What should you know about stage four chronic kidney disease?

The kidneys help remove waste, balance fluid and salts, support blood pressure control and make hormones involved in blood production. With stage four chronic kidney disease, these jobs are impaired, although the experience varies between people. Possible effects include fatigue, ankle swelling, changes in urination, itching, nausea, poor appetite, muscle cramps or restless legs. Anaemia, hypertension, type 2 diabetes and gout may occur alongside kidney disease or contribute to kidney damage. Symptoms alone cannot determine the stage; clinicians use kidney blood and urine tests over time.

Keep scheduled kidney reviews and take prescribed medicines as directed. Ask before using anti-inflammatory pain medicines, supplements or contrast-related treatments because some products can strain the kidneys or require dose changes. Follow the fluid, salt, protein or potassium advice tailored to your results rather than adopting a generic diet. Control blood pressure and diabetes if relevant, avoid smoking and bring home readings and medicine changes to appointments. Your team may discuss future treatment choices early so decisions are not rushed.

Seek urgent help for severe breathlessness, chest pain, fainting, new confusion, very little urine, persistent vomiting or rapidly worsening swelling. Contact your kidney team promptly if you develop fever, diarrhoea, dehydration, a sudden change in urine or difficulty taking medicines. These problems can cause an abrupt decline in kidney function even when chronic disease had been stable.

Ask what your latest kidney tests show, how often they should be repeated, which medicines need dose adjustment and what dietary limits apply to you. Discuss anaemia treatment, blood-pressure targets, referral to a kidney specialist and how future care options will be explained.