What to Know About Stage IV Chronic Kidney Disease

Medically Reviewed by Dan Brennan, MD on June 13, 2021

It’s possible to live a long, healthy life even when you have stage four chronic kidney disease. Your quality of life is greatly impacted by your nutrition and lifestyle. Learn more about how you can improve your life with stage four chronic kidney disease.

The Stages of Kidney Disease

Chronic kidney disease has five stages. In the earliest stages, your kidneys are damaged and not working at their full capacity. Once you reach stage three, you’ve lost half of your kidney function.‌

At this point, you may begin to experience other health problems as a result of kidney failure. Treating other health conditions is important in slowing down the loss of your kidney function at this stage.‌

Once you reach stage four, your kidneys are severely damaged. Your doctor may implement a strict treatment plan to keep the function that is left in your kidneys. Once you reach stage five, your kidneys are failing. You need dialysis or a kidney transplant to live.

Understanding Stage IV Kidney Disease

You receive a chronic kidney disease (CKD) diagnosis when your kidneys are damaged and can't function properly. Kidney damage often happens as a result of a physical injury or a health condition like diabetes or high blood pressure.‌

Damaged kidneys can't filter blood well enough to keep you healthy. Other important kidney functions include:

  • Balancing fluids in your body
  • Regulating hormones
  • Controlling your blood pressure
  • Keeping bones healthy‌
  • Producing red blood cells‌

If your doctor gives you a stage four chronic kidney disease diagnosis, it’s important for you to know how you can manage your condition. Take steps to maintain a healthy diet and lifestyle to prevent complications like:

  • Problems with your heart and blood vessels
  • Anemia, or low red blood cells
  • Problems with your bones
  • High blood pressure
  • Lack of energy from poor nutrition 

Kidney Failure

By stage four of chronic kidney disease, your kidneys are only functioning at a greatly decreased capacity. Kidney function is measured on the glomerular filtration rate (GFR) scale. If your kidney function reaches 10-15% capacity, you are experiencing kidney failure.‌

While there is no cure for chronic kidney disease, there are treatment options.‌

Kidney transplant. In some cases, you can receive a donated kidney from an organ donor who has died or someone living who donates a healthy kidney. A transplanted kidney usually begins working immediately following surgery. Keep in mind that a kidney transplant doesn’t cure chronic kidney disease. You may still need to take some medications to maintain the health of your kidney(s) and prevent further kidney failure.

Hemodialysis (HD). This type of dialysis can be done at home or in a dialysis center and filters waste and extra fluid from your body. During a dialysis treatment, your blood filters through a machine that functions as an artificial kidney. Once your blood filters a little at a time, it returns to your body.

‌If you go to a center for dialysis, you receive treatment three times each week for three to five hours each time. If you are able to complete dialysis at home daily, your treatments may only last one-and-a-half to two hours. Needle placement for your dialysis treatment includes:

  • Fistula – your doctor completes a surgical procedure to join one of your arteries to a vein closer to the skin’s surface for easier access. This is the preferred method because it has the least chance of failing over time. 
  • Graft – If you aren’t a candidate for a fistula, your doctor may connect an artery closer to your skin using a small soft tube. ‌
  • Catheter – You may need to have a larger tube inserted into your neck or chest. The tube stays outside your body and is usually used when your doctor anticipates short-term dialysis. 

Peritoneal dialysis (PD). This treatment is strictly home based. You must do it daily. Your doctor inserts a catheter into your abdomen so your blood filters inside your body instead of using a machine. A cleansing solution is inserted through the tube. After several hours, you can drain the solution and refill the tube with fresh solution to begin the cleaning process again.

Maintain Kidney Function

High blood pressure. This leads to your arteries growing thick and narrow, making it harder for your body to pump blood effectively. If left untreated, high blood pressure leads to stroke or heart attack. You may need to take blood pressure medication to help maintain a healthy blood pressure level.‌

Diabetes and high cholesterol. When left uncontrolled, both diabetes and bad cholesterol leave fatty deposits in your arteries that may cause clots, heart attack, or stroke. You may need to make diet changes to treat these conditions, which may include cutting out sugar and fatty foods. Talk to your doctor about your specific dietary needs. If you need help, ask for a referral to a dietician who can help you create a plan that fits your life.‌

Anemia. When you have fewer red blood cells to carry oxygen, your heart has to work harder. This can lead to heart failure or death when left untreated. You may need to take iron supplements to increase your red blood cell counts.

Bone and mineral disease. This condition causes your bones to get rid of extra calcium, putting it into your blood flow. Too much calcium can narrow and stiffen your arteries and reduce your blood flow. You may need a vitamin D supplement to help your bones retain calcium.

Maintaining your health with these conditions can help you keep your kidneys functioning at a higher capacity.

Show Sources


American Kidney Fund: “Stages of Chronic Kidney Disease (CKD).”

Cleveland Clinic: “Kidney Disease / Chronic Kidney Disease.”

National Kidney Foundation: “Key Points: Living With Stage 4 Kidney Disease.”

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