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Stage 4 of Chronic Kidney Disease

Stage 4

Severe loss of kidney function, eGFR of 15–29

Stage 4 kidney disease occurs when your estimated glomerular filtration rate (eGFR) falls between 15–29, indicating a severe loss of kidney function. At this stage of chronic kidney disease (CKD), it’s important to manage your health as best you can to preserve kidney function and start planning ahead for potential treatments like a kidney transplant or dialysis. Seeing a kidney doctor (nephrologist) can help you learn about and compare options, so you can make treatment choices that are right for you. 

    Symptoms of stage 4 kidney disease

    Many people do not experience symptoms of kidney disease until the later stages when kidney damage has occurred. Possible stage 4 kidney disease symptoms and signs include:

    • Anemia
    • Decreased appetite
    • Bone disease
    • Abnormal blood levels of phosphorous, calcium, or vitamin D

    Steps to take at stage 4 kidney disease

    • Follow a kidney-friendly diet—Learning how to eat well with kidney disease is key to keeping your kidneys working longer. If you're not already working with a dietitian, ask your doctor or nephrologist for a referral. A dietitian can help you choose kidney-friendly foods and beverages.
    • See a nephrologist—If you’re not already seeing a kidney doctor (nephrologist), ask your primary care doctor for a referral. A nephrologist specializes in kidney disease and is the most qualified to guide your CKD treatment. He or she will examine your lab tests, talk to you about managing your kidney health, and help you determine which treatment best fits your lifestyle. You'll continue to see your regular doctor to monitor your overall health and any other existing conditions.
    • Start building your support network—Reach out to people who care about you and can encourage you. Your family, friends, and doctor will want to support you and help you stay motivated.
    • Learn about your potential treatment options—Now is a good time to start learning all you can about your potential treatment options in case of kidney failure. Ask your doctor about peritoneal dialysis, in-center or home hemodialysis, and a kidney transplant. It's important to find a treatment option that best fits your lifestyle.
    • Choose a dialysis access type—If you're considering dialysis, talk to your doctor about your options for dialysis access and how to get your access placed.

    Questions to ask your doctor about stage 4 kidney disease

    • Which treatment option may be right for me?
      There are several treatment options for kidney failure to consider, including a kidney transplant or home dialysis. Ask your doctor which option may best fit your lifestyle.
      • Kidney transplant
        The closest thing to natural kidney function and considered the most effective option for ESRD. With a kidney transplant you receive a new, healthy kidney from a living or deceased donor.
      • Dialysis
        This life-extending treatment option helps remove unwanted toxins, waste products, and excess fluids from the body by filtering your blood.
    • Am I eligible for a kidney transplant?
      Talk to your doctor about whether or not kidney transplant surgery is right for you. A successful kidney transplant is the closest to natural kidney function and considered the most effective treatment for kidney failure.
    • What should I know about dialysis access types?
      Your access is the location on your body where dialysis equipment can be connected to your bloodstream (for hemodialysis) or peritoneum (for peritoneal dialysis). Choosing your dialysis access early may give you more placement options.

    How to follow a kidney-friendly diet with stage 4 kidney disease


    One of the best ways to keep your kidneys working longer is to follow a kidney-friendly diet. A healthy stage 4 kidney disease diet may involve limiting or monitoring your intake of:

    Your level of kidney function and individual lab tests will determine your dietary needs. Talk to a renal dietitian about what foods you should eat. He or she will help you plan kidney-friendly meals that you'll enjoy eating.

    Stage 4 kidney disease life expectancy

    Stage 4 kidney disease life expectancy depends on a number of factors, including your age at the time of diagnosis, your other medical conditions, and your individual treatment plan. While there’s no cure for kidney disease and any kidney damage that has occurred can’t be reversed, you can take action now to help preserve kidney function and slow the progression of CKD. Looking after your health and eating a kidney-friendly diet can also help you feel your best.

    Learn more about kidney disease stages

    Take a free kidney care class
    Learn how to look after your kidney health and thrive—in a class that fits your life. Choose an educator-led or self-guided format.
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    Why you need a kidney doctor
    A nephrologist, also known as a kidney doctor, is the most qualified doctor to help you manage kidney disease. Ask your doctor for a referral to a nephrologist when your eGFR is between 30-44.
    Learn More