Stage 4 Kidney Disease: What to Expect

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Chronic kidney disease (CKD) is when the kidneys are damaged and not able to work as they should in filtering blood. It affects more than 37 million adults in the United States. While the most common causes of CKD are diabetes and high blood pressure, other causes include infections, genetic disorders, and heavy metal poisoning.

There are five stages of kidney disease, with each stage referring to the level of your kidney functioning. This article will go over the specifics of stage 4 kidney disease, including symptoms, complications, and treatments.

Middle-aged man being examined by a female doctor in a doctor's office. Patient complains to the doctor of kidney pain.

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Stage 4 Kidney Disease

Your stage of kidney disease is based on eGFR (estimated glomerular filtration rate) blood tests. This test measures how well your kidneys are working.

Stage 4 kidney disease is when your eGFR is between 15 and 29. This number means there is moderate to severe damage to the kidneys, and the situation is serious. It is also the last stage before kidney failure. You and your healthcare provider may start to prepare options for when your kidneys fail, including treatments you may want to pursue.

Symptoms

By this point, many people living with stage 4 kidney disease will have notable symptoms. This is because the kidneys are significantly impaired and cannot function properly, leading to worsening of symptoms. These symptoms can include:

  • Swelling in the hands and feet
  • Back pain
  • Changes in urination frequency and/or amount (either more or less than is typical)

Other symptoms may include trouble concentrating, dry and itchy skin, trouble sleeping, appetite changes, foamy or bubbly urine, and muscle cramping.

Side Effects

Complications due to low kidney function often occur at stage 4. This is because the kidneys cannot filter waste and excess fluid or perform tasks to help other organs and body systems work properly. Complications can include:

  • High blood pressure
  • Anemia (low red blood cells)
  • Bone disease such as osteodystrophy (abnormal changes in the growth and formation of bone)
  • Cardiovascular and metabolic complications
  • Systemic drug toxicity

Treatment

There is no curative treatment for stage 4 kidney disease, but there are things you can do to help slow down the progression and keep you as healthy as possible.

Monitor

Monitoring kidney disease is important so that your healthcare provider and treatment team can keep an eye on your blood and urine levels, and make sure that any related health complications can be kept under control and appropriately treated. Regular visits to your nephrologist (kidney specialist) are an important part of monitoring.

Slow Progression

The aim at every stage is to slow the progression of kidney disease, and this is especially important at stage 4. This can include diet and lifestyle, as explained below, but also medication, if appropriate. Medication can include medication to help control blood pressure, or medication to control blood glucose (for those with diabetes).

Diet

Changes to your diet can help to slow down progressive kidney disease and help treat and prevent complications. The most important aspects of dietary modifications include:

  • Limiting sodium to 2300 milligrams per day
  • Limiting protein consumption (0.8 grams per kilogram body weight a day)

These help to control blood pressure and excess protein in the urine.

Other steps for a healthy diet can include limiting dietary phosphorus and potassium. Meeting and working with a nutritionist who specializes in healthy diets for chronic kidney disease is important to help you create personalized diets for your medical and nutritional needs. Ask your nephrologist for suggestions for local nutritionists that can help you.

Foods High in Phosphorus
  • Lean meats, such as chicken and turkey

  • Seafood

  • Dairy, such as milk, cheese, and yogurt

  • Sunflower and pumpkin seeds

  • Nuts, including cashews, pistachios, pine nuts, and almonds

  • Whole grains, such as wheat, oats, and rice

  • Quinoa

  • Beans and lentils

  • Soy

Foods High in Potassium
  • Potatoes, including sweet potatoes

  • Legumes (beans)

  • Juices, such as prune, orange, and pomegranate

  • Seafood, such as fish and clams

  • Leafy greens, such as kale, spinach, and romaine lettuce

  • Dairy, such as milk and yogurt

  • Tomatoes

  • Bananas

  • Avocadoes

  • Cantaloupe and honeydew

Lifestyle

Lifestyle changes can help slow down the progression of kidney disease as well. Things like quitting smoking and/or alcohol, and staying physically active (if your provider says it’s OK) are important. Smoking cigarettes is associated with CKD progression, and physical activity can help with glucose control and maintaining a healthy weight.

Life Expectancy

Life expectancy with stage 4 kidney disease can vary, depending on your age, overall health, other medical conditions, and your adherence to treatment and management plans. It can range from a little more than a year to more than 15 years.

There is no specific time frame, as this can vary widely among individuals and their circumstances.

Summary

Kidney disease has five stages, with stage 5 being kidney failure. Stage 4 occurs when the kidneys are significantly damaged. Symptoms are likely very noticeable, such as back pain, changes in urination, and swelling of the hands and feet. Complications from kidney disease are not uncommon, such as anemia or bone disease.

At this point, it is important to try to delay disease progression for as long as possible. Monitoring, medication management, and dietary and lifestyle changes can help.

A Word From Verywell

Although kidney disease is not curable, it is treatable. Even at stage 4, there are things you can do to stay as healthy as possible. Talk with your healthcare provider about steps you can take to improve your health. While it's a scary conversation to have, now is the time to discuss what you would like to do when you go into kidney failure.

Frequently Asked Questions

  • Is stage 4 kidney disease curable?

    Kidney disease is not curable, but there are treatments and actions you can take to help slow down the progression of kidney disease. The overall goal is to delay kidney failure for as long as possible. You can still live a long life with treatment and management of kidney disease.

  • What’s the life expectancy of someone with stage 4 kidney disease?

    Life expectancy for someone with stage 4 kidney disease can vary among individuals. Those who do not make changes to their diet or lifestyle behaviors may hasten kidney failure, whereas those who make changes may delay it. Life expectancy can range from about a year to 15 years or more. Those who have more heart disease complications are at increased risk.

  • Is kidney failure painful?

    Kidney failure itself is not painful. What is painful are the different complications it can cause throughout the body from a buildup of fluids or toxins. In stage 4 kidney disease, you may have back pain due to blockage or infection. Pain depends on what complications the kidney failure is causing in your body.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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