (ihi), keep minerals in balance, help control blood pressure and make hormones for healthy blood and bones.

Chronic kidney disease (CKD) means the kidneys are damaged and have not worked as well as they should for at least 3 months. The damage usually builds up slowly over years. It can stay mild, or get worse until the kidneys stop working: kidney failure, also called CKD stage 5.

Many Filipinos call it sakit sa bato. "Bato" can mean the kidney or a kidney stone, so ask your doctor which one they mean. Kidney stones and kidney infections are different problems; for infections, see our UTI guide.

Acute kidney injury (AKI) is different. It happens over hours or days, for example with a severe infection, dehydration, some medicines or leptospirosis, and often gets better with quick care. Even one AKI raises the risk of CKD later.

In a 2025 circular, PhilHealth cited the National Kidney and Transplant Institute (NKTI): about one Filipino develops kidney failure every hour.

Early kidney disease usually causes no symptoms. Many people find out only when a routine blood or urine test shows a problem.

When symptoms appear, they can include:

• foamy urine
• peeing more or less often than usual, especially at night
• tiredness, itchy or dry skin, muscle cramps and poor sleep
• poor appetite, nausea, or losing weight without trying

Kidney failure symptoms come later, as waste and water build up:

• swelling (manas) of the feet, ankles, legs or hands
• shortness of breath and vomiting
• trouble focusing or confusion
• making very little urine, or blood in the urine

Other, less serious problems can cause these too. Only blood and urine tests can show whether you have CKD.

Many people believe pain in the waist or lower back (sakit sa balakang) means "sakit sa bato". Back pain is not one of the usual signs of CKD, and early CKD usually causes no pain at all. Back or side pain with fever, or pain when peeing, is a different problem: see our UTI guide and get checked soon.

CKD is usually caused by other long-term conditions that strain the kidneys, often several at once. Diabetes and high blood pressure are the most common causes.

• Diabetes: too much sugar in the blood damages the kidney's tiny filters.
• High blood pressure: strains the small blood vessels in the kidneys. Damaged kidneys then raise blood pressure further.
• Heart disease and high cholesterol
• Glomerulonephritis: inflammation of the kidney's filters, sometimes from lupus or other immune problems.
• Inherited conditions, such as polycystic kidney disease.
• Blocked urine flow, from repeated kidney stones or an enlarged prostate.
• Kidney infections and severe infections.
• Regular, long-term use of NSAID painkillers

Your risk is higher if you have diabetes, high blood pressure, heart disease or heart failure; are obese or over 60; have a close relative with kidney failure; had an AKI before; smoke; or drink a lot of alcohol. The World Health Organization (WHO) notes that in countries like ours, many people with CKD have none of these risks.

Two simple tests find CKD:

1. Blood creatinine. Creatinine is a waste product from muscles that healthy kidneys remove. The lab uses it, with your age and sex, to estimate how well your kidneys filter: your eGFR (estimated glomerular filtration rate). A higher eGFR is better.
2. Urine albumin. Albumin is a protein that should stay in the blood; damaged kidneys let it leak into urine. A urine dipstick (part of a urinalysis) can show it, and the urine albumin-creatinine ratio (uACR) measures it exactly. A lower uACR is better.

One abnormal result is not enough. An eGFR below 60, or albumin in the urine, that lasts 3 months or more points to CKD.

CKD stages by eGFR

• Stage 1: 90 or more, with other signs of kidney damage
• Stage 2: 60 to 89, with signs of kidney damage
• Stage 3a: 45 to 59; stage 3b: 30 to 44
• Stage 4: 15 to 29
• Stage 5: below 15, kidney failure

Urine albumin has its own stages, A1 to A3. Your doctor reads both together and may add a kidney ultrasound.

Get tested regularly if you have diabetes, high blood pressure, heart disease, a family history of kidney failure, a past AKI, repeated kidney stones, lupus, or blood or protein in your urine. Creatinine and urinalysis are on PhilHealth's primary care lab list, so a PhilHealth YAKAP doctor can order them. Write down your eGFR each time to compare.

There is no cure for CKD, but treatment can slow it, ease symptoms and protect the heart. Most people control it with medicines and check-ups; in the UK only about 2 in 100 reach kidney failure. CKD raises the risk of heart attack and stroke, so heart care is part of the plan.

• Control the cause. Keep blood pressure and blood sugar at the goals your doctor sets. See our guides on high blood pressure and diabetes.
• Kidney-protecting medicines. Doctors often prescribe an ACE inhibitor (such as enalapril) or an ARB (such as losartan), which lower blood pressure and can slow kidney damage, even in people whose blood pressure is normal. Some people also take an SGLT2 inhibitor or a statin. Take them as prescribed and do not stop on your own.
• Treat complications such as anemia, high potassium, or weak bones from too much phosphorus, with iron, tablets or injections that help the body make red blood cells (such as EPO), phosphate binders or diet changes.

Food and habits

• Eat less salt: go easy on patis, toyo, bagoong, instant noodles and processed meats.
• Limit potassium only if told to. Then eat less of potassium-rich foods such as bananas (saging), potatoes, beans, tomatoes and citrus, and avoid salt substitutes.
• Do not cut protein too much; a dietitian can find your balance. In advanced CKD you may need to limit fluids, soups included.
• Be active for at least 150 minutes a week if your doctor agrees, stop smoking, limit alcohol and sleep 7 to 8 hours.

Careful with painkillers and products. NSAIDs such as ibuprofen, naproxen and mefenamic acid can harm the kidneys; they are in many pain, cold and flu medicines. Ask your pharmacist what is safe. Tell your doctor about every vitamin, supplement and herbal product, and bring your medicines to each visit. No "kidney cleanse" or "detox" product can repair damaged kidneys.

At stage 5, the kidneys can no longer do enough on their own, and most people need dialysis or a transplant to stay alive. It usually comes slowly, so there is time to plan with your nephrologist (kidney doctor).

• Hemodialysis: a machine filters your blood, usually at a dialysis center about three times a week, through a fistula (a joined artery and vein in the arm) or a catheter.
• Peritoneal dialysis (PD): fluid goes into the belly through a soft tube, draws out waste, and is drained. It is done at home every day, by hand several times a day (CAPD) or overnight by machine. A dialysis nurse trains you first, often with a family member.
• Kidney transplant: a kidney from a living donor or from a deceased donor. It is often the best treatment, but means major surgery and lifelong anti-rejection medicines.
• Supportive care: for people who choose not to have dialysis, the team treats symptoms and supports the family.

Without a transplant, dialysis is usually for life. Do not skip sessions: potassium and fluid can build up dangerously. Find dialysis centers near you.

As of November 2026, PhilHealth pays for most basic kidney failure care:

• Hemodialysis: ₱6,350 per session since October 2024, up to 156 sessions a year (up to ₱990,600). You need CKD stage 5 and registration in the PhilHealth Dialysis Database; ask your dialysis facility to check yours. The basic services, including dialyzer, anemia medicines and some labs, should need no extra payment; premium extras may be charged only after the facility explains them. Unused sessions do not carry over to the next year. The same case rate also covers emergency dialysis for sudden kidney failure.
• Peritoneal dialysis: the Z Benefits package for adults pays ₱389,640 or ₱510,140 a year, depending on daily fluid bags, plus care to prevent infection. Children's packages can be higher. Adult cover is for CAPD at an accredited PD provider.
• Kidney transplant: the Z Benefits package pays ₱865,000 to ₱1,045,000 with a living donor, and ₱1,583,000 to ₱2,146,000 with a deceased donor, at contracted hospitals.
• Early CKD care: check-ups and covered labs are free at public YAKAP clinics (private YAKAP clinics may charge up to ₱900 a year), and listed medicines are free at accredited pharmacies up to ₱20,000 a year.

Still have bills? Ask the hospital social worker or a Malasakit Center; PhilHealth refers costs beyond its rates there. See our Malasakit Center guide and what PhilHealth covers.

• "Lots of water flushes out kidney disease." Enough water prevents dehydration, but it does not repair kidneys. In advanced CKD, too much fluid causes swelling and strains the heart. Ask how much to drink.
• "Buko juice or herbal teas clean the kidneys." No drink reverses CKD, and many fruit drinks are rich in potassium, which weak kidneys cannot remove.
• "Maintenance medicines damage the kidneys." High blood pressure and high blood sugar are the main causes of kidney damage, and some blood pressure medicines help protect the kidneys. Your doctor adjusts medicines using your tests.
• "Dialysis means the end." Dialysis does the work the kidneys can no longer do, and helps people feel better and live longer. Planning early with your kidney doctor gives you time to choose and prepare.

• Know your numbers: blood pressure, blood sugar and, if at risk, creatinine and urine tests. See our annual check-up guide.
• Control diabetes and high blood pressure, take medicines as prescribed and keep appointments.
• Eat plenty of vegetables, fruit and whole grains, with less salt, sugar and processed meat. Stay active and keep a healthy weight.
• Do not smoke, and keep alcohol low.
• Use painkillers carefully: follow the label, and avoid long-term NSAIDs without a doctor.
• Prevent sudden kidney injury: treat dehydration from diarrhea early with ORS, and get infections treated early, including leptospirosis.

Find a health center, ask our AI symptom guide or ask a nurse.