Stage 4 Chronic Kidney Disease (CKD)

A person with stage 4 chronic kidney disease (CKD) has advanced kidney damage with a severe decrease in theglomerular filtration rate (GFR) to 15-30 ml/min. It is likely someone with stage 4 CKD will need dialysis or a kidney transplant in the near future.

As kidney function declines waste products build up in the blood causing a condition known as “uremia.” In stage 4 a person is likely to develop complications of kidney disease such as high blood pressure, anemia (a shortage of red blood cells), bone disease, heart disease and other cardiovascular diseases.

Symptoms that are experienced in stage 4 include:

Fatigue: Feeling tired is common for people with CKD and is often caused by anemia.

Too much fluid: The kidneys may lose their ability to control how much fluid stays in the body. A person may notice swelling (edema) in their lower legs, hands or face around the eyes. With too much fluid someone, could even feel short of breath.

Urination changes: Urine may be foamy if there is protein in it, or dark orange, brown, tea colored or red if it contains blood. A person may urinate more or less than normal, or get up at night to go to the bathroom.

Kidney pain: Most people with CKD do not have kidney pain, but with some kinds of kidney problems, such aspolycystic kidney disease (PKD) or infections, they may have pain in their back where the kidneys are located.

Sleep problems: Some people have trouble falling asleep or staying asleep. Itching, muscle cramps or restless legs can keep them awake.

Nausea: Vomiting or feeling nauseated may occur with CKD.

Taste changes: Food may not taste like it usually does, or may have a metallic taste.

Uremic breath: As urea builds up in the blood, it may be detected in the breathing causing bad breath.

Loss of appetite: People in this stage may not feel like eating, and some people report having a metallic taste in their mouth or bad breath.

Difficulty in concentrating: Having trouble balancing a checkbook or focusing on reading the newspaper can happen with CKD.

Nerve problems: Numbness or tingling in your toes or fingers is a symptom of CKD.

Chronic kidney disease (CKD) happens if your kidneys have been damaged. Kidneys can become damaged from a physical injury or a disease like diabetes or high blood pressure. Once your kidneys are damaged, they are not able to filter blood or do their other jobs well enough to keep you healthy. Some of the important jobs kidneys do:

• Filter blood
• Balance your body's fluids
• Regulate hormones
• Help keep blood pressure under control
• Keep bones healthy
• Help make red blood cells

Even if you get treatment in stage 4 and are careful about your health, your kidneys may still fail. Kidney failure happens when:

• 85-90% of kidney function is gone
• GFR falls below 15
• Kidneys don't work well enough to keep you alive

There is no cure for kidney failure, but with treatment it is possible to live a long, fulfilling life. Having kidney failure is not a death sentence. People with kidney failure live active lives and continue to do the things they love.


Is Kidney Failure in Your Chronic Kidney Disease(CKD) Future? Make An Estimation of Your Current CKD. http://www.kidneyabc.com/CKDQuestionnaire.html

Stage 3 Chronic Kidney Disease(CKD) Diet

In Stage 3 CKD,GFR is approximately 30-60%: GFR 45-59 (3A) or 30-44 (3B). Rememember that GFR is an estimate and may require a correction for (black) race.Developing a healthy lifestyle may be able to help prevent some long-term complications of kidney disease like bone disease or heart problems and maintain the kidney function for as long as possible.

Stage 3 chronic kidney disease is defined as having moderate kidney damage that limits some of the filtering ability of the kidneys, but doesn't necessitate dialysis. Decreasing the level of waste by making diet modifications preserves the remaining function and staves off further damage.

Protein Restrictions

Protein serves to maintain muscle mass and support your immune system. Urea is a by-product of protein breakdown by the liver. Your kidneys take the urea and produce urine for excretion of waste products. Reducing your protein intake reduces the amount of urea produced and, thus, the workload of the kidneys. However, according to DaVita, a dialysis facility for kidney failure, for stage 3, a dietitian will usually recommend eating a healthy diet with protein at the level of 0.8 grams of protein per kilogram of body weight, the same level recommended for all healthy people. One kilogram of body weight is equivalent to 2.2 lb.

Phosphorus and Calcium

Phosphorus is a mineral that works with calcium to support bone health. As your kidney function worsens, phosphorus can build up in the blood causing itchy skin and your bones to lose calcium. This stage of the diet restricts the amount of phosphorus in your diet by limiting beans, legumes, beer and dark colored carbonated beverages. Phosphorus binders can be used to remove excess phosphorus from your ingested food. These binders are usually concentrated calcium supplements because phosphorus and calcium compete for absorption in your intestines. Providing high amounts of calcium with your meals decreases the amount of phosphorus your body absorbs, thereby preventing kidney associated bone disease.

Fat-Soluble Vitamins

Fat-soluble vitamins A, D, E and K may have to be taken in water-soluble form, according to DaVita. Switching to water-soluble forms prevents buildup of these fat-soluble vitamins. Increasing the availability of vitamin D in water-soluble form is helpful as your kidneys may not be able to convert UV light into the active form of vitamin D.

Fluid Restrictions

Fluid isn't restricted on the stage 3 diet for chronic kidney disease. Your kidneys are still filtering your blood with some limitations. Stage 3 chronic kidney disease doesn't warrant a change in how much fluid and water you drink per day. If the filtration rate of your kidneys decreases, your physician may restrict how much fluid you can have per day to delay dialysis.



Is Kidney Failure in Your Chronic Kidney Disease(CKD) Future? Make An Estimation of Your Current CKD:http://www.kidneyabc.com/CKDQuestionnaire.html

CKD and Low-Potassium

Chronic kidney disease is a serious condition that occurs when your kidneys cannot filter the way they are supposed to. There are many situations that can cause kidney disease and there are various stages of this condition. Making dietary changes such as watching your potassium intake is an important step in managing CKD. Given the serious nature of CKD, check with your doctor on how much potassium you need.
Potassium and the Kidneys
Along with regulating fluid balance and removing wastes, your kidneys also regulate the amount of potassium circulating in the blood by removing excess. If the kidneys lose their ability to filter properly, potassium levels may get too high and in the later stages of kidney disease, high potassium levels can cause complications, notes the National Kidney and Urologic Diseases Information Clearinghouse. Hyperkalemia or too much potassium in the blood can lead to irregular heart rhythms, nausea, muscle weakness, numbness and tingling in various areas of your body and in severe cases it can contribute to a heart attack.
Low-Potassium Diet
Many foods contain potassium, so you will need to work closely with your doctor or registered dietitian to find the right plan. Avoid high-potassium foods such as apricots, dates, melons, oranges, artichokes, beets, potatoes and spinach, suggests the University of Michigan. Soy milk, yogurt, dried peas, beans and bran are also high in potassium. Instead, choose apples, berries, cranberries, grapes, cauliflower, corn, eggplant, lettuce and mushrooms. You can also leach foods to help remove some of the potassium from them. Because each person is different, it may take some trial and error to find the right diet to keep your potassium levels in check.

Is Kidney Failure in Your Chronic Kidney Disease(CKD) Future?

Make An Estimation of Your Current CKD. This health checker estimates the risk to develop Kidney Failure and provide some guidance for CKD patients:http://www.kidneyabc.com/CKDQuestionnaire.html

Chronic Kidney Disease and Stages

About Chronic Kidney Disease

Chronic kidney disease (CKD) is a disease whereby the kidneys have trouble removing waste products and fluid from the body. Usual causes of CKD include Diabetes Mellitus, high blood pressure and chronic glomerulonephritis. People with CKD often have no symptoms although the kidney function is severely affected.


CKD stages


The stages of CKD (Chronic Kidney Disease) are mainly based on measured or estimated GFR (Glomerular Filtration Rate). There are five stages but kidney function is normal in Stage 1, and minimally reduced in Stage 2.

The table below shows CKD and GFR for each stage:

Stage GFR* Description 1 With normal or high GFR 90+ Normal kidney function but tests show early signs of kidney damage 2 Mild CKD 60-89 Mildly reduced kidney function, test results point to some signs of kidney damage 3 Moderate CKD 30-59 Moderately reduced kidney function 4 Severe CKD 15-29 Severely reduced kidney function 5 End-stage CKD <15 or on dialysis Established kidney failure, kidney dialysis or transplant may be needed

Chronic Kidney Disease Causes Symptoms and Stages

What causes CKD?

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.

Other conditions that affect the kidneys are:

Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney's filtering units. These disorders are the third most common type of kidney disease.

Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue.

Malformations that occur as a baby develops in its mother's womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.
Lupus and other diseases that affect the body's immune system.

Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.

Repeated urinary infections.

What are the symptoms of CKD?

Most people may not have any severe symptoms until their kidney disease is advanced. However, you may notice that you:

• feel more tired and have less energy
• have trouble concentrating
• have a poor appetite
• have trouble sleeping
• have muscle cramping at night
• have swollen feet and ankles
• have puffiness around your eyes, especially in the morning
• have dry, itchy skin
• need to urinate more often, especially at night.

Anyone can get chronic kidney disease at any age. However, some people are more likely than others to develop kidney disease. You may have an increased risk for kidney disease if you:

• have diabetes
• have high blood pressure
• have a family history of chronic kidney disease
• are older
• belong to a population group that has a high rate of diabetes or high blood pressure, such as African Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians.

Five stages of chronic kidney disease


Below shows the five stages of CKD and GFR for each stage:

• Stage 1 with normal or high GFR (GFR > 90 ml/min)
• Stage 2 Mild CKD (GFR = 60-89 ml/min)
• Stage 3 Moderate CKD (GFR = 30-59 ml/min)
• Stage 4 Severe CKD (GFR = 15-29 ml/min)
• Stage 5 End Stage CKD (GFR <15 ml/min)

Chronic Kidney Disease (CKD)

Chronic Kidney Disease (CKD) means lasting damage to the kidneys that can get worse over time. If the damage is very bad, your kidneys may stop working. This is called kidney failure, or end-stage renal disease (ESRD). If your kidneys fail, you will need dialysis or a kidney transplant in order to live.

The stages of chronic kidney disease, as follows:

Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m2)

Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m2)

Stage 3: Moderate reduction in GFR (30-59 mL/min/1.73 m2)

Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m2)

Stage 5: Kidney failure (GFR < 15 mL/min/1.73 m2 or dialysis)

In stage 1 and stage 2 chronic kidney disease, GFR alone does not clinch the diagnosis. Other markers of kidney damage, including abnormalities in the composition of blood or urine or abnormalities on imaging studies, should also be present in establishing a diagnosis of stage 1 and stage 2 chronic kidney disease.

Patients with chronic kidney disease stages 1-3 are generally asymptomatic; clinically manifestations typically appear in stages 4-5 (see Clinical). Early diagnosis and treatment of the underlying cause and/or institution of secondary preventive measures is imperative in patients with chronic kidney disease. These may delay, or possibly halt, progression.