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A person with stage 4 chronic kidney disease (CKD) has advanced kidney damage with a severe decrease in the glomerular filtration rate (GFR) to 15-30 ml/min. It is likely someone with stage 4 CKD will need dialysis or a kidney transplant in the near future.
As kidney function declines, waste products build up in the blood causing a condition known as uremia. In stage 4, a person is likely to develop complications of kidney disease such as high blood pressure, anemia (a shortage of red blood cells), bone disease, heart disease and other cardiovascular diseases.
Symptoms that are experienced in stage 4 include:
At stage 4, it’s necessary to see a nephrologist (a doctor who specializes in treating kidney disease). The nephrologist examines the patient and orders lab tests to gather information to recommend treatment.
People in stage 4 CKD will usually visit their doctor at least every three months. Blood tests for creatinine, hemoglobin, calcium and phosphorus levels will be done to see how well the kidneys are working. The doctor will also monitor other conditions such as high blood pressure and diabetes. In addition to helping the patient keep their kidneys working as long as possible, the nephrologist will also help prepare the patient for dialysis or a kidney transplant.
Those with stage 4 CKD who will need treatment are told about their choices, including:
A person in stage 4 may also be referred to a dietitian. Because diet is such an important part of treatment, the dietitian will review a person’s lab work results and recommend a meal plan individualized for their needs. Eating a proper diet can help preserve kidney function and overall health.
For stage 4 CKD, a healthy diet is likely to consist of:
It’s recommended that people in stage 4 keep their blood pressure at a healthy level and those with diabetes keep their glucose level under control. Taking all the medicines as prescribed by the doctor may help prolong kidney function.
In addition to eating right and taking prescribed medicines, exercising regularly and not smoking are helpful in maintaining health. Patients should talk to their doctors about an exercise plan. Doctors can also provide tips on how to stop smoking.
The National Kidney Foundation (NKF) guidelines recommend starting dialysis when kidney function drops to 15 percent or less. By doing everything possible to help prolong kidney function and overall health, the goal is to put off dialysis or transplant for as long as possible.
If you would like to see a doctor who specializes in the care of kidneys, called a nephrologist, you can use DaVita's Find a Kidney Doctor tool to locate a nephrologist in your area.
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