Chronic kidney disease (CKD) progresses in stages, with stage 4 indicating severe kidney function loss. At this stage, the kidneys operate at only 15-29% of normal capacity, as measured by an estimated glomerular filtration rate (eGFR) between 15 and 29. While damage cannot always be reversed, taking proactive steps can help slow CKD’s progression and reduce the risk of other health complications.*

Health Risks and Complications of Stage 4 CKD

Stage 4 CKD significantly increases the risk of kidney failure and heart disease. Even with lower urine albumin-creatinine ratio (uACR) levels, heart disease remains a concern, and higher uACR levels correlate with increased risks for both heart and kidney complications. Monitoring and lowering uACR levels can help mitigate these risks.

Common complications of stage 4 CKD include:

• Anemia. Reduced red blood cell production, leading to fatigue
• Metabolic acidosis. Acid buildup in the blood, which affects metabolism
• Mineral and bone disorders. Imbalances in calcium and phosphorus that can weaken bones and contribute to heart disease
• Hyperkalemia. High potassium levels that can cause heart problems

Regular medical check-ups (at least four times a year) are crucial to detect and manage these complications. Additionally, individuals with CKD often develop high blood pressure, making routine monitoring essential.

Recognizing Symptoms and Taking Action

Symptoms of stage 4 CKD vary but often include:

• Changes in urination frequency
• Fatigue and difficulty concentrating
• Itchy or dry skin
• Swelling in the limbs
• Muscle cramps and shortness of breath
• Loss of appetite, nausea, and trouble sleeping

While some symptoms are manageable, CKD may still progress despite treatment. However, making lifestyle changes and working with healthcare professionals can significantly improve quality of life and slow disease advancement.

Lifestyle, Nutrition, and Medication Management

Adopting a healthier lifestyle can help manage CKD. Important steps include:

• Quitting smoking, as it worsens kidney function and increases cardiovascular risks
• Exercising regularly, starting with short walks and gradually increasing activity
• Getting sufficient sleep and effectively managing stress

Dietary changes are also crucial. Sodium intake should be limited to less than 2,300 mg per day, and adjustments to potassium, phosphorus, and protein intake may be necessary based on blood test results. Consulting a kidney dietitian can help create a personalized nutrition plan.

Medication management is essential since many drugs are processed through the kidneys. Some medications may need dosage adjustments or should be avoided entirely. Doctors may prescribe medications such as ACE inhibitors, ARBs, SGLT2 inhibitors, or nsMRAs to slow CKD progression, as well as statins to reduce heart disease risk.

Planning for the Future

Stage 4 CKD is a critical time to explore future treatment options, including dialysis and kidney transplantation. Early planning can make the transition smoother and improve long-term outcomes. If considering a transplant, starting the evaluation process early is beneficial, as it can take time to find a donor or secure a spot on the transplant waitlist.

Additionally, avoiding non-steroidal anti-inflammatory drugs (NSAIDs), monitoring metabolic acidosis, and staying informed about treatment options can help manage the disease effectively. Regular consultations with healthcare providers ensure that CKD complications are addressed and that individuals receive the best possible care.

By taking proactive steps and working closely with healthcare professionals, people with stage 4 CKD can improve their health outcomes and maintain a better quality of life for as long as possible.

*National Kidney Foundation. (2023, July 6). Stage 4 Chronic Kidney Disease (CKD). https://www.kidney.org/kidney-topics/stage-4-chronic-kidney-disease-ckd 

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