Chronic kidney disease (CKD) is a medical condition affecting the kidneys, characterized by a gradual decline in kidney function. This condition progresses through five stages, with Stage 4 representing a significant decrease in kidney function.

While CKD may not manifest noticeable symptoms in its early stages, Stage 4 CKD often presents with symptoms such as fatigue, swelling, blood pressure changes, and impaired urine output.

Innovative Renal Care aims to provide you with essential information about CKD, particularly Stage 4 CKD, offering insights into its causes, symptoms, and treatment options.

We aim to guide individuals, families, and caregivers through the challenges of managing CKD at this advanced stage, helping you make informed decisions about your kidney health and improve your overall quality of life.

Couple talking with their doctor

What is CKD Stage 4?

Stage 4 kidney disease is a pivotal point in the stages of chronic kidney disease, where kidney function is severely impaired, often characterized by an estimated Glomerular Filtration Rate (eGFR) in the range of 15-29 mL/min/1.73 m².

At this stage, the kidneys are significantly compromised in their ability to filter waste and excess fluids from the blood.

Patients with Stage 4 CKD typically experience noticeable symptoms and a buildup of waste products in the blood, which can lead to a loss of appetite.

Moreover, individuals with Stage 4 CKD face an increased risk of progressing to end-stage renal disease (ESRD), where kidney function is insufficient to sustain life without renal replacement therapies such as dialysis or kidney transplantation.

The impact on the quality of life is substantial at this stage, necessitating careful consideration of treatment options and informed decisions about future kidney care.

CKD Stage 4 Symptoms

Individuals with Stage 4 CKD may experience a range of symptoms, including

  • Fatigue and weakness
  • Swelling in the legs and ankles
  • Changes in urination patterns, such as decreased urine output, the frequent need to urinate, or foamy urination
  • High blood pressure
  • Nausea and vomiting
  • Poor appetite
  • Itching and dry skin
  • Muscle cramps and twitches
  • Shortness of breath
  • Changes in mental alertness and concentration
  • Increased levels of waste products in the blood lead to a condition known as uremia

Healthy Habits for Stage 4 CKD Patients

Managing CKD stage 4 requires a combination of medical care and healthy lifestyle choices to help slow the progression of the disease and improve overall well-being.

A balanced diet is crucial for Stage 4 kidney disease patients. A renal diet tailored to reduce the kidney burden is often recommended. This diet focuses on limiting the intake of certain nutrients like protein, phosphorus, and potassium. It ensures that patients receive adequate nutrition while minimizing the accumulation of waste products in the blood.

Controlling fluid intake is vital for patients with Stage 4 CKD, as the kidneys may struggle to regulate fluids. Monitoring fluid intake helps prevent fluid overload and swelling. Additionally, managing blood pressure is essential to slow kidney damage, often through medications and dietary modifications. Reducing sodium (salt) intake can be particularly effective in controlling blood pressure.

Engaging in regular, moderate exercise can be beneficial for Stage 4 CKD patients. Exercise helps maintain cardiovascular health, control weight, and improve overall fitness. Activities like walking, cycling, and swimming are typically safe options, but you must consult a healthcare provider to determine the right level of physical activity for you.

It’s also important to understand that smoking and excessive alcohol consumption can worsen kidney disease and increase the risk of complications. Quitting smoking and moderating alcohol intake are crucial lifestyle changes.

Stage 4 Kidney Disease Causes and Risk Factors

Understanding the causes and risk factors associated with Stage 4 kidney disease is essential for prevention and effective management.

This advanced stage of CKD is influenced by various factors, including.

  • Diabetes, both Type 1 and 2, can play a role in kidney function. Elevated blood sugar levels can progressively damage the kidneys’ small blood vessels and filtration units, leading to diminished kidney function and an increased risk of developing Stage 4 CKD.
  • Hypertension, or high blood pressure, is another significant contributor to the onset and progression of Stage 4 CKD. Sustained high blood pressure places undue stress on the kidneys’ blood vessels, resulting in kidney damage.
  • Anemia is common in Stage 4 CKD patients due to reduced erythropoietin production, a hormone vital for red blood cell production, leading to fatigue and weakness.
  • Proteinuria, excess protein in the urine, is another hallmark of severe kidney impairment in Stage 4 CKD, highlighting the diminished filtration function. 
  • Urinary tract infections (UTIs) pose an added risk, potentially resulting in complications such as pyelonephritis, a kidney infection that can exacerbate the preexisting kidney damage.

Treatment for Stage 4 Kidney Disease

When faced with a stage 4 kidney disease diagnosis, their kidney doctor will tailor patients’ treatment to meet their unique circumstances and health status. These options include:

CKD Management

Individuals with stage 4 kidney disease will be offered CKD management by their doctors. This approach focuses on controlling symptoms and complications through lifestyle modifications and medications.

It can include:

  • Dietary restrictions
  • Blood pressure control
  • The management of anemia, bone health, and other CKD-related issues

CKD Treatment Education

Dialysis is not typically started during stage 4. Kidney doctors will help patients learn more about dialysis and a kidney transplant as upcoming treatment options so they can stay informed about what’s to come.

Explore these options in more detail below.


A standard treatment for stage 4 kidney disease, dialysis is used to replicate the kidney’s filtration function.

There are two primary types of dialysis:

  • Hemodialysis involves using a machine to filter the blood externally, typically done in a dialysis center. It’s an effective way to remove waste products and excess fluids from the blood.
  • Peritoneal Dialysis: Performed at home, it utilizes the peritoneal membrane in the abdomen to filter blood. It offers greater flexibility and independence for patients.

Kidney Transplant

A kidney transplant is often considered the most effective treatment for Stage 4 CKD, providing the best chance for improved quality of life and kidney function.

A transplant involves replacing the patient’s damaged kidney with a healthy kidney from a living or deceased donor.

A thorough evaluation process is required to determine eligibility, including medical assessments, compatibility checks, and suitability for the surgical procedure.

Stage 4 Kidney Disease Life Expectancy

The life expectancy for individuals with stage 4 kidney disease can vary widely and is influenced by age, overall health, treatment choices, and access to medical care.

With appropriate management and treatment, many people can live with stage 4 CKD for several years. Still, the disease’s progression and its impact on life expectancy can differ from person to person.

Regular monitoring and adherence to treatment recommendations are key factors in extending life expectancy.

Personalized and Effective Care for Stage 4 Kidney Disease

Your kidney health matters to us.

If you or a loved one are living with stage 4 kidney disease, our compassionate and experienced team is here to help you every step of the way.

Contact us today to learn more about Stage 4 CKD, schedule an appointment, and determine your best treatment path.

Informed patients are healthier and can more easily adjust to the restrictions associated with having a chronic disease.

“You’ll never find the quality of care that you get at an ARA facility anywhere else. The staff always have your best interest at heart and will go out of their way to make you feel comfortable and help however they can. The truth is, I consider them my extended family!” 

Mr. Randal Beatty, University Kidney Center Hikes Lane, Louisville, KY