Chronic Kidney Disease Stages 4 and 5: Symptoms, Treatments and Everything You Need to Know

CKD is divided into 5 stages and each of them represents a different stage of kidney failure. Here we talk about its last phases and what happens to patients when they reach this point.

After being diagnosed with chronic kidney disease, also known as CKD, it is important for the patient to know its different stages. This will allow you to better understand your medical condition, follow the correct treatment and improve some lifestyle habits. Jennifer Garay, a nephrologist at Baxter RCS, explains what it means when a person is in the last stages, that is, stages 4 and 5.

What you can read in this content:

  • Chronic Kidney Disease Stage 4: Diagnosis, Symptoms, and Treatments
  • Evolution from stage 4 to 5 of CKD
  • Chronic kidney disease grade 5: what does it mean to enter this last stage?
  • Accompaniment by family and caregivers

What happens when a patient is in CKD grade 4?

It is the persistence of kidney damage or decreased kidney function for at least a period of three or more months, regardless of the cause, where the glomerular filtration rate is between 15 to 29.


What are the symptoms that occur in this stage?

Many patients have no symptoms, even in these advanced stages of the disease. They will often be detected incidentally in a routine check-up or in cardiovascular risk or diabetes mellitus programs. A decrease in the ability to produce urine is rarely observed, so being asymptomatic does not exclude having advanced kidney disease.

Some patients may have signs or symptoms related to decreased kidney function such as high blood pressure or edema.


Can kidney damage be reversed when CKD grade 4 is reached?

People who come with chronic deterioration do not revert, however, today we have nephroprotection programs that allow us to keep the patient stable for a longer time and reduce the risk of advancing to the last stage of kidney damage.

There are also other cases: they are subjects who have chronic kidney disease in stage 2 or 3 and when they present an event that deteriorates their health status, even if it is not directly due to the kidney, such as an infection such as pneumonia that requires hospitalization, they can to present grade 4 kidney damage. But, once this acute event is resolved, they can gradually recover until they reach what we know as the patient's baseline renal function.


How fast is the progression of the disease from this stage to the next?

Determining how fast kidney disease progresses depends on the cause, as well as how stable it is. For example, if you have poorly controlled diabetes mellitus, CKD will continue to progress significantly. That is why it is necessary to properly follow the instructions of the nephrologist.


What happens when a patient has reached grade 5 chronic kidney disease?

You must begin a process of preparation and acceptance, since you are in the final stage of kidney disease. You should also start training in dialysis therapies, which you can do at home through peritoneal dialysis, or in a renal unit through hemodialysis.

It should always be borne in mind that postponing the correct treatment can lead to a clinical condition called "dialytic urgency", in which the lungs fill with water, there are seizures, cardiac arrhythmias, stupor or coma, and which could end with death. death.


What are the symptoms that occur in this last stage?

Despite being the most advanced stage of the disease, there are patients who do not exhibit any symptoms, and may even continue with an adequate ability to urinate. However, depending on the duration of this and the gradual deterioration, they may present the following picture:

  1. low appetite
  2. Threw up
  3. easy fatiguability
  4. generalized weakness
  5. Pruritus or itching of the body
  6. In extreme cases: altered state of consciousness, convulsions, edema and difficulty breathing.

Are dialysis and kidney transplant the only treatments that exist for stage 5 CKD?

Until the advance in medicine that we have to date, these are the two treatment options. Going to other management, commonly known as naturopathic, can lead to a greater probability of intoxication and irreversible sequelae.


Some patients with stage 5 disease consider life expectancy to be very low. What can be said to them?

Currently, there are renal units that bring together a multidisciplinary team with a nephrologist (kidney disease specialist), nutritionist, social worker, nurses and psychologists who have extensive experience, in addition to having state-of-the-art technology and therapies that have advanced important way. Thanks to all these elements life expectancies are higher.


In these advanced stages of chronic kidney disease, how should the accompaniment of the patient's caregivers or loved ones be?

They are of vital importance both emotionally and by being able to train in all aspects of kidney disease: eating patterns, medication administration, transfers and others.