Chronic Kidney Disease Stage 4

At CKD stage 4, there is advanced kidney damage, with a high risk of progression to kidney failure. There would need to be discussions and planning for replacing kidney function with dialysis. 

5 Stages of Chronic Kidney Disease

An overview of stage 4 kidney disease

Someone suffering chronic kidney disease (CKD) is described as being in one of 5 stages. To determine which stage applies, kidney function is assessed, and tests are performed to determine whether there are signs of blood or protein in the urine. 

At CKD stage 4, your kidneys are severely damaged and there is substantial decline in kidney function, leading to toxin and fluid build-up in your body. A blood test to determine kidney function at this stage would give an estimated glomerular filtration rate (eGFR) of 15-29 ml/min. The eGFR indicates kidney function. Your GP may complete this test as part of routine blood tests. 

At stage 4, it is likely that you would be experiencing symptoms from CKD. This is a critical phase for discussions with your doctors to understand the need for replacing kidney function and what your options may be. 

You are likely to be under the care of a nephrologist and a pre-dialysis educator. Together, this team will work with you to control your diet, manage medication and consider treatment options. 

Symptoms of stage 4 kidney disease

Symptoms of kidney disease may vary between people. Sometimes symptoms may not even be present, even at stage 4, although they are more common in stage 4 and may worsen as kidney function declines further.   

It’s important to be aware of all the symptoms of CKD, so if you are experiencing any symptoms you can discuss with your nephrologist. 

The signs and symptoms of CKD stage 4 may include: 

  • Fatigue  
  • Shortness of breath  
  • Swelling in your hands and feet   
  • Puffy eyes  
  • Change in urine colour or volume 
  • Muscle cramps  
  • Poor appetite 
  • Nausea and bad taste in the mouth  
  • Trouble sleeping  
  • Itch 
  • Discolouration of nails and skin 
Illustration of a Male Doctor Speaking with a Patient about Chronic Kidney Disease

Treatment for stage 4 kidney disease

CKD stage 4 treatment is focused on treating health issues caused by reduced kidney function, slowing down the progression of CKD, and exploring the need for kidney (or renal) replacement therapy. 

During stage 4, your regular doctor may refer you to a kidney specialist, also known as a nephrologist. Based on an assessment of your overall condition, your nephrologist will discuss with you, and start planning for potential kidney replacement therapy (dialysis and transplantation) or conservative care if you progress to CKD stage 5, also known as end-stage kidney disease. 

Illustration of a Doctor Explaining Causes for Chronic Kidney Disease

Managing stage 4 kidney disease

Managing your kidney disease to slow down its progression is critical at CKD stage 4. In addition, CKD stage 4 treatment will be focused on the complications caused by CKD. At this stage, it is also important to focus on maintaining fluid balance to avoid fluid build-up. 

 Other recommendations include adapting your diet, moderate exercise, stopping smoking, limiting alcohol consumption, maintaining a healthy weight, and monitoring other health conditions, such as high blood pressure or diabetes. 

Female physician reviewing information with a man and woman

Talking about kidney replacement therapy

Your nephrologist and other members of the multidisciplinary healthcare team will start assessing your overall condition and giving you information about kidney replacement therapy. They will discuss the available treatment options and want to hear your view about how they would fit with your lifestyle and your preferences. You should get a full understanding of the options, seeing the different options and spend time thinking carefully about how they would work best for you. At the end of that process, you and your nephrologist will decide on the best treatment option for you. 

Find out important questions to ask your nephrologist to make the most informed decision regarding your kidney disease treatment. 

Illustration of a Female Doctor Explaining Treatments for Chronic Kidney Disease

Prognosis for stage 4 kidney disease

At CKD stage 4, your kidneys are severely damaged, and overall kidney function has substantially declined. However, it is still possible to slow down the progression of CKD and manage other potential health issues by following your healthcare team’s recommendations. 

It is important to know that depending on your overall condition and the decline in kidney function; your healthcare team will start planning kidney replacement therapy options for when you progress to stage 5 kidney disease, also known as end-stage kidney disease.