Early Stage 4 Chronic Kidney Disease (CKD) means severe kidney damage and significant loss of function (eGFR 15-29 ml/min), where kidneys struggle to filter waste, leading to toxin buildup and potential symptoms like swelling, fatigue, and back pain, requiring close monitoring by a kidney specialist (nephrologist) to manage complications and plan for eventual kidney failure treatments like dialysis or transplant.
There is no cure for kidney failure, but with treatment it is possible to live a long, fulfilling life.
Common Symptoms of Stage 4 Kidney Disease
For someone around 60, stage 1 stage 2 kidney disease life expectancy will be approximately 15 years. That figure falls to 13 years, 8 years, and 6 years in the second, third, and fourth stages of kidney disease, respectively.
Stage 4 of CKD (eGFR between 15 and 29)
This waste can build up in your body and cause other health problems, such as high blood pressure, bone disease, and heart disease. You will likely have symptoms such as swelling of your hands and feet and pain in your lower back.
These medicines include an ACE inhibitor/ARB, an SGLT2 inhibitor and/or an nsMRA. Your healthcare professional may also prescribe a statin (cholesterol medicine). Guidelines recommend statins for people with stage 4 CKD who also have diabetes, a history of heart disease, or are age 50 or older.
In the general population, approximately 38% of adults aged 70 or older have an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, with most having moderate reductions in eGFR in the 30-59 ml/min/1.73 m2 range (1).
With end-stage renal disease, you need dialysis or a kidney transplant to stay alive. But you can also choose to opt for conservative care to manage your symptoms — aiming for the best quality of life during your remaining time.
It is likely someone with stage 4 CKD will need dialysis or a kidney transplant in the near future as part of their treatment.
Treating the cause is key, leading to reduced complications and slowing progression of kidney disease. For example, getting better blood pressure control, improved sugar control and diabetes, and reducing weight are often key interventions.
Extreme, on-going tiredness, together with a lack of energy, is often called fatigue. There are lots of reasons why you may experience fatigue with CKD. If your kidneys are not working well, toxins (waste products) build up in your blood and this can make you feel tired and weak.
Drugs / Medications to Avoid or Reduce for People with Chronic Kidney Disease:
Blood and urine tests determine which stage of CKD you're in. The stages range from very mild (stage 1) to kidney failure (stage 5). Healthcare providers determine the stage of your kidney function according to the glomerular filtration rate (GFR).
The signs and symptoms of CKD stage 4 may include:
Fatigue. Shortness of breath. Swelling in your hands and feet. Puffy eyes.
We found that participants with progressive CKD spent a median of 7.9 years in stage 3a, 5 years in stage 3b, 4.2 years in stage 4, and <1 year in stage 5.
The three key early warning signs of kidney disease are changes in urination (more/less frequent, foamy, blood), persistent fatigue/low energy, and swelling (edema) in your hands, feet, or face, often from fluid buildup. Other signs include itchy skin, poor appetite, and high blood pressure, though symptoms can be subtle until later stages.
Treatment options for kidney failure in end-stage kidney disease include:
The life expectancy for individuals with stage 4 kidney disease can vary widely and is influenced by age, overall health, treatment choices, and access to medical care. With appropriate management and treatment, many people can live with stage 4 CKD for several years.
Stress and uncontrolled reactions to stress can also lead to kidney damage. As the blood filtering units of your body, your kidneys are prone to problems with blood circulation and blood vessels. High blood pressure and high blood sugar can place an additional strain or burden on your kidneys.
Key Warning Signs That You May Need Dialysis Soon
Chronic kidney disease usually progresses slowly. Regular blood and urine tests can help doctors to decide whether the kidneys are still working well enough, whether the treatment needs to be adjusted, or whether dialysis will be needed soon, for example.
A GFR of 60 or higher is in the normal range. A GFR below 60 may mean kidney disease. A GFR of 15 or lower may mean kidney failure.
Antibiotics, Antifungals, and Antivirals
Many medicines used to treat infections caused by bacteria (antibiotics), fungus (anti-fungals), or a virus (antivirals) leave your body through the kidneys. So, they can build up in your body and cause extra side effects if the dose is too high for your eGFR.