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In stage 4 chronic kidney disease (CKD), the level of kidney damage you have ranges from moderate to severe, and your kidneys are definitively not working properly. Stage 4 CKD is the final stage before kidney failure, which means you must start to prepare for the need for dialysis treatment and/or a kidney transplant. 

What is stage 4 kidney disease?

At stage 4 CKD, your eGFR is between 15 and 29, which means you are in an advanced stage of kidney disease, with moderate to severe damage to your kidneys. As your kidney function worsens, more waste products will build up in your blood, which causes uremia, one of the major signs of kidney failure.

Moreover, this stage of kidney disease predisposes you to related complications and conditions, which include:

  • High blood pressure
  • Diabetes
  • Anemia (shortage of red blood cells)
  • Bone disease
  • Heart disease
  • Other cardiovascular diseases

What are the symptoms of stage 4 kidney disease?

Much like the symptoms that begin to present themselves in stage 3 CKD, you may experience:

  • Back pain
  • Swelling (edema) in your hands and feet
  • Changes in urination (foamy; dark orange, brown, tea-colored, or red if bloody; and urinating less or more than normal)
Doctor checking back pain on patient from kidney disease
You may experience back pain as a symptom of kidney disease. (This photo is from Freepik.)

Additional symptoms include:

  • Fatigue
  • Fluid retention
  • Shortness of breath
  • Sleep issues (due to muscle cramps or restless legs)
  • Nausea and/or vomiting
  • Changes in taste (metallic taste in mouth)
  • Bad breath (caused by urea buildup in the blood)
  • Loss of appetite
  • Difficulty concentrating on everyday tasks
  • Nerve problems (numbness or tingling in toes or fingers)

What treatments are available for stage 4 CKD?

You will need to see a nephrologist (kidney specialist) regularly, who will create a personalized treatment plan for you that will include how often you need to get your kidneys checked. Your nephrologist will order lab tests to check your levels of:

  • Creatinine
  • Hemoglobin
  • Calcium
  • Phosphorus

He or she will monitor any related conditions, too, like high blood pressure or diabetes, and will refer you to a renal dietitian to get you on a kidney-friendly diet to best support your unique needs. Blood pressure medications, such as ACE inhibitors and ARBs, may be prescribed to help prevent disease progression.

The goal of your nephrologist is to ensure kidney function for as long as possible, while simultaneously preparing you for a future need for dialysis and/or a kidney transplant.

Can stage 4 kidney disease be reversed?

Stage 4 kidney disease cannot be reversed, but you can do different things to help slow disease progression. For people with CKD, it’s crucial to control any other health issues you may have, treat any potential complications of kidney disease, and manage or prevent heart disease.

Woman doing light exercise to prevent kidney disease progression
Talk to your doctor about creating an exercise plan that fits your personalized needs as a stage 4 CKD patient. (This image is by @Racool_studio on Freepik.)

In addition to following a kidney-healthy diet and the high blood pressure medications above, it’s advisable to make lifestyle modifications, such as:

  • Maintain a healthy weight, including losing weight if you are overweight.
  • Cut down on the amount of sodium (salt) in your diet.
  • Monitor your blood sugar, follow your diet, and take your medications as prescribed if you have diabetes.
  • Exercise regularly, if possible.
  • Quit smoking if you are a smoker. Do not start smoking if you aren’t a smoker.

How long can you live with stage 4 kidney disease?

As previously stated, stage 4 CKD is not kidney failure. Stage 4 is the last stage before kidney failure. Kidney failure occurs in stage 5 CKD, which is also known as end-stage kidney disease (ESKD) or end-stage renal disease (ESRD). 

Prognosis varies by person and is affected by any related medical conditions and what treatments you have done or are doing. Your doctor can give you a more accurate idea of your unique prognosis and what to expect moving forward.

While there is no cure for kidney disease nor kidney failure, proper treatment and lifestyle changes can allow you to maintain a good quality of life. As the National Kidney Foundation (NKF) states, “[W]ith treatment it is possible to live a long, fulfilling life. Having kidney failure is not a death sentence. People with kidney failure live active lives and continue to do the things they love.”

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