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Initially, it may present solely as a biochemical abnormality. However, as the excretory, metabolic, and endocrine functions of the kidney deteriorate, clinical symptoms and signs of renal failure, collectively known as uremia, eventually emerge. End-stage renal disease (ESRD), or CKD stage 5, represents a critical point where death is likely without renal replacement therapy (RRT). The prevalence of CKD stages 3–5, characterized by an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2, affects approximately 5–7% of the population, predominantly individuals aged 65 and above. The incidence of CKD is substantially higher in patients with pre-existing conditions such as hypertension, diabetes, and vascular disease, underscoring the importance of targeted screening in these high-risk groups. Specifically, over 25% of individuals older than 75 years exhibit an eGFR less than 60 mL/min/1.73 m2, with most cases falling under stage 3A CKD. In this demographic, an impaired eGFR is often indicative of an increased cardiovascular risk burden. Consequently, the primary focus of investigation and management for these patients should be on cardiovascular risk prevention, as the likelihood of developing ESRD is considerably lower. The underlying cause of CKD is frequently unclear, particularly among the substantial number of elderly patients diagnosed with stage 3 CKD. Many patients identified at advanced stages present with bilateral small kidneys. Renal biopsy is seldom performed in this group due to increased risks, a lower probability of achieving a histological diagnosis owing to the severity of damage, and its limited impact on management strategies. 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