Stage 4 CKD means you have an eGFR between 15 and 29.

An eGFR between 15 and 30 means your kidneys are moderately or severely damaged and are not working as they should. Stage 4 kidney disease should be taken very seriously – it is the last stage before kidney failure.

At Stage 4 kidney disease, many people have symptoms such as:

  • Swelling in your hands and feet
  • Back pain
  • Urinating (peeing) more or less than normal

At Stage 4, you will likely also have health complications as waste builds up in your body and your kidneys are not working well, such as:

To keep kidney disease from getting worse at this stage, your doctor will recommend that you:

  • Have regular appointments with a nephrologist (kidney doctor), who will make a treatment plan that is right for you and tell you how often you will need to have your kidneys checked
  • Meet with a dietitian, who will help you follow a healthy diet 
  • Take special blood pressure medicines like ACE inhibitors and ARBs if your doctor says you should. If you have diabetes or high blood pressure, sometimes these medicines can help keep kidney disease from getting worse.

At Stage 4 kidney disease, this is the time to start talking with your nephrologist about how to prepare for kidney failure. Once your kidneys have failed, you will need to start dialysis or have a kidney transplant to live.

  • Preparing for dialysis: Dialysis helps clean your blood when your kidneys have failed. There are several things to think about, such as the type of dialysis, how to plan your treatments and how they will affect your daily life. Learn more about hemodialysis and peritoneal dialysis.
  • Preparing for a transplant: A kidney transplant is a surgery to give you a healthy kidney from someone else’s body. If you can find a living kidney donor, you may not need to start dialysis at all. It is possible to have a transplant when your kidneys are getting close to failure. Learn more about kidney transplants.