Stage 4 of Chronic Kidney Disease

Stage 4 is an advanced stage of CKD defined by an eGFR range of 15-29, which indicates a significant decline in kidney function. At this stage, learning how to make healthy lifestyle changes is highly important to help slow the progression of CKD.

Seeing a kidney doctor (nephrologist) can help you learn about your treatment options and ways to keep your kidneys working for as long as possible, so you can make treatment decisions that are right for you. Work with your nephrologist to track symptoms, closely watch your lab values, and prepare for a transplant or dialysis.

When your GFR is 20 or lower, it’s important to start planning for longer-term treatment options, like dialysis and taking steps toward a kidney transplant. This will help you avoid hospital stays and provide a planned start to dialysis when your kidneys need greater support to remove waste, toxins, and excess fluid from your body.

Some people may experience more noticeable symptoms of kidney disease in stage 4 due to the increased decline in kidney function. Symptoms that can occur in stage 4 include:

• More noticeable changes in urine, such as urinating often or foamy urine
• Significant swelling (edema) in your hands, feet, ankles, and face due to fluid retention
• Increased weakness or tiredness due to anemia and toxin buildup
• Persistent dry or itchy skin, often a sign of mineral and bone disorder
• Muscle cramping and restless legs due to electrolyte imbalances

While there is no cure for CKD, lifestyle changes like eating a balanced diet, taking medications as prescribed, and staying active can make a big impact on your well-being and kidney health.

Using key strategies may help you preserve kidney function, manage symptoms, and prepare for future care. These tips will help you manage your long-term health and may delay the need for dialysis or kidney transplant.

Managing stage 4 CKD often includes a team of healthcare providers. In addition to your care team, there are plenty of steps you can take to help manage the condition.

1. Make healthy lifestyle choices: Eating a kidney-friendly diet, quitting smoking, doing simple exercises, and maintaining a healthy weight are even more important at this advanced stage to preserve remaining kidney function.
2. Monitor your health carefully: Keep track of your other health conditions. Watch for risk factors such as high blood pressure, diabetes, and/or infection. Discuss any medications or supplements you are taking with your kidney doctor (nephrologist) to make sure they are still safe to take.
3. Regularly see a kidney doctor: At stage 4, seeing a nephrologist is no longer optional—it is essential. They will oversee your care, closely monitor your kidney function, manage complications, and discuss future treatment options.
4. Manage complications: Your nephrologist will actively manage common complications in stage 4. This may include anemia, bone disease, fluid overload, and cardiovascular issues, and may involve medications or treatments.
5. Learn everything you can about CKD and treatment options: Taking the Fresenius Kidney Care free online kidney disease class can help you better understand your condition. You'll learn how to manage symptoms and about kidney replacement therapies like dialysis and transplantation. This is the time to actively explore these options.
6. Prepare for kidney replacement therapy: As stage 4 progresses, it’s highly important to learn about treatment options like peritoneal dialysis (PD) that can offer a gentler start to dialysis and help preserve kidney function for as long as possible. You should also learn about other home and in-center treatments you might need in the future, like hemodialysis, hemodiafiltration, and kidney transplant. Your kidney healthcare team will help you understand your options and begin any needed actions.

When your eGFR is 20 or less, talk to your nephrologist about your treatment options. One option may be peritoneal dialysis (PD), and it can be prescribed as incremental PD. This offers a more gradual and gentle start to treatment and may help relieve some of your CKD symptoms.

Incremental PD uses the blood vessels in the lining of your abdomen—which is called the peritoneum—along with a solution called dialysate to filter and clean your blood. With this method, blood never leaves your body. Each PD session is called an exchange. Peritoneal dialysis exchanges can be done with a machine or manually at home, at work, or while traveling.

With incremental PD, you can start treatment with as little as one exchange per day. As your kidney function decreases over time, your doctor will increase the number of exchanges to meet your needs. Potential benefits of incremental PD include fewer or less severe CKD symptoms and longer-lasting kidney function. Talk to your nephrologist to learn more.

A kidney-friendly diet is one of the most important ways to manage stage 4 CKD and help slow progression. Knowing how to eat well with stage 4 kidney disease will help lower the strain on your kidneys. Kidney-friendly foods will help you manage fluid balance, support other health conditions like hypertension and diabetes, and prevent complications associated with advanced kidney disease.

Fresenius Kidney Care offers resources that can help you learn how to build a meal plan for healthy eating. You can also visit our library of delicious kidney-friendly recipes for inspiration. We have recipes for every occasion, from smothered pork chops and sautéed greens for a delicious and filling family meal to delectable slow-cooked lemon chicken.

Stage 4 CKD life expectancy depends on a number of factors. These include your age at the time of diagnosis, other medical conditions, and individual treatment plan. There is no cure for CKD, and loss of kidney function that has occurred can’t be reversed. You can act now to help preserve kidney function and slow the progression of CKD. Looking after your health and eating a kidney-friendly diet can also help you feel your best.