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Dr. Patricia Shelton

Dr. Patricia Shelton

Jul 06, 20227 min read

Chronic Kidney Disease Stage 4

The information provided herein does not constitute an expert or medical advice, nor intended to replace such advice.


Patients with chronic kidney disease experience a slow decline in kidney function. This reduces the kidneys’ ability to clear waste products from the blood, which can result in a variety of symptoms and serious health complications. The disease progresses through five stages, with stage 4 being an advanced stage.

What does stage 4 kidney disease mean?

The stages of kidney disease are defined by the eGFR. This is a measurement of how well the kidneys are cleaning the blood, and is determined by measuring the levels of a waste product called creatinine in the blood. A formula is used to calculate the eGFR from the measured level of creatinine.

In people with stage 4 kidney disease, the eGFR is 15 to 29. By comparison, the normal eGFR is 90 or above. Stage 2 kidney disease involves an eGFR of 60 to 89, while in stage 3, the eGFR is 30 to 59.

There are five stages of chronic kidney disease, with increasing numbers indicating greater severity. Stage 5 represents kidney failure, and stage 4 kidney disease is the last stage before kidney failure.

What causes stage 4 kidney disease?

There are many different potential causes of chronic kidney disease. The most common causes are diabetes and high blood pressure. When these two conditions are not controlled, they cause damage to the tiny blood vessels inside the kidney. Over time, this damage begins to add up, leading to a loss of kidney function. In a patient with stage 4 kidney disease, it’s likely that blood sugar and/or blood pressure has been poorly controlled for years. If a patient has reached the 4th stage, kidney disease has likely been present for a long period of time, even if the patient didn’t realize it.

There are also other potential causes, including heavy alcohol use and smoking. Severe or frequent kidney infections or kidney stones can also cause damage to the kidney and lead to kidney disease.

How bad is stage 4 kidney disease?

Stage 4 is considered to indicate severe kidney damage. A patient with stage 4 kidney disease doesn’t yet need dialysis, but if they progress to stage 5, then they will need dialysis.

The chronic kidney disease stage 4 prognosis is relatively poor, and the patient’s life expectancy is significantly reduced. For example, a 30 year old woman with stage 4 kidney disease has a life expectancy of just 12.7 years, compared with 43.8 years for a woman of her age in the general population. However, treatment can help to avoid further progression of kidney disease from stage 4 to stage 5, and may improve life expectancy.

How to Reverse Stage 4 Kidney Disease

There is no known way to reverse damage to the kidney. Once kidney disease has progressed to stage 4, it’s generally not possible to heal the damage and regain normal kidney function.

However, it is possible to reduce the chances that stage 4 kidney disease will progress to stage 5, where a person needs dialysis. The best way to do this is by addressing the cause of the chronic kidney disease. The most common causes are diabetes and high blood pressure. Keeping both your blood sugar and your blood pressure under control can help to prevent further damage to your kidneys and progression of your kidney disease from stage 4 to stage 5. This may involve taking medications regularly, along with lifestyle changes.

Regular use of certain painkillers, such as ibuprofen, can lead to kidney disease and even kidney failure. If you have kidney disease at any stage, avoid using ibuprofen in order to protect your kidneys from further damage.

What are the 4th stage kidney failure symptoms?

Kidney failure is actually defined as stage 5 chronic kidney disease. Patients with stage 4 chronic kidney disease have severe kidney damage, but have not yet reached the point of having kidney failure. This stage should not really be referred to as chronic renal failure stage 4, but rather stage 4 chronic kidney disease. 

However, because their kidneys are not filtering the blood properly, many patients with stage 4 kidney disease have a variety of symptoms, including:

  • Nausea and vomiting
  • Lack of appetite
  • Trouble sleeping
  • Swelling of the hands and feet
  • Itchy skin
  • Fatigue

These stage 4 kidney failure symptoms are often accompanied by health problems in other parts of the body. Patients with stage 4 kidney disease often suffer from issues like high blood pressure, anemia (low red blood cell count), heart disease, and bone disease.

Stage 4 Kidney Disease Weight Loss

In patients with advanced kidney disease, severe weight loss, also known as wasting, is common. This is an unintentional weight loss of greater than 5% over three months, or 10% over six months. Wasting is common in stage 5, but weight loss can also occur in stage 4.

One symptom of advanced kidney disease is a lack of desire to eat. Nausea and vomiting are also common. Because of this, patients with stage 4 kidney disease may not consume enough food to meet their body’s energy needs, and they can start to lose weight. In addition, in patients with severe kidney damage, the body is losing protein in the urine. This can lead to a breakdown of muscle tissue, to meet the body’s needs for protein. 

Stage 4 Kidney Disease Creatinine Levels

In stage 4 kidney disease, the eGFR is 15 to 29. The level of creatinine is used to calculate the eGFR, but this calculation takes into account a number of different factors, including a person’s body mass, gender, and age. It’s not the creatinine level that matters in determining whether a patient is in stage 4, but the eGFR. 

Doctors sometimes also use other methods to evaluate kidney function, including a urine test called the albumin creatinine ratio, which looks for leakage of protein into the urine as well as the kidney’s ability to clear creatinine from the blood.

In order to determine your eGFR, you’ll need a blood test. You can go to a medical laboratory for this test, or you can order a home testing kit, which may be more convenient for many people. If you have stage 4 kidney disease, then you should be under the care of a doctor, and should talk with them about your results. 


Chronic Kidney Disease Basics. Centers for Disease Control and Prevention. https://www.cdc.gov/kidneydisease/basics.html. Accessed 29 June 2022.

Chronic Kidney Disease (CKD). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd. Accessed 29 June 2022.

Chronic kidney disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521. Accessed 29 June 2022.

Dialysis. National Kidney Foundation. https://www.kidney.org/atoz/content/dialysisinfo. Accessed 29 June 2022.

Estimated Glomerular Filtration Rate (eGFR). National Kidney Foundation. https://www.kidney.org/atoz/content/gfr. Accessed 29 June 2022.

Mak RH, Ikizler AP, et al. ​​Wasting in chronic kidney disease. J Cachexia Sarcopenia Muscle. 2011 Mar; 2(1): 9–25. doi: 10.1007/s13539-011-0019-5

Neild GH. Life expectancy with chronic kidney disease: an educational review. Pediatr Nephrol. 2017; 32(2): 243–248.  doi: 10.1007/s00467-016-3383-8.

Slow Progression and Reduce Complications. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/identify-manage-patients/manage-ckd/slow-progression-reduce-complications. Accessed 29 June 2022.

Treatment – chronic kidney disease. National Health Service. https://www.nhs.uk/conditions/kidney-disease/treatment/. Accessed 29 June 2022.

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