There are five stages of CKD. Your doctor determines your stage of kidney disease based on the presence of kidney damage and your estimated Glomerular Filtration Rate [GFR], which is a measure of your level of kidney function. Your treatment is based on your stage of kidney disease. Speak to your doctor or specialist nurse
if you have any questions about your stage of kidney disease or your treatment. A patient at Stage 1 CKD has a GFR of 90 or higher. Kidney function is normal with few or no physical symptoms. At this stage because the kidneys are still well most people will not know they are at Stage 1 CKD. If a person is diagnosed at Stage 1 CKD it is because they are being treated for diabetes of high blood pressure or they have a family history of kidney disease. A patient at Stage 2 CKD has a GFR of 60-89. There is usually are few or no physical symptoms at this stage. Although the kidneys are not working at
100% at this stage because the kidneys are still well most people will not know they are at Stage 2 CKD. If a person is diagnosed at Stage 2 CKD it is because they are being treated for diabetes of high blood pressure or they have a family history of kidney disease. A patient at Stage 3 CKD has moderate kidney damage. At Stage 3a GFR is 45-59 and Stage 3b is 30-44. As the function of the kidney will be declining waste products will start to build up in the blood. The toxic build-up of high concentrations of nitrogenous substances is called uraemia. A patient with Stage 4 CKD has severe kidney damage. At Stage 4 GFR is 15-30. As the function of the kidney will be declining waste products will start to build up in the blood. The toxic build-up of
high concentrations of nitrogenous substances is called Uraemia. It is likely that a patient at Stage 4 CKD will need dialysis or a kidney transplant soon. A person with stage 5 chronic kidney disease has
end stage renal disease [ESRD] with a glomerular filtration rate [GFR] of 15 ml/min or less. At this advanced stage of kidney disease, the
kidneys have lost nearly all their ability to do their job effectively, and eventually dialysis or a kidney transplant is needed to live.Stage 1
Signs & Symptoms of Stage 1 CKD
Stage 2
Signs & Symptoms of Stage 2 CKD
Stage 3
Signs & Symptoms of Stage 3 CKD
Stage 4
Signs & Symptoms of Stage 4 CKD
Stage 5
Signs & Symptoms
of Stage 5 CKD
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.
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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