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.

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.

Diet

Diet is an important part of managing your kidney disease as kidneys are responsible for filtering out toxins and salts (such as potassium). A dietitian is a key member of your healthcare team who will be overseeing your care. For CKD stage 4, you will get specific dietary recommendations around your consumption of protein, phosphorus, and potassium, along with reduced sodium intake. You will also receive specific advice about your daily fluid intake.

Exercising

Regular monitoring

You will have to continue to consult your primary care doctor and any other specialists for specific health conditions.

If your GP hasn’t referred you to a nephrologist at stage 3 of CKD, they should refer you to one once you reach stage 4. Regular monitoring and follow-ups with your healthcare team are vital from stage 4 onwards. Your nephrologist will want to see you at regular intervals to assess the progression of your kidney disease and help manage your symptoms and complications caused by CKD.

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.

FREQUENTLY ASKED QUESTIONS

Can CKD be cured at stage 4?

How do doctors diagnose my stage of CKD?

What should I ask my healthcare team when diagnosed with CKD stage 4?

At CKD stage 4, you may be under the care of a nephrologist and a CKD educator. It can be overwhelming when you are first diagnosed with CKD, so it is best to address your concerns with your healthcare team. Some questions you may want to ask at this stage are:

What is my eGFR? This will help you understand the severity of your kidney damage.
What should I expect next?
What drugs may reduce kidney damage and slow the progression of CKD?
What lifestyle changes do I need to make?
Do I need to make any changes to my medicines for other health issues?
Under what circumstances should I seek urgent medical attention?

Find out important questions to ask when meeting your kidney doctor or nephrologist to make an informed decision about your kidney disease treatment.

How serious is CKD stage 4?

CKD stage 4 indicates severe kidney damage, and there is a significant risk of it progressing to stage 5, also known as end-stage kidney disease. You will need to start considering the various treatment options for kidney replacement therapy, including the possibility of undergoing kidney transplant. Your healthcare team and nephrologist will advise and prepare you accordingly.

Do I have to start dialysis now?

Should I tell my family about my stage of CKD?