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

There are five stages of chronic kidney disease. Keep learning more about stage 4 kidney disease, how it’s treated, and what you can do to manage your health.

Doctors consider stage 1 and stage 2 early-stage chronic kidney disease. At these stages, the kidneys aren’t working at 100%, but they still work well enough that you might not have symptoms.

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

If you have stage 4 kidney disease, your kidneys have experienced severe damage. Stage 4 is the last stage before kidney failure or stage 5 kidney disease.

Doctors use two tests to monitor your kidney functions and disease progression. The first is the estimated glomerular filtration rate or eGFR. This test is one of the most reliable methods to check kidney function.

The current formula, which will be changing soon, takes age, sex, ethnicity, and body size into account.

When you have an eGFR of 15–29 milliliters per minute per 1.73 meters squared (ml/min/1.73m2), you have stage 4 kidney disease. This means your kidneys are not functioning as they should, and you are at the last stage before kidney failure.

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

  • pregnant
  • overweight
  • very muscular

In addition to an eGFR test, a doctor will likely order a urine test to check for albumin. Albumin is a protein found in the blood. Healthy kidneys do not allow the protein to pass into the urine. Its presence can help a doctor determine the severity of kidney disease.

They will also likely order an ultrasound or other imaging test to examine the kidneys and help determine the underlying cause.

In stage 4 kidney disease, symptoms may include:

  • trouble concentrating
  • nausea
  • dry skin
  • itching or numbness
  • feeling tired
  • headaches
  • chest pain
  • increased or decreased urination
  • loss of appetite
  • muscle cramps
  • weight loss
  • sleep problems
  • shortness of breath
  • vomiting

You may not experience all of the symptoms, but if you start to notice these symptoms, you may want to speak to a doctor.

Stage 4 kidney disease can cause complications to your overall health.

Common complications of kidney disease include:

  • high blood pressure (hypertension)
  • anemia (low red blood cell count)
  • mineral and bone problems
  • heart and blood vessel problems
  • poor nutritional health

Experts recommend a person with stage 4 or 5 kidney disease avoid pregnancy. This is due to the high risk of complications associated with the condition.

If you are living with stage 4 kidney disease, a doctor may recommend several treatment options. They will likely tailor treatment based on your needs. Some treatment strategies can include the following.

Monitoring and managing

In stage 4 kidney disease, you will likely see a kidney specialist (nephrologist) frequently to monitor your condition. The American Kidney Fund recommends a visit every three months.

To check kidney function and monitor the progression of the disease, a doctor will order eGFR blood tests and urine tests. They will also likely order tests to check for potassium and phosphate levels in the blood, as both of these can be too high or too low.

Your doctor will likely review your:

  • cardiovascular risk
  • immunization status
  • current medications
  • blood pressure

Slowing the progression

There’s no cure for stage 4 kidney disease, but there are therapies that can help slow its 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. Some medications and supplements a doctor may recommend include:

  • blood pressure medications, such as ACE inhibitors
  • calcium and vitamin D supplements
  • diuretics
  • erythropoiesis-stimulating agents (ESAs) or iron supplements
  • medications for diabetes management

They will also likely recommend avoiding certain medications that may damage the kidneys, such as nonsteroidal anti-inflammatory medicines (NSAIDs).

Deciding next steps

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

Kidney failure is treated with:

  • dialysis
  • kidney transplantation
  • supportive (palliative) care

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

Diet for kidney disease may depend on other comorbid conditions, such as diabetes. Talk with your healthcare professional 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 monitor them. 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, you may need to cut down on the following:

  • 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 with a healthcare professional at every appointment. You may have to make adjustments after reviewing your latest test results.

Talk with your healthcare professional about which, if any, dietary supplements you should take and whether or not you should change your 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 with your healthcare professional about smoking cessation programs.
  • Exercise: Aim to exercise 30 minutes daily, at least five days a week.
  • Take all prescribed medications as directed: In addition to taking all prescribed medications, ask your healthcare professional before adding over-the-counter (OTC) medications or supplements.
  • See your healthcare professional regularly: Be sure to report and discuss any new and worsening symptoms with your healthcare professional.

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.

Your life expectancy will depend on several factors, including:

  • age at diagnosis
  • overall health and other health conditions
  • how well you follow your treatment plan

A 2017 study notes that current life expectancy, while feasible to predict, is typically based on older data that may be up to a decade old.

However, they note that outcome trends continually improve, indicating that treatments and therapies may be effective.

What is the life expectancy with stage 4 kidney cancer?

It is difficult to predict how long a person can live with stage 4 kidney disease. Still, factors such as age, comorbid conditions, and adherence to treatment can all improve your overall outcome and increase life expectancy.

Is stage 4 kidney disease considered end-stage?

Stage 4 kidney disease is the last stage before end-stage kidney failure. Typically, once it advances to stage 5, you will need a kidney transplant or dialysis.

Can you live a long life with stage 4 kidney disease?

According to some experts, you can live a long, fulfilling life after being diagnosed with stage 4 kidney disease. Following your treatment plan and managing comorbid conditions can help improve your outcome.

Can your kidneys recover from stage 4 kidney failure?

Once your kidneys become damaged, they cannot be repaired. Doctors can replace the kidney with a donor’s kidney if one is available, but they cannot use medications or other methods to fix the kidney.

Is there a difference in prognosis by age?

In a 2017 study, researchers noted that both age and severity of kidney disease helped to predict outcomes. In general, they found that younger age and stage 1 or 2 kidney disease had the highest life expectancy while older age and stage 4 or 5 kidney disease had worse outcomes.

At any age, advanced kidney disease causes a decrease in life expectancy.

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 preparations for dialysis or kidney transplant in the event of kidney failure.

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