Chronic kidney disease stage IV: what to expect

Stage IV indicates a substantial loss of kidney function, although the exact outlook differs between people. Waste and fluid can build up, and the kidneys may have more difficulty supporting blood production and mineral balance. Possible effects include tiredness, ankle swelling, itching, nausea, appetite changes, altered urination, or breathlessness. Symptoms are not a reliable measure of kidney function by themselves, so blood tests, urine tests, blood pressure, and the rate of change all guide decisions.

Stay connected with your kidney team and ask when preparation for future treatment should start. Discuss dialysis choices, access planning, transplant assessment when suitable, and non-dialysis supportive care. Take medicines exactly as directed and have all prescriptions, over-the-counter products, and supplements checked. Follow your personalised advice about salt, fluids, food, activity, and sick days. Make a plan for who to contact outside clinic hours.

Call your clinical team promptly if urine output falls, swelling increases quickly, vomiting continues, or you develop new severe weakness, drowsiness, or breathlessness. Seek emergency help for chest pain, severe difficulty breathing, collapse, seizure, or sudden confusion. A new symptom does not identify its cause, but a rapid change matters and should be assessed without delay.

How quickly is my kidney function changing? When should I choose or prepare for dialysis access? Am I suitable for transplant assessment? What would supportive care include? Which blood or urine changes matter most? What should my family know about urgent symptoms and contacting the team?