Stage 4 kidney disease is considered an advanced from of chronic kidney disease (CKD) that is characterized by a severe decrease in its ability to perform its function. At this point, the condition has reached a life-threatening territory and will require significant treatment to increase survival.
Our kidneys are two of the most important organs in the body and are responsible for removing waste and excess fluid. Most of these discarded substances are considered toxic and would lead to several abnormalities if not promptly removed.
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Suffering from a damaged kidney is a major problem in the United States, with more than 30 million Americans having chronic kidney disease. Kidney function is measured based on its glomerular filtration rate (GFR), which is the process by which the kidneys filter blood and is calculated by using a mathematical formula that compares a person’s size, age, sex, and race to serum creatinine levels.
The following are stages of kidney disease and their corresponding GFR:
- Stage 1 with normal or high GFR (GFR > 90 mL/min)
- Stage 2 Mild CKD (GFR = 60-89 mL/min)
- Stage 3A Moderate CKD (GFR = 45-59 mL/min)
- Stage 3B Moderate CKD (GFR = 30-44 mL/min)
- Stage 4 Severe CKD (GFR = 15-29 mL/min)
- Stage 5 End Stage CKD (GFR
Also read: End stage renal disease (ESRD) or stage 5 kidney disease: Causes, symptoms, and treatment
What is stage 4 chronic kidney disease?
Stage 4 chronic kidney disease is defined as having a GFR of 15–39 ml/min. This means your kidneys have lost nearly 85–90 percent of its function and will require the assistance medical therapy.
Declining kidney function results in the build of waste products in the blood that can lead to several complications. This includes high blood pressure, anemia, bone disease, heart disease, and other cardiovascular diseases. If these complications are not taken care of promptly, it can lead can severe health consequences.
Also read: Stage 3 chronic kidney disease: Symptoms, diet, and treatment
Life expectancy of stage 4 kidney disease patients
Without treatment in the form of kidney dialysis, stage 4 kidney disease patients will be subjected to several negative symptoms that will not only cause pain, but also an overall decrease in quality of life. It is expected that stage 4 patients will not survive more than a year without dialysis treatment.
With dialysis, however, patients are expected to increase survivability considerably, allowing them to extend their prognosis by an additional 2–5 years. By allowing a dialysis machine to perform the work normally done by the kidneys, your body can perform optimally again. However, it is important to note that every patient is different and may have additional circumstances that may affect survival.
Dialysis should only be considered as a temporary measure to help get rid of harmful toxins and wastes from the body. All efforts are geared toward promoting kidney treatment and recovery that help repair diseased cells and tissues so that eventually a patient’s kidney function is sufficient enough to do the job on its own. This will require the dedication and vigilance of the patient to adhere strict dietary plans and treatments prescribed by the doctor.
However, some cases of kidney disease are beyond what can be treated with modern medicine, with the only resort left being kidney transplantation.
Symptoms of stage 4 kidney disease
Stage 4 kidney disease symptoms include:
- Flank pain (kidney pain felt in the back)
- Sleep problems
- Nausea
- Vomiting
- Metallic taste in the mouth
- Bad breath due to urea buildup in the blood
- Loss of appetite
- Difficulty in concentrating
- Numbness or tingling in the toes or fingers
- Fatigue
- Edema (swelling) of extremities
- Shortness of breath
- Dark orange, brown, tea-colored urine
- Restless leg syndrome
Also read: What your urine color and urine odor say about your health
When and what to discuss with doctor about stage 4 CKD
Having a close relationship with your doctor is vital for optimal kidney disease treatment. You should disclose any problems and concerns that you may be having as well as symptoms that develop. This is important as your doctor will be able to pick out and investigate potential problems before they become any more serious.
For the sake of convenience, you may discuss with your doctor your dialysis options and whether you can perform dialysis from the comfort of your own home. Speaking directly to a nephrologist will also provide more insight into your condition.
Those with stage 4 kidney disease are expected to visit their doctor at least every three months, getting a full workup and making sure the treatment plan is working well.
Treating stage 4 CKD
Kidney transplantation
An operation that exchanges your diseased kidney for a healthy one. Organ transplantation is a complex science, as both the donor and recipient have to match an immunological level or else the recipients own antibodies will reject it, seeing it as foreign tissue. This can be somewhat mitigated with immune-suppressing medication, but this will not be effective for the long term. For this reason, kidney transplantation should not be viewed as a cure, but rather another form of treatment.
Hemodialysis
A treatment that removes wastes and extra fluid directly from the patient’s blood. The process involves being hooked up to a machine with which blood can be pumped through special filters within the hemodialysis machine. Treatment time generally takes about three to five hours and is performed three times a week.
Fistula
The creation of an opening of your circulatory system, making it easier to attach you to a dialysis machine. This may be an ideal option for some patients, but can be difficult to implement as it requires minor surgery.
Graft
An alternative to a fistula and involves joining an artery with a nearby vein with a small, soft tube made of synthetic material. Grafts require a minor operation and are placed beneath the skin.
Catheter
Another type of dialysis access point that involves a long tube inserted into a large vein in your neck or chest. The end of the tube sits outside the body and serves as a permanent access point when a fistula or graft cannot be placed.
Peritoneal dialysis
A form of home-based treatment that must be done on a daily basis and will require the insertion of a permanent catheter. Peritoneal dialysis works by cleaning the body within, as opposed to outside of your body, as it uses your abdominal lining (the peritoneum) as a natural filter.
An overall good idea for maintaining good kidney health.
Diet for stage 4 kidney disease
High-phosphorus foods
Includes cheese, ice cream, milk, seeds, chocolate, legumes, nuts, and yogurt. Because your kidneys have difficulty removing phosphorus, it can build up in the blood caused by additional problems with calcium absorption and parathyroid hormone production (PTH). Stage 4 kidney disease patients should limit their phosphorus intake to 800–1,000mg a day.
High-potassium foods
It is advised to avoid foods high in potassium as it could lead to a condition called hyperkalemia that may affect the rhythm of the heart. Foods high in potassium include spinach, potatoes, carrots, mushrooms, bananas, oranges, apple, and grapes. Instead, choose to consume low potassium foods such as pumpkin, rice, and tofu, but in moderation. Potassium restriction should be limited to 2,000–3,000mg per day.
Protein
Eating too much protein can increase the work required by the kidneys. While it is not recommended to skip protein altogether, limit your consumption of it. Sources of high-quality protein include fish, lean meat, egg whites, and milk.
Sodium
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Commonly known as salt, it is recommended to reduce your sodium content in the food you eat as your kidneys are unable to filter it from the body as efficiently. It may lead to fluid retention and swelling (edema). Foods high in sodium include pickles, ham, bacon, potato soup, and cheese sauce.
Fluid
While staying hydrated is important, kidney failure patients are advised to limit the amount of water they drink, as too much may lead to excess fluid retention. As a general rule, patients suffering from chronic kidney disease should be drinking only the amount of urine the peed out in the previous day.
Related:
- Renal diet: Foods to eat and avoid for kidney failure
- Uremia, a complication of chronic kidney disease: Causes, symptoms, treatment, and diet
Mohan Garikiparithi got his degree in medicine from Osmania University (University of Health Sciences). He practiced clinical medicine for over a decade before he shifted his focus to the field of health communications. During his active practice he served as the head of the Dept. of Microbiology in a diagnostic centre in India. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine (Homoeopathy), and other alternative systems of medicine. He now advocates treating different medical conditions without the use of traditional drugs. An ardent squash player, Mohan believes in the importance of fitness and wellness.
