🧬 Your Kidney Function Results – Stage 4 CKD

Severe reduction in kidney function (eGFR 15‑29 mL/min). Preparation for renal replacement therapy should begin now.

🚨 High urgency – see a nephrologist within 1 month.

📊 Estimated Glomerular Filtration Rate (eGFR)

0 mL/min Stage 4 – Severe CKD (15‑29)

Medical description: Kidney function is reduced to 15‑29% of normal. Complications such as anaemia, electrolyte imbalances, metabolic acidosis, and bone disease are common. You should be under the care of a nephrologist. Planning for dialysis or transplant is essential, though many people remain stable for years with careful management.

⏰ Critical: You should see a nephrologist immediately to identify the cause, start or adjust management, and prepare for stage 5.

🎯 The four main goals in Stage 4 CKD

1️⃣ Slow progression

Control BP, blood sugar, diet, and avoid nephrotoxins.

2️⃣ Treat underlying cause

Diabetes, hypertension, glomerulonephritis, etc.

3️⃣ Manage complications

Anaemia, bone disease, acidosis, electrolyte disorders.

4️⃣ Prepare for RRT

Dialysis access (AV fistula) or transplant evaluation.

🐢 1. Slow down the progression

Control blood pressure: Target < 130/80 mmHg. Use ACE inhibitors or ARBs as tolerated.
Control blood sugar: If diabetic, aim for HbA1c ≤ 7.0% (individualised).
Low protein diet: 0.6‑0.8 g per kg ideal body weight. Avoid protein starvation – consult a renal dietitian.
Reduce salt: Less than 5g/day (no added salt, avoid processed foods).
Painkillers: Only paracetamol (Panadol). Never use NSAIDs (ibuprofen, diclofenac, naproxen).
Avoid non‑medical prescriptions: Herbal remedies or unproven supplements can worsen kidney function.
Aminoglycoside antibiotics: These are nephrotoxic – inform every doctor about your CKD.
Hydration: Drink sufficient fluids to prevent dehydration (unless fluid restricted for heart failure).
Avoid pickles and spices: High in salt and potassium.

🩺 2. Treat the underlying cause

Continue prescribed medications for:

Diabetes (insulin, oral hypoglycaemics – adjust for GFR)
Hypertension (especially ACEi/ARB, calcium channel blockers)
Glomerulonephritis (immunosuppression if indicated)
Obstruction (urology referral)

Never stop or change medications without your nephrologist’s advice.

🩸 3. Manage complications

Enter your latest lab results below to receive stage‑specific advice for anaemia, bone disease, acidosis, and electrolytes.

💡 The linked script (complication_management_of_stage_four.php) should interpret these values and give specific recommendations for anaemia, hyperkalaemia, hyperphosphataemia, secondary hyperparathyroidism, metabolic acidosis, and malnutrition.

🔄 4. Preparation for Stage 5 (Renal Replacement Therapy)

You may progress to end‑stage kidney disease (eGFR < 15 mL/min), which requires renal replacement therapy (RRT). There are two main options:

Dialysis – either haemodialysis (in‑centre or home) or peritoneal dialysis (home).
Kidney transplant – from a living or deceased donor (best long‑term outcome).

If you choose haemodialysis, it is much better to prepare before it is needed. The most important step is creating a vascular access – ideally an arteriovenous fistula (AV fistula).

💪 Why create an AV fistula in advance?

It takes time to mature – usually 2‑4 months (or longer).
It is a small incision under the skin; not noticeable.
Uses your own arteries and veins – no artificial material.
Can function for years (often >5 years) with good care.
Lower infection and clotting rates than catheters or grafts.
Provides excellent blood flow for efficient dialysis.
Less expensive in the long run.

Example of an AV fistula (arm)

Stage 4 CKD – prepare now

📌 Key message: Do not wait until you feel symptoms of stage 5 (nausea, itching, fatigue, fluid overload) to create an AV fistula. Early planning avoids emergency dialysis with a central venous catheter, which has higher risks.

← Back to GFR Calculator Learn about Stage 5 →