There are 5 stages of chronic kidney disease. In stage 4, you have severe, irreversible damage to the kidneys. However, there are steps you can take now to slow or prevent progression to kidney failure.

Continue reading as we explore:

  • stage 4 kidney disease
  • how it’s treated
  • what you can do to manage your health

Stage 1 and stage 2 are considered early-stage chronic kidney disease. The kidneys aren’t working at 100 percent, but they still work well enough that you might not have symptoms.

By stage 3, you’ve lost about half of kidney function, which can lead to more serious problems.

If you have stage 4 kidney disease, it means your kidneys have experienced severe damage. You have a glomerular filtration rate, or GFR, of 15–29 ml/min. That’s the amount of blood your kidneys can filter per minute.

GFR is determined by measuring the amount of creatinine, a waste product, in your blood. The formula also takes age, sex, ethnicity, and body size into account. The kidneys are functioning at 15–29 percent of normal.

GFR may not be accurate in certain circumstances, such as if you:

  • are pregnant
  • are very overweight
  • are very muscular
  • have an eating disorder

Other tests that help determine the stage are:

  • bloods tests to look for other waste products
  • blood glucose
  • urine test to look for the presence of blood or protein
  • blood pressure
  • imaging tests to check the structure of the kidneys

Stage 4 is the last stage before kidney failure, or stage 5 kidney disease.


In stage 4, symptoms may include:

  • fluid retention
  • fatigue
  • lower back pain
  • sleep problems
  • increase in urination and urine that appears red or dark

Complications from fluid retention can include:

If your potassium levels get too high (hyperkalemia), it can affect your heart’s ability to function.

Other potential complications include:

If you’re pregnant, kidney disease can increase risks to you and to your baby.

Monitoring and managing

In stage 4 kidney disease, you’ll see your kidney specialist (nephrologist) often, usually once every 3 months to monitor your condition. To check kidney function, your blood will be tested for levels of:

  • bicarbonate
  • calcium
  • creatinine
  • hemoglobin
  • phosphorus
  • potassium

Other regular tests will include:

  • protein in the urine
  • blood pressure
  • fluid status

Your doctor will review your:

Slowing the progression

There’s no cure, but there are steps that can slow progression. This means monitoring and managing conditions such as:

  • anemia
  • bone disease
  • diabetes
  • edema
  • high cholesterol
  • hypertension

It’s important to take all your medications as directed to help prevent kidney failure and heart disease.

Deciding next steps

Because stage 4 is the last stage before kidney failure, your healthcare provider will talk to you about that possibility. This is the time to decide on the next steps should that happen.

Kidney failure is treated with:

The National Kidney Foundation recommends starting dialysis when kidney function is at 15 percent or less. Once function is less than 15 percent, you’re in stage 5 kidney disease.

Diet for kidney disease depends on other conditions, such as diabetes. Talk to your healthcare provider about diet or ask for a referral to a dietician.

In general, a diet for kidney disease should:

  • prioritize fresh foods over processed products
  • have smaller portions of meat, poultry, and fish
  • involve moderate to no alcohol consumption
  • limit cholesterol, saturated fats, and refined sugars
  • avoid salt

Phosphorus levels can be too high or too low, so it’s important to go by your latest bloodwork. Foods that are high in phosphorus include:

  • dairy products
  • nuts
  • peanut butter
  • dried beans, peas, and lentils
  • cocoa, beer, and dark cola
  • bran

If potassium levels are too high, cut down on:

  • bananas, melons, oranges, and dried fruit
  • potatoes, tomatoes, and avocados
  • dark leafy vegetables
  • brown and wild rice
  • dairy foods
  • beans, peas, and nuts
  • bran cereal, whole wheat bread, and pasta
  • salt substitutes
  • meat, poultry, pork, and fish

Be sure to discuss your diet at every appointment with your healthcare provider. You may have to make adjustments after reviewing your latest tests.

Talk to your healthcare provider about which, if any, dietary supplements you should take and whether or not you should change fluid intake.

There are other lifestyle changes to help prevent further damage to your kidneys. These include:

  • Not smoking, if you smoke. Smoking damages blood vessels and arteries. It increases the risk of clotting, heart attack, and stroke. If you have trouble quitting, talk to your healthcare provider about smoking cessation programs.
  • Exercise. Aim to exercise 30 minutes a day, at least 5 days a week.
  • Take all prescribed medications as directed. In addition to taking all prescribed medications, ask your healthcare provider before adding over-the-counter (OTC) medications or supplements.
  • See your healthcare provider regularly. Be sure to report and discuss any new and worsening symptoms with your healthcare provider.

There’s no cure for stage 4 chronic kidney disease. The goal of treatment is to prevent kidney failure and maintain a good quality of life.

In 2012, researchers found that men and women with low kidney function, especially less than 30 percent, had substantially reduced life expectancy.

They noted that women tend to have longer life expectancy in all stages of kidney disease except stage 4, where there’s only a slight difference by gender. Prognosis tends to be poorer with age.

  • At 40 years old, life expectancy is about 10.4 years for men and 9.1 years for women.
  • At 60 years old, life expectancy is about 5.6 years for men and 6.2 years for women.
  • At 80 years old, life expectancy is about 2.5 years for men and 3.1 years for women.

Your individual prognosis also depends on co-existing conditions and what treatments you get. Your healthcare provider can give you a better idea of what to expect.

Stage 4 kidney disease is a serious condition. Careful monitoring and treatment can help slow progression and potentially prevent kidney failure.

At the same time, it’s important to make preparation for dialysis or kidney transplant in the event of kidney failure.

Treatment involves managing co-existing health conditions and supportive care. It’s vital to see your kidney specialist regularly to monitor your condition and slow progression of the disease.