Chronic Kidney Disease in Singapore: Stages, Causes, and Prevention
by: Dr. Paul Chang - MBBS, GDFM, MBA, General Practitioner, Regis Medical
Last updated: December 20, 2026
This page is for general knowledge. For CKD patients visiting a General Practitioner, it is advised that you let your doctors know about your condition when discussing past medical history. This is to help them give the correct type and dose of medications for you.
Chronic kidney disease is one of the fastest-growing health concerns in Singapore, and it is one of the quietest. Your kidneys can lose a significant proportion of their function before you notice a single symptom. By the time symptoms appear, the disease is usually advanced and the damage largely irreversible.
Based on the United States Renal Data System's international comparisons, more than 300,000 people in Singapore have chronic kidney disease. Singapore ranks 4th in the world for existing cases of kidney failure, and 1st in the world for diabetes-induced kidney failure, with 2 out of 3 kidney failures being the direct result of diabetes. A Singapore health screening study found that 3.7 per cent of participants had moderate to severe CKD (stage 3 to 5), the majority of whom were previously undiagnosed.
These numbers reflect a condition that is common, serious, and largely preventable through early detection and management of its most frequent causes: diabetes and hypertension.
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What is Chronic Kidney Disease?
Chronic kidney disease (CKD) is also referred to as chronic kidney failure. It occurs when damage to the kidneys results in a gradual, progressive loss of their ability to filter waste and excess fluids from your blood. The disease has varying levels of seriousness and is generally progressive, meaning it worsens over time if the underlying cause is not controlled.
With CKD, your kidneys are unable to remove waste products and fluids from your body properly. This can result in a buildup of toxins, fluid retention, electrolyte imbalances, and secondary damage to other organ systems. Left untreated, the kidneys may eventually fail, requiring dialysis or transplant to sustain life.
Stages of Chronic Kidney Disease
CKD is a progressive disease that is staged according to the estimated glomerular filtration rate (eGFR), a measure of how well your kidneys are filtering blood. Your eGFR is calculated from a blood test measuring creatinine, a waste product produced by your muscles that your kidneys normally clear efficiently.
- Stage 1 (eGFR 90 or above) - Your kidneys have experienced very mild damage but are still functioning normally. Symptoms are not apparent at this early stage, making CKD difficult to detect. Patients at stage 1 usually discover their condition incidentally through routine blood and urine tests during a health screening. The presence of protein in the urine (proteinuria) or structural abnormalities may indicate kidney damage even with a normal eGFR.
- Stage 2 (eGFR 60 to 89) - Mildly reduced kidney function is present as a result of kidney damage. Even at this stage, symptoms may not be apparent. Some patients experience nonspecific symptoms such as fatigue and sleep problems. As we discussed in our blog on kidney function and ageing, an eGFR in this range must be interpreted alongside your age, because normal age-related decline can produce readings in the lower end of this range without indicating disease.
- Stage 3a (eGFR 45 to 59) and Stage 3b (eGFR 30 to 44) - Moderately reduced kidney function. The kidneys are unable to properly filter waste, toxins, and fluids, potentially leading to fluid buildup. At this stage, careful management with medication and regular monitoring is necessary. Follow-up visits and tests will be required to monitor the condition and make adjustments. As we discussed in our blog on whether kidney damage can be reversed, intervention at stage 3 can often stabilise kidney function and prevent further decline.
- Stage 4 (eGFR 15 to 29) - Moderate-to-severe kidney damage with significantly reduced function. At this stage, specialist nephrology care is typically required, and planning for potential future kidney replacement therapy begins.
- Stage 5 (eGFR below 15 or on dialysis) - Also referred to as end-stage renal disease (ESRD). With kidney failure, the buildup of waste and toxins within the body becomes life-threatening. Dialysis or a kidney transplant will be necessary. The risk of heart disease and stroke is also significantly elevated.
Causes of Chronic Kidney Disease
A disease or condition can damage your kidney, causing kidney function to be impaired. This results in chronic kidney disease. The damage to your kidney can worsen progressively.
Common causes of chronic kidney disease include:
- Type 1 or type 2 diabetes
- High blood pressure
- Inherited kidney diseases such as polycystic kidney disease
- Obstruction of the urinary tract over an extended period of time
- Vesicoureteral reflux, which causes urine to go back up into the kidneys
- Recurrent kidney infections
- Glomerulonephritis, an inflammation of the filtering units in the kidney
- Interstitial nephritis, an inflammation of the tubules and surrounding structures of the kidneys
Symptoms of Chronic Kidney Disease
Symptoms of chronic kidney disease may take time to develop, especially in the early stages. For some cases, symptoms may not even show until their kidney disease has advanced. Common symptoms of chronic kidney disease include:
- Feeling fatigued
- Difficulty concentrating
- Difficulty sleeping at night
- Muscle cramps
- Swelling in the feet and ankles
- Dry, itchy skin
- Need to urinate more frequently, especially at night
Risk Factors for Chronic Kidney Disease
Understanding your risk factors helps determine whether you should be screened and how frequently.
- Diabetes - The single largest risk factor. If you have diabetes or prediabetes, your kidneys are at risk regardless of whether they are currently symptomatic.
- High blood pressure - Persistently elevated blood pressure damages kidney blood vessels over time. Even "borderline" hypertension contributes to cumulative kidney stress.
- Family history of kidney disease - If a parent or sibling has CKD or has required dialysis, your personal risk is elevated. As we discussed in our blog on family health history as a screening tool, knowing your family's kidney history should prompt earlier and more frequent screening.
- Age - Kidney function declines naturally with age, as we explained in our blog on kidney function and ageing. Combined with other risk factors, age increases the likelihood that cumulative damage has reached a clinically significant level.
- Obesity - Excess weight, particularly visceral fat, drives both diabetes and hypertension, the two conditions most likely to cause CKD.
- Smoking - Smoking damages blood vessels throughout the body, including those within the kidneys, and accelerates the rate of kidney function decline.
- Regular heavy alcohol consumption - Excess alcohol raises blood pressure and cholesterol, both of which contribute to kidney damage over time.
- Long-term medication use - Certain medications, particularly NSAIDs taken regularly, can impair kidney function. If you take any medication long-term, your kidney function should be monitored periodically.
Complications of Chronic Kidney Disease
Chronic kidney disease can lead to many complications that affect all parts of your body. Possible complications of chronic kidney disease include:
- Build up of fluid in the body - causing swelling in the arms and legs, high blood pressure or fluid in your lungs, a sudden spike in potassium levels in your blood, that can be life-threatening if it impairs your heart’s function.
- Anaemia
- Heart Disease
- Weakening of your bones
- Reduced sex drive
- Damage to your nervous system
- Impairment to your immune response
- Pregnancy complications for the mother and developing foetus
- Irreversible damage to your kidneys
Diagnosing Chronic Kidney Disease
To accurately diagnose CKD, your doctor will need to know your medical and family history. Whether you have related conditions such as diabetes or hypertension, and whether family members have kidney disease, helps assess your risk.
The primary diagnostic tests include:
- Kidney function blood test - This is the main way to test for kidney disease. Your blood creatinine level is used to calculate your eGFR, which determines how well your kidneys are filtering. Blood urea level, blood creatinine level, and electrolytes (particularly potassium) are also assessed. Abnormally high levels suggest impaired kidney function.
- Urine tests - A sample of your urine is checked for the presence of blood, protein (proteinuria), and cellular debris. Protein in the urine is one of the earliest detectable signs of kidney damage, often appearing before eGFR begins to decline.
These two tests together provide a comprehensive assessment of kidney status. If abnormalities are found, additional tests may be recommended, including ultrasound scan, MRI, CT scan, or kidney biopsy, depending on the clinical picture.
Because CKD is closely linked to diabetes and cardiovascular disease, a comprehensive health screening that includes diabetes testing, cholesterol screening, liver function, and blood pressure measurement alongside kidney function provides the full metabolic picture.
Treatment for Chronic Kidney Disease
CKD cannot be cured. However, the disease can be managed to relieve symptoms, reduce complications, and slow its progression. Early-stage CKD can often be stabilised through aggressive management of its underlying causes, particularly blood pressure and blood sugar control.
- Treating the causes of kidney damage - The most important treatment is addressing the condition driving the kidney damage. Diabetes medication to keep blood sugar within target. Hypertension medication to keep blood pressure at or below target. ACE inhibitors and ARBs are particularly valuable because they provide additional kidney protection beyond their blood pressure-lowering effect.
- Managing potassium levels - CKD can cause potassium levels to reach dangerously high levels (hyperkalaemia) because the kidneys cannot excrete potassium normally. This can lead to irregular heart rhythms and potentially a heart attack. Patients with CKD may need to avoid potassium supplements and certain medications that raise potassium.
- Managing fluid retention - CKD reduces the kidneys' ability to remove excess fluid. This can cause swelling in the ankles, feet, and hands. Reducing salt and fluid intake helps manage this. Diuretics may be prescribed to help remove excess fluid.
- Treating anaemia - In advanced CKD, reduced erythropoietin production leads to anaemia (low red blood cells). Erythropoietin injections can stimulate red blood cell production. Iron supplements may also be needed if iron deficiency is contributing.
- Protecting bone health - Severe kidney damage disrupts calcium, phosphate, and vitamin D balance, causing bone thinning. Phosphate binders may be prescribed to reduce phosphate absorption from food. Vitamin D supplements may be needed to maintain bone health.
Treatment for end-stage kidney disease - When kidney function declines to stage 5, the kidneys can no longer sustain life without intervention. Two options exist.
Dialysis removes waste and fluid from the body since the kidneys can no longer do so. Haemodialysis filters waste and excess fluids directly from the blood through a machine. Peritoneal dialysis uses a dialysis solution introduced into the abdomen through a thin tube to absorb waste and excess fluids, which are then drained.
Kidney transplant replaces the damaged kidneys with a healthy kidney from a donor via surgery. After transplant, lifelong immunosuppressive medication is required to prevent organ rejection.
Treatment for Chronic Kidney Disease
CKD cannot be cured. However, the disease can be managed to relieve symptoms, reduce complications, and slow its progression. Early-stage CKD can often be stabilised through aggressive management of its underlying causes, particularly blood pressure and blood sugar control.
- Treating the causes of kidney damage - The most important treatment is addressing the condition driving the kidney damage. Diabetes medication to keep blood sugar within target. Hypertension medication to keep blood pressure at or below target. ACE inhibitors and ARBs are particularly valuable because they provide additional kidney protection beyond their blood pressure-lowering effect.
- Managing potassium levels - CKD can cause potassium levels to reach dangerously high levels (hyperkalaemia) because the kidneys cannot excrete potassium normally. This can lead to irregular heart rhythms and potentially a heart attack. Patients with CKD may need to avoid potassium supplements and certain medications that raise potassium.
- Managing fluid retention - CKD reduces the kidneys' ability to remove excess fluid. This can cause swelling in the ankles, feet, and hands. Reducing salt and fluid intake helps manage this. Diuretics may be prescribed to help remove excess fluid.
- Treating anaemia - In advanced CKD, reduced erythropoietin production leads to anaemia (low red blood cells). Erythropoietin injections can stimulate red blood cell production. Iron supplements may also be needed if iron deficiency is contributing.
- Protecting bone health - Severe kidney damage disrupts calcium, phosphate, and vitamin D balance, causing bone thinning. Phosphate binders may be prescribed to reduce phosphate absorption from food. Vitamin D supplements may be needed to maintain bone health.
Treatment for end-stage kidney disease - When kidney function declines to stage 5, the kidneys can no longer sustain life without intervention. Two options exist.
Dialysis removes waste and fluid from the body since the kidneys can no longer do so. Haemodialysis filters waste and excess fluids directly from the blood through a machine. Peritoneal dialysis uses a dialysis solution introduced into the abdomen through a thin tube to absorb waste and excess fluids, which are then drained.
Kidney transplant replaces the damaged kidneys with a healthy kidney from a donor via surgery. After transplant, lifelong immunosuppressive medication is required to prevent organ rejection.
Early Detection Is the Difference
The gap between a CKD diagnosis at stage 2, where intervention can stabilise function for decades, and a diagnosis at stage 4, where options are limited and dialysis planning begins, is not medical complexity. It is timing.
A kidney function test is a simple blood draw. It is included in every comprehensive health screening at Regis Medical. If you have diabetes, hypertension, a family history of kidney disease, or if you are over 40 and have never had your kidney function checked, a visit to our GP clinic provides the screening, the interpretation, and the management plan.
Singapore ranks first in the world for diabetes-induced kidney failure. That statistic is not inevitable. It is the consequence of late detection in a condition that is detectable years or decades before failure occurs. Your kidneys deserve a blood test before they ask for a dialysis machine.
Screen for Kidney Disease with a Kidney Function Test
Comprehensive, fast result, personalised review session
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“Chronic Kidney Disease (CKD).” Chronic Kidney Disease (CKD) - Symptoms, Causes, Treatment, National Kidney Foundation, 10 Oct. 2022, https://www.kidney.org/atoz/content/about-chronic-kidney-disease.
“Chronic Kidney Disease (CKD).” Chronic Kidney Disease (CKD) - The National Kidney Foundation, The National Kidney Foundation NKF Singapore, https://nkfs.org/kidney-failure/chronic-kidney-disease-ckd/.
“Chronic Kidney Disease Basics.” Chronic Kidney Disease Basics | Chronic Kidney Disease Initiative, Centers for Disease Control and Prevention, 28 Feb. 2022, https://www.cdc.gov/kidneydisease/basics.html.
Chronic Kidney Disease, SingHealth, https://www.singhealth.com.sg/patient-care/conditions-treatments/chronic-kidney-disease.
“Chronic Kidney Disease.” Chronic Kidney Disease - Diagnosis and Treatment, Mayo Foundation for Medical Education and Research, 3 Sept. 2021, https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis-treatment/drc-20354527.
“Chronic Kidney Disease.” Chronic Kidney Disease - HealthHub, HealthHub, 3 Nov. 2021, https://www.healthhub.sg/a-z/diseases-and-conditions/334/chronic_kidney_disease_nuh.
“Chronic Kidney Disease.” Chronic Kidney Disease - Symptoms and Causes, Mayo Foundation for Medical Education and Research, 3 Sept. 2021, https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521.
“Drink Alcohol in Moderation.” Drink Alcohol in Moderation - SingHealth, SingHealth, 17 Dec. 2018, https://www.singhealth.com.sg/news/patient-care/drink-alcohol-in-moderation#:~:text=The%20Health%20Promotion%20Board%20recommends,shot%20(35ml)%20of%20spirit.
“Eating Right for Chronic Kidney Disease.” Eating Right for Chronic Kidney Disease | NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases, Oct. 2016, https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition.
“Global Facts: About Kidney Disease.” Global Facts: About Kidney Disease | National Kidney Foundation, National Kidney Foundation, 11 Mar. 2015, https://www.kidney.org/kidneydisease/global-facts-about-kidney-disease.
“Key Statistics.” Key Statistics - The National Kidney Foundation (NKF), The National Kidney Foundation NKF Singapore, https://nkfs.org/about-us/key-statistics/.
Khatri, Minesh. “Kidney Disease.” Kidney Disease (Chronic & Acute) - Causes, Risk Factors, Stages, WebMD, 31 Aug. 2022, https://www.webmd.com/a-to-z-guides/understanding-kidney-disease-basic-information.
Kovesdy, Csaba P. “Epidemiology of chronic kidney disease: an update 2022.” Kidney international supplements vol. 12,1 (2022): 7-11. doi:10.1016/j.kisu.2021.11.003
“Overview.” Chronic Kidney Disease - NHS, NHS Choices, 29 Aug. 2019, https://www.nhs.uk/conditions/kidney-disease/.
Pietrangelo, Ann. “Stages of Chronic Kidney Disease.” Chronic Kidney Disease (CKD) Stages: Symptoms & Treatment, Healthline Media, 11 Feb. 2020, https://www.healthline.com/health/ckd-stages.
“Preventing Chronic Kidney Disease.” Preventing Chronic Kidney | NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases, Oct. 2016, https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/prevention.
“Prevention.” Chronic Kidney Disease - Prevention - NHS, NHS Choices, 29 Aug. 2019, https://www.nhs.uk/conditions/kidney-disease/prevention/.
“Treatment.” Chronic Kidney Disease - Treatment - NHS, NHS Choices, 29 Aug. 2019, https://www.nhs.uk/conditions/kidney-disease/treatment/.
Wang, Yunlai et al. “Traditional Chinese Medicine in the Treatment of Chronic Kidney Diseases: Theories, Applications, and Mechanisms.” Frontiers in pharmacology vol. 13 917975. 18 Jul. 2022, doi:10.3389/fphar.2022.917975
Xiong, Wei et al. “Acupuncture Application in Chronic Kidney Disease and its Potential Mechanisms.” The American journal of Chinese medicine vol. 46,6 (2018): 1169-1185. doi:10.1142/S0192415X18500611
