Chronic kidney disease stage 4

An overview of stage 4 kidney disease

Someone with chronic kidney disease (CKD) is described as being in one of 5 stages. To determine which stage applies, kidney function is assessed using blood tests, 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 a substantial decline in kidney function, leading to toxin and potentially 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 will be experiencing symptoms of 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 kidney specialist (a nephrologist) and a pre-dialysis educator, who will work with you to control your diet, manage medication and consider treatment options. 

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. 

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. 

 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. 

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. 

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 if you progress to stage 5 kidney disease, also known as end-stage kidney disease, your healthcare team will start planning kidney replacement therapy. Your overall condition and the decline in kidney function will determine the timing of this.