Stage 4 of Chronic Kidney Disease

Stage 4 chronic kidney disease is severe impairment to the kidneys with glomerular filtration rate (GFR) reduced to 15-30ml/min. The patients with stage 4 chronic kidney disease are prone for initiating dialysis or kidney transplant especially if no active treatments are adopted.

With kidney condition worsening, wasteful products accumulate in the body which will cause systemic complications in the patients including swelling, high blood pressure, anemia, cardiovascular diseases, gastrointestinal tract disorders, etc.

Symptoms in stage 4 chronic kidney disease mainly include the follows:

Fatigue or tiredness: feeling over fatigued is quite common in the patients with CKD due to occurrence of renal anemia.

Fluid accumulation. Failing kidneys are unable to excrete excess water out of the body and thus the patients may experience water accumulation in the body. The patients with CKD may have obvious swelling/edema in hands, limbs, ankles and face. Severe buildup of fluid in bloodstream may make the patients short of breath.

Urination changes. Foamy or bubbly urine may occur if there is protein in urine, or the urine might be dark orange, brown, tea colored or red in case abnormal leakage of red blood cells in urine happen. In some cases, the patients with CKD may find themselves urinate much more or very less than normal, or visit the toilets more often at night.

Flank/kidney pains. Most patients with CKD don't have kidney pains, but in some diseases such as Polycystic Kidney Disease (PKD) or infections, the patients may have pains in their back where kidneys are located.

Nausea/vomiting: the patients may vomit or feel nauseated due to severe buildup of wastes in their body.

Uremic breath. As urea pile up in the body, it can be reflected in the breathing causing bad breath.

Sleep problems. Some patients have trouble in falling asleep. Skin itching, muscle cramps or restless legs can make them awake.

Nerve problems. Numbness or tingling in toes or fingers can both be symptoms of CKD.

At stage 4 chronic kidney disease, it is necessary to see a nephrologist (a doctor who specializes in treating kidney disease). The patient will be ordered a series of full lab tests to confirm their specific illness condition which will guide the treatment.

Usually, blood tests including creatinine, hemoglobin, electrolytes, Cystatin C, etc, combined with urine tests including microalbuminuria, urine IgG, urine NAG, urine GGT and urine osmotic pressure are adopted to tell how well the kidneys are working. The patients at stage 4 chronic kidney disease should not miss timely treatment. When at stage 4, the patients by repairing their kidneys can hopefully improve their kidney function and avoid entering dialysis. The new treatment options for repairing the kidneys are Micro-Chinese Medicine Osmotherapy and Immunotherapy. GFR<15 is clinical diagnosis of end-stage kidney disease which requires immediate dialysis treatment, the patients by timely treatment are likely to avoid renal replacement therapies.

Those with stage 4 CKD may also be referred to a dietitian. Dietary therapy is essential to protect kidneys and reduce potential risks of complications. The dietitian will review a person's lab results and recommend meal plan individualized for their condition. A patient with stage 4 CKD is suggested by dietitian to cut off consumptions of proteins to help decrease build up of urea nitrogen. Phosphorus should also be limited to reduce high blood levels and reduce chances of bone disorders. In addition, the patients often also need to limit their intake of potassium if their blood result is also high. The dietitian will also need to confirm whether the patient has Diabetes and provide some suggestions on reducing consumption of carbohydrates. A low sodium diet is also essential in case the patient experiences severe fluid accumulation or high blood pressure. It is helpful to work with a registered dietitian because as the stage or kidney condition differs, the diet also will vary.

A healthy diet recommended in stage 4 CKD:

﹡Limiting intake of proteins based on the amount of protein in urine and extent of kidney impairment based on assessment from dietitians. Substitute plant proteins with animal proteins such as lean meat, egg white, fish, etc.

· Control the intake of calories to maintain a healthy weight.

﹡Follow a diet low in saturated fats and cholesterols and moderate in total lipids, especially if one has Diabetes, Nephrotic Syndrome and heart disease.

﹡A diet low in sodium is beneficial for controlling blood pressure and reducing fluid retention in the patients. Remember to make adjustments based on specific blood pressure and swelling condition.

﹡Limit potassium and phosphorus levels if blood levels are above normal range.

﹡Confirm healthy body weight by proper dietary calorie consumption and proper physical activities.

In addition to the above, it is recommended that stage 4 CKD patients need to control their blood pressure within targeted range and those with Diabetes keep healthy blood glucose level. The patients need to avoid infections or over fatigue so as not to deteriorate kidney condition.

The patients at stage 4 CKD need treatments for not only targeted at reducing symptoms but also repairing underlying kidney injury. By doing everything possible to help improve kidney function and overall health, the goal is to put off dialysis or transplant as long as possible.

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