# Chronic kidney disease, stage 4-5
What is it
Chronic kidney disease (CKD) is a condition where the kidneys gradually function less well. The kidneys filter waste and excess fluid from your blood, which are normally excreted through urine. As the kidneys weaken, these substances accumulate in your body.
The disease is divided into five stages, based on how well the kidneys still work. **Stages 4 and 5 are advanced stages:**
- **Stage 4**: the kidneys work at only 15–29% of their normal capacity
- **Stage 5** (end-stage renal disease): the kidneys work at less than 15%, which usually requires dialysis or kidney transplantation
CKD is a long-term disease. It does not mean your kidneys stop completely — rather that they gradually lose their ability to filter. The course varies from person to person.
Causes
The most common causes of CKD are:
- **Diabetes** (especially type 2): high blood sugar damages the fine blood vessels in the kidneys
- **High blood pressure**: damages the same blood vessels
- **Chronic inflammation** in the kidneys themselves (glomerulonephritis)
- **Hereditary conditions**: for example, polycystic kidney disease
- **Recurrent kidney infections**
- **Obstructions**: for example, kidney stones
Sometimes the cause is not entirely clear. CKD can also develop after severe acute kidney failure. The disease can progress quietly for years without strong symptoms, until kidney function has decreased significantly.
How the disease progresses
CKD usually progresses slowly, except in certain underlying conditions. At stages 4 and 5, the process can move faster, although this varies from person to person.
**Before you notice symptoms**, your kidneys are already seriously damaged. This is why CKD is often discovered by chance through blood tests.
**The disease can stabilize** at a certain point, but can also gradually worsen. This depends on:
- The underlying cause
- Whether your blood pressure is well controlled
- Whether your diabetes (if you have it) is under control
- Your overall health
- How well you care for yourself and take your medicines
At stage 5, kidney function becomes so poor that **kidney function replacement treatment** (dialysis or transplantation) becomes necessary. This can be needed gradually or suddenly, depending on how quickly your kidneys deteriorate.
Symptoms by phase
**Stage 4** – symptoms are often still mild, but can occur:
- Fatigue
- Concentration problems
- Reduced appetite
- Nausea
- Nausea, especially in the mornings
- Itching
- Pain in the flanks (around the kidneys)
- Swelling of feet or legs
- Poor sleep
Many people have no noticeable complaints at this stage.
**Stage 5** – without treatment, symptoms become more intense:
- Severe fatigue
- Nausea and vomiting
- Reduced appetite (loss of appetite)
- Persistent itching
- Poor night's sleep
- Concentration problems
- Swelling of feet, legs, hands (due to fluid buildup)
- Shortness of breath (due to fluid excess)
- High blood pressure problems
These symptoms usually improve significantly when dialysis or transplantation begins.
What it means for daily life
**Medical consequences at play:**
Your body cannot properly eliminate excess substances and fluid. This can lead to high blood pressure, heart problems, anemia, bone decalcification, and weak bones.
**Diet:**
In stages 4 and 5, you often need to be careful with certain nutrients:
- **Potassium** (in bananas, oranges, nuts): can build up
- **Phosphorus** (in dairy, meat): affects bone health
- **Sodium** (salt): can raise blood pressure and worsen fluid retention
- **Fluid**: the worse your kidneys, the more careful you need to be with drinking
Your doctor and dietitian usually provide personalized advice.
**Medicines:**
You usually receive multiple medicines to:
- keep your blood pressure low
- protect your kidneys
- prevent weakness
- treat fluid overload
Some common medicines can be harmful for failing kidneys and must be avoided or adjusted.
**Work and energy:**
- Fatigue is very common
- Many people can still work in stage 4, but notice an energy dip
- In stage 5 without treatment, working can become difficult
- Dialysis requires regular time (often 3 times per week, several hours per session)
**Social life:**
- Appointments may need to be planned around dialysis
- Travel is possible, but requires preparation
- Food and fluid restrictions can make social eating more complicated
**Mental wellbeing:**
The diagnosis can be burdensome. It is normal to feel worried, sad, or angry. Many hospitals offer support.
Outlook
**For stage 4:**
With good control of your blood pressure, diabetes (if applicable), and regular medical monitoring, this phase can last for years. Not everyone progresses to stage 5. Some remain in stage 4.
**For stage 5:**
Without dialysis or transplantation, your kidneys do not function enough to keep you alive. **But dialysis and transplantation are effective treatments** that give many people a good life.
**Survival rates:**
Studies from different countries show that people with end-stage kidney disease on dialysis or after transplantation can live for many years — sometimes decades. The figures vary greatly from person to person, depending on age, other illnesses, how well you care for yourself, and how you respond to treatment. These general figures say nothing about your personal situation.
**Dialysis** (artificial kidney treatment):
- Is usually given 3 times per week, each time 3–5 hours
- Removes waste substances and excess fluid
- Many people feel better and stronger after starting
- Can be done at home (home dialysis) or at a center
**Transplantation** (a healthy kidney from a donor):
- Can come from a family member, known donor, or deceased person
- Requires lifelong immunosuppressive medications
- Usually offers more freedom than dialysis
- Outcomes vary; some kidneys function for decades
Frequently asked questions
**Can I do anything to make my kidneys better?**
CNZ cannot be cured, but can be slowed or stabilized. This happens by controlling blood pressure well, keeping diabetes under control (if you have it), taking medications consistently, eating healthily, not smoking, and having your kidney function checked regularly. Your doctor and dietitian will help you with a plan.
**Will I definitely need dialysis?**
Not everyone with stage 4 progresses to stage 5. Some remain stable. Those who reach stage 5 usually need dialysis or transplantation to stay alive. This will be planned together with your team.
**Is dialysis burdensome?**
Dialysis requires time and planning, and can feel like a limitation. But many people adjust to it and feel better than before they started. It gives you a longer life and more energy. Some choose home dialysis, which offers more flexibility.
**Can I still travel with CNZ stage 4-5?**
Yes, but it requires preparation. If you need dialysis, you must arrange dialysis centers at your destination in advance. Your doctor will help you set this up. For stage 4, traveling is usually easier.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._