An individual in stage 4 of chronic kidney disease (CKD) is confronted with advanced kidney damage, leading to a significant reduction in the glomerular filtration rate (GFR), typically falling within the range of 15-30 ml/min. At this stage, it becomes highly probable that the individual will require either dialysis or a kidney transplant in the near future.

As kidney function deteriorates, waste products accumulate in the bloodstream, causing a condition known as uremia. In stage 4 CKD, individuals are prone to developing complications associated with kidney disease, such as high blood pressure, anemia (characterized by a shortage of red blood cells), bone disease, heart disease, and other cardiovascular ailments.

Signs and symptoms of stage 4 kidney disease include:

• Fatigue
• Fluid retention, resulting in swelling (edema) of extremities and breathlessness
• Changes in urination patterns (foamy urine; urine that is dark orange, brown, tea-colored, or contains blood; increased or decreased frequency of urination)
• Kidney-related pain, often felt in the back
• Sleep disturbances due to muscle cramps or restless legs
• Nausea and/or vomiting
• Taste alterations, including a metallic taste in the mouth
• Halitosis (bad breath) due to the buildup of urea in the blood
• Loss of appetite, leading to reduced food intake, with some individuals reporting a metallic taste in their mouth or bad breath
• Difficulty in concentration, resulting in challenges with tasks such as managing finances or reading
• Nerve problems, including numbness or tingling in the fingers or toes

Medical care for stage 4 CKD:

During stage 4 CKD, it is crucial to consult with a nephrologist, a specialist in kidney disease. The nephrologist conducts an evaluation of the patient and orders laboratory tests to gather information for treatment recommendations. Individuals in stage 4 CKD typically visit their doctor every three months, where blood tests for creatinine, hemoglobin, calcium, and phosphorus levels are conducted to assess kidney function. The doctor also monitors other conditions such as high blood pressure and diabetes. In addition to assisting the patient in preserving kidney function for as long as possible, the nephrologist provides guidance in preparation for dialysis or a kidney transplant.

Exploring treatment options for stage 4 CKD:

Individuals diagnosed with stage 4 CKD and requiring treatment are presented with several options, including:

1. Hemodialysis: This treatment can be administered at a specialized center or at home with assistance from a caregiver. Hemodialysis involves the use of a machine that extracts a small portion of the patient’s blood through an artificial kidney (dialyzer) to eliminate toxins that the kidneys can no longer filter. The purified blood is then returned to the body.
2. Peritoneal dialysis (PD): Unlike hemodialysis, PD does not require needles or a caregiver’s assistance during treatment. It can be performed at home or in a work environment.
3. Kidney transplant: This option is preferred and entails fewer dietary restrictions compared to individuals on hemodialysis or PD.

Consulting with a dietitian for stage 4 CKD:

Individuals in stage 4 CKD may be referred to a dietitian due to the critical role that diet plays in their treatment. The dietitian reviews the patient’s lab results and tailors a personalized meal plan to address their specific needs. Adhering to a proper diet can help preserve kidney function and overall health.

Dietary recommendations for stage 4 CKD often include:

• Reducing protein consumption to minimize the buildup of protein waste
• Incorporating grains, fruits, and vegetables (with normal levels of potassium and phosphorus)
• Limiting phosphorus intake to maintain normal PTH levels, prevent bone disease, and preserve existing kidney function
• Restricting potassium if blood levels exceed normal ranges
• Reducing calcium consumption
• Adjusting carbohydrate intake for individuals with diabetes
• Lowering saturated fat intake to manage cholesterol levels
• Minimizing sodium intake to address hypertension or fluid retention by avoiding processed and pre-packaged foods
• Considering water-soluble vitamins such as vitamin C (100 mg per day) and vitamin B complex, or refraining from over-the-counter dietary supplements (unless approved by the nephrologist)

Medications and stage 4 CKD:

It is advisable for individuals in stage 4 CKD to maintain healthy blood pressure levels and manage glucose levels effectively if they have diabetes. Adherence to prescribed medications can potentially prolong kidney function.

Managing stage 4 CKD:

In addition to following a proper diet and taking medications as directed, regular exercise and abstaining from smoking play vital roles in maintaining health. Patients should discuss an exercise plan with their healthcare providers, and doctors can offer guidance on smoking cessation. The National Kidney Foundation recommends initiating dialysis when kidney function drops to 15 percent or less, and efforts should be made to delay the need for dialysis or a transplant for as long as possible through comprehensive care.