What Are the Symptoms of Stage IV Kidney Disease?

Based on the estimated eGFR test results, CKD stages are divided into 5 stages:

• Stage I: Mild CKD
  • eGFR about 90 mg/dL
  • Kidney function is normal, with or without other signs of kidney damage
  • Microalbuminuria may be detected by a special urine test
• Stage II: Mild kidney damage
  • eGFR 60-89 mg/dL
  • Other signs, such as proteinuria (1+ or 2+), may be present
• Stage III: Moderate kidney damage
  • eGFR 30-59 mg/dL
  • Declining kidney function with symptoms such as swelling in the hands and feet, pain in the back, and increased or decreased frequency of urination
  • Accumulation of toxic nitrogenous substances called uremia (blood urea levels more than 45 mg/dL and blood creatinine levels above 1.2 mg/dL)
    • Stage 3a: eGFR 45-59 mg/dL
    • Stage 3b: eGFR 30-44 mg/dL
• Stage IV: Severe and irreversible damage to kidney function
  • eGFR 15-29 mg/dL
  • Last stage preceding kidney failure
  • Presence of other complications, such as anemia and bone diseases
  • The patient may need dialysis or kidney transplant soon
  • Blood creatinine levels over 2 mg/dL and electrolyte imbalance (high potassium levels)
• Stage V: Kidney failure is inevitable, also called end-stage renal disease (ESRD)
  • eGFR less than 15 mg/dL
  • Once the kidneys are damaged, the only two options left are:
    • Dialysis: Use of a machine that helps filter blood and remove toxins
    • Transplantation: Most effective option for ESRD

Possible complications of stage IV kidney disease include:

• Edema (general body swelling) due to fluid retention
• Hypertension
• Pulmonary edema (fluid accumulation in the lungs)
• Hyperkalemia (high blood potassium level)
• Anemia
• Weak bones
• Hyperlipidemia or hypercholesterolemia
• Pericarditis (inflammation of the lining of the heart)
• Erectile dysfunction
• Seizures
• Heart disease
• Higher lipid levels

Stage IV kidney disease cannot be reversed. However, following tips may help slow down disease progression and prevent other complications:

• Keep blood sugar levels under control
• Maintain normal blood pressure levels
• Exercise for at least 30 minutes a day, 5 days a week
• Maintain a healthy weight
• Avoid or quit smoking
• Avoid alcohol consumption
• Visit a nephrologist (kidney specialist) to decide on an appropriate treatment plan
• Check and monitor kidney function every 3 months through parameters such as creatinine, hemoglobin, bicarbonate, calcium, phosphorus, and potassium levels
• Eat a healthy, nutritious, and kidney-friendly diet:
  • Avoid processed and canned foods
  • Limit salt intake
  • Limit intake of saturated fats and refined sugars
  • Restrict intake of high-protein foods, such as meat, poultry, fish, eggs, dairy, beans, nuts, and whole-grain bread
  • Limit intake of oranges, potatoes, and tomatoes
  • Consume plenty of fruits and vegetables (berries, grapes, pineapples, cherries, apples, cauliflower, onions, eggplant, turnip)
• Maintain fluid intake according to your doctor’s recommendation

There is no cure for stage IV kidney disease. Treatment aims to prevent kidney failure and provide better quality of life.

According to the National Kidney Foundation, it is possible for kidney disease patients to live a long life with proper treatment. Dialysis is recommended when kidney function is at 15% or less.

Although prognosis depends on factors such as treatment adherence, diet, lifestyle, co-existing health conditions, and age, life expectancy with stage IV CKD tends to worsen with age unless a kidney transplant is performed.