Are you looking for a diet plan for stage 4 kidney disease? If you are then you are in the right place. The purpose of this article is to describe a diet plan for stage 4 kidney disease. It will also tell you what foods to avoid and which ones to eat. We all want to look good, feel good, and be healthy. And being healthy is achieved one step at a time. When you feel well, you are happy. A little weight loss will make you healthier, increase your confidence level and make other people notice you more as well.
What to Know About Stage 4 Kidney Disease
There are 5 stages of chronic kidney disease. In stage 4, you have severe, irreversible damage to the kidneys. However, there are steps you can take now to slow or prevent progression to kidney failure.
Continue reading as we explore:
- stage 4 kidney disease
- how it’s treated
- what you can do to manage your health
What is stage 4 kidney disease?
Stage 1 and stage 2 are considered early-stage chronic kidney disease. The kidneys aren’t working at 100 percent, but they still work well enough that you might not have symptoms.
By stage 3, you’ve lost about half of kidney function, which can lead to more serious problems.
If you have stage 4 kidney disease, it means your kidneys have experienced severe damage. You have a glomerular filtration rate, or GFR, of 15–29 ml/min. That’s the amount of blood your kidneys can filter per minute.
GFR is determined by measuring the amount of creatinine, a waste product, in your blood. The formula also takes age, sex, ethnicity, and body size into account. The kidneys are functioning at 15–29 percent of normal.
GFR may not be accurate in certain circumstances, such as if you:
- are pregnant
- are very overweight
- are very muscular
- have an eating disorder
Other tests that help determine the stage are:
- bloods tests to look for other waste products
- blood glucose
- urine test to look for the presence of blood or protein
- blood pressure
- imaging tests to check the structure of the kidneys
Stage 4 is the last stage before kidney failure, or stage 5 kidney disease.
What are the symptoms of stage 4 kidney disease?
In stage 4, symptoms may include:
- fluid retention
- fatigue
- lower back pain
- sleep problems
- increase in urination and urine that appears red or dark
What are the complications from stage 4 kidney disease?
Complications from fluid retention can include:
- swelling of the arms and legs (edema)
- high blood pressure (hypertension)
- fluid in the lungs (pulmonary edema)
If your potassium levels get too high (hyperkalemia), it can affect your heart’s ability to function.
Other potential complications include:
- heart and blood vessel (cardiovascular) problems
- inflammation of the membrane around your heart (pericardium)
- high cholesterol
- low red blood cell count (anemia)
- malnutrition
- weak bones
- erectile dysfunction, reduced fertility, lower sex drive
- difficulty concentrating, seizures, and personality changes due to damage to the central nervous system
- vulnerability to infection due to weakened immune response
If you’re pregnant, kidney disease can increase risks to you and to your baby.
What are the treatment options for stage 4 kidney disease?
Monitoring and managing
In stage 4 kidney disease, you’ll see your kidney specialist (nephrologist) often, usually once every 3 months to monitor your condition. To check kidney function, your blood will be tested for levels of:
- bicarbonate
- calcium
- creatinine
- hemoglobin
- phosphorus
- potassium
Other regular tests will include:
- protein in the urine
- blood pressure
- fluid status
Your doctor will review your:
- cardiovascular risk
- immunization status
- current medications
Slowing the progression
There’s no cure, but there are steps that can slow progression. This means monitoring and managing conditions such as:
- anemia
- bone disease
- diabetes
- edema
- high cholesterol
- hypertension
It’s important to take all your medications as directed to help prevent kidney failure and heart disease.
Deciding next steps
Because stage 4 is the last stage before kidney failure, your healthcare provider will talk to you about that possibility. This is the time to decide on the next steps should that happen.
Kidney failure is treated with:
- dialysis
- kidney transplantation
- supportive (palliative) care
The National Kidney Foundation recommends starting dialysis when kidney function is at 15 percent or less. Once function is less than 15 percent, you’re in stage 5 kidney disease.
Stage 4 kidney disease diet
Diet for kidney disease depends on other conditions, such as diabetes. Talk to your healthcare provider about diet or ask for a referral to a dietician.
In general, a diet for kidney disease should:
- prioritize fresh foods over processed products
- have smaller portions of meat, poultry, and fish
- involve moderate to no alcohol consumption
- limit cholesterol, saturated fats, and refined sugars
- avoid salt
Phosphorus levels can be too high or too low, so it’s important to go by your latest bloodwork. Foods that are high in phosphorus include:
- dairy products
- nuts
- peanut butter
- dried beans, peas, and lentils
- cocoa, beer, and dark cola
- bran
If potassium levels are too high, cut down on:
- bananas, melons, oranges, and dried fruit
- potatoes, tomatoes, and avocados
- dark leafy vegetables
- brown and wild rice
- dairy foods
- beans, peas, and nuts
- bran cereal, whole wheat bread, and pasta
- salt substitutes
- meat, poultry, pork, and fish
Be sure to discuss your diet at every appointment with your healthcare provider. You may have to make adjustments after reviewing your latest tests.
Talk to your healthcare provider about which, if any, dietary supplements you should take and whether or not you should change fluid intake.
Stage 4 kidney disease lifestyle changes
There are other lifestyle changes to help prevent further damage to your kidneys. These include:
- Not smoking, if you smoke. Smoking damages blood vessels and arteries. It increases the risk of clotting, heart attack, and stroke. If you have trouble quitting, talk to your healthcare provider about smoking cessation programs.
- Exercise. Aim to exercise 30 minutes a day, at least 5 days a week.
- Take all prescribed medications as directed. In addition to taking all prescribed medications, ask your healthcare provider before adding over-the-counter (OTC) medications or supplements.
- See your healthcare provider regularly. Be sure to report and discuss any new and worsening symptoms with your healthcare provider.
What’s the prognosis for stage 4 kidney disease?
There’s no cure for stage 4 chronic kidney disease. The goal of treatment is to prevent kidney failure and maintain a good quality of life.
In 2012, researchers found that men and women with low kidney function, especially less than 30 percent, had substantially reduced life expectancy.
They noted that women tend to have longer life expectancy in all stages of kidney disease except stage 4, where there’s only a slight difference by gender. Prognosis tends to be poorer with age.
- At 40 years old, life expectancy is about 10.4 years for men and 9.1 years for women.
- At 60 years old, life expectancy is about 5.6 years for men and 6.2 years for women.
- At 80 years old, life expectancy is about 2.5 years for men and 3.1 years for women.
Your individual prognosis also depends on co-existing conditions and what treatments you get. Your healthcare provider can give you a better idea of what to expect.
Key takeaways
Stage 4 kidney disease is a serious condition. Careful monitoring and treatment can help slow progression and potentially prevent kidney failure.
At the same time, it’s important to make preparation for dialysis or kidney transplant in the event of kidney failure.
Treatment involves managing co-existing health conditions and supportive care. It’s vital to see your kidney specialist regularly to monitor your condition and slow progression of the disease.
Stage 4 Kidney Disease Diet: Focusing on Nutrition
Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.
When you have stage 4 chronic kidney disease (CKD), your diet goals should help minimize symptoms and help you maintain adequate nutrient intake to prevent weight loss and malnutrition.
Kidney function is severely decreased in stage 4 CKD. Protein waste, toxins and minerals build up in the body and lead to uremia with symptoms such as nausea, vomiting, loss of appetite, abnormal taste, bad breath, nerve and sleep problems, difficulty concentrating and fatigue. Fluid retention due to a decrease in urine output may also occur.
Knowing your nutritional goals can help you have a better quality of life.
Protein and stage 4 CKD
On average, Americans consume 90 to 100 grams of protein a day, but our bodies only need about 46 (for women) to 56 grams (for men) of protein.
The Kidney Disease Outcome Quality Initiatives (K/DOQI) Nutrition Guidelines suggest that a protein intake of 0.6 grams per kg of body weight may be beneficial when glomerular filtration rate (GFR) drops below 25, or approximately 25 percent remaining kidney function. Half of your protein should come from high-quality sources that provide all the essential amino acids (e.g., eggs, milk, poultry, seafood, red meats, soy).
This lower-protein diet is thought to have a protective effect on the kidneys. However, it also brings the risk of protein malnutrition, with muscle wasting and low albumin levels. Ask your nephrologist or renal dietitian to calculate how much protein you should consume per day.
Phosphorus and stage 4 CKD
As kidney function decreases, phosphorus isn’t removed from your body efficiently and can build up in the blood. At the same time, calcium is not absorbed well from your food, leading to low blood levels. In response, parathyroid hormone (PTH) production increase and causes a release of calcium and phosphorus from your bones. The loss of calcium and phosphorus from your bones causes bones to weaken and the increase of phosphorus and calcium in your body can cause calcifications in your heart, blood vessels and other soft tissues within your body. Based on your lab results for phosphorus, calcium and PTH, your stage 4 CKD diet may include a phosphorus restriction of 800-1,000 mg daily.
Check food ingredient lists for any type of phosphorus additive (phosphoric acid, hexametaphosphate, triphosphate, etc.). Many beverages and processed foods have these additives.
Other high-phosphorus foods to limit include:
| Cheese | Chocolate |
| Ice cream | Legumes |
| Milk | Nuts |
| Seeds | Yogurt |
Potassium and stage 4 CKD
If kidneys aren’t able to remove enough potassium to maintain normal blood levels in stage 4 CKD, you will need to limit high-potassium foods. Your doctor may prescribe a potassium restriction of 2,000 to 3,000 mg a day. Some high-potassium foods to limit or avoid include:
| Avocado | Bananas |
| Cantaloupe and honeydew melon | Dried fruit |
| Legumes | Milk |
| Nuts and seeds | Oranges and orange juice |
| Potatoes | Pumpkin and winter squash |
| Tomato products (juices, sauces, paste) | Yogurt |
A high potassium level may also be related to angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) prescribed to reduce protein in the urine, potassium-sparing diuretics or other blood pressure management medications and your doctor may make medication changes.
Sodium and stage 4 CKD
Most kidney diets start with a goal of 1,500 to 2,000 mg per day or the amount recommended by your doctor or dietitian. The sodium recommendation for stage 4 CKD is 1,000-4,000 mg/day based on fluid balance, blood pressure and other diseases that may affect sodium requirements. The average American consumes 3,700 mg of sodium a day.
Calories and stage 4 CKD
When you make changes in your diet, your calorie intake may decrease, resulting in undesirable weight loss. Decreasing your protein intake alone can result in 200 to 400 fewer calories a day. Weigh yourself and track your weight weekly to see if you need more calories. Ask your dietitian to help with setting realistic weight goals depending on your current weight.
Fluid and stage 4 CKD
If you start to retain fluid in stage 4 CKD, you may need to limit the amount of liquids you consume. Signs of fluid retention include swelling in the feet, hands and face; sudden weight gain; shortness of breath; and high blood pressure. These symptoms may indicate decreased urine output as kidney function declines.
Stage 4 of Chronic Kidney Disease
Severe loss of kidney function, eGFR of 15–29
Stage 4 kidney disease occurs when your estimated glomerular filtration rate (eGFR) falls between 15–29, indicating a severe loss of kidney function. At this stage of chronic kidney disease (CKD), it’s important to manage your health as best you can to preserve kidney function and start planning ahead for potential treatments like a kidney transplant or dialysis. Seeing a kidney doctor (nephrologist) can help you learn about and compare options, so you can make treatment choices that are right for you.
Symptoms of stage 4 kidney disease
Many people do not experience symptoms of kidney disease until the later stages when kidney damage has occurred. Possible stage 4 kidney disease symptoms and signs include:
- Anemia
- Decreased appetite
- Bone disease
- Abnormal blood levels of phosphorous, calcium, or vitamin D
Steps to take at stage 4 kidney disease
- Follow a kidney-friendly diet—Learning how to eat well with kidney disease is key to keeping your kidneys working longer. If you’re not already working with a dietitian, ask your doctor or nephrologist for a referral. A dietitian can help you choose kidney-friendly foods and beverages.
- See a nephrologist—If you’re not already seeing a kidney doctor (nephrologist), ask your primary care doctor for a referral. A nephrologist specializes in kidney disease and is the most qualified to guide your CKD treatment. He or she will examine your lab tests, talk to you about managing your kidney health, and help you determine which treatment best fits your lifestyle. You’ll continue to see your regular doctor to monitor your overall health and any other existing conditions.
- Start building your support network—Reach out to people who care about you and can encourage you. Your family, friends, and doctor will want to support you and help you stay motivated.
- Learn about your potential treatment options—Now is a good time to start learning all you can about your potential treatment options in case of kidney failure. Ask your doctor about peritoneal dialysis, in-center or home hemodialysis, and a kidney transplant. It’s important to find a treatment option that best fits your lifestyle.
- Choose a dialysis access type—If you’re considering dialysis, talk to your doctor about your options for dialysis access and how to get your access placed.
Questions to ask your doctor about stage 4 kidney disease
- Which treatment option may be right for me?
There are several treatment options for kidney failure to consider, including a kidney transplant or home dialysis. Ask your doctor which option may best fit your lifestyle.- Kidney transplant
The closest thing to natural kidney function and considered the most effective option for ESRD. With a kidney transplant you receive a new, healthy kidney from a living or deceased donor. - Dialysis
This life-extending treatment option helps remove unwanted toxins, waste products, and excess fluids from the body by filtering your blood.
- Kidney transplant
- Am I eligible for a kidney transplant?
Talk to your doctor about whether or not kidney transplant surgery is right for you. A successful kidney transplant is the closest to natural kidney function and considered the most effective treatment for kidney failure. - What should I know about dialysis access types?
Your access is the location on your body where dialysis equipment can be connected to your bloodstream (for hemodialysis) or peritoneum (for peritoneal dialysis). Choosing your dialysis access early may give you more placement options.
How to follow a kidney-friendly diet with stage 4 kidney disease
One of the best ways to keep your kidneys working longer is to follow a kidney-friendly diet. A healthy stage 4 kidney disease diet may involve limiting or monitoring your intake of:
- Protein
- Potassium
- Phosphorus
- Sodium
- Fluids
Your level of kidney function and individual lab tests will determine your dietary needs. Talk to a renal dietitian about what foods you should eat. He or she will help you plan kidney-friendly meals that you’ll enjoy eating.
Stage 4 kidney disease life expectancy
Stage 4 kidney disease life expectancy depends on a number of factors, including your age at the time of diagnosis, your other medical conditions, and your individual treatment plan. While there’s no cure for kidney disease and any kidney damage that has occurred can’t be reversed, you can take action now to help preserve kidney function and slow the progression of CKD. Looking after your health and eating a kidney-friendly diet can also help you feel your best.
Renal Diet Basics
When you eat and drink, your body absorbs nutrients needed for fuel. Anything it doesn’t need is carried through the blood to the kidneys. The kidneys filter out excess nutrients and make urine. If you have kidney disease, some nutrients can build up and damage your kidney. A renal diet can help protect you from kidney damage.
What type of food plan should I follow if I have kidney disease?
People with kidney disease may need to control these important nutrients: sodium, potassium and phosphorus. Please discuss your specific and individual diet needs with your healthcare provider or the registered dietitian at your dialysis center. Here are some tips to follow for a renal diet.
What should I know about sodium and salt if I follow a renal diet?
Sodium is a mineral found in salt (sodium chloride). It’s widely used to prepare foods.
Salt is one of the most commonly used seasonings. It’ll take time for you to get used to reducing the salt in your diet. However, reducing salt/sodium is an important tool in controlling your kidney disease.
Here are some suggestions.
- Don’t use salt when cooking food.
- Don’t put salt on food when you eat.
- Learn to read food labels. Avoid foods that have more than 300mg sodium per serving (or 600mg for a complete frozen dinner). Avoid foods that have salt in the first four or five items in the ingredient list.
- Don’t eat ham, bacon, sausage, hot dogs, lunch meats, chicken tenders or nuggets, or regular canned soup. Only eat reduced-sodium soups that don’t have potassium chloride as an ingredient (check the food label.) Also, only eat 1 cup, not the whole can.
- Choose only canned vegetables that say “no salt added” on the label.
- Don’t use flavored salts such as garlic salt, onion salt, or seasoned salt. Don’t use kosher or sea salt.
- Be sure to look for lower salt or no salt added options for your favorite foods such as peanut butter or box mixes.
- Don’t purchase refrigerated or frozen meats that are packaged in a solution or those that have been flavored or pre-seasoned. These items can include boneless chicken and bone-in chicken pieces, turkey breast, whole turkeys, steaks, roasts, burgers, pork tenderloin and pork chops.
What should I know about potassium if I follow a renal diet?
Potassium is a mineral involved in how muscles work. When your kidneys don’t work properly, potassium builds up in your blood. This can cause changes in how your heart beats and possibly even lead to a heart attack.
Potassium is found mainly in fruits and vegetables, as well as milk and meats. You’ll need to avoid certain fruits and vegetables and limit the amount of others.
Potassium-rich foods to avoid
These include:
- Melons such as cantaloupe and honeydew. (Watermelon is OK.)
- Bananas.
- Oranges and orange juice.
- Avocado.
- Prune juice.
- Tomatoes, tomato sauce and tomato juice.
- Dried beans — all kinds.
- Pumpkin and winter squash.
- Cooked greens, spinach, kale, collards and Swiss chard.
- Broccoli and Brussels sprouts.
- Nuts and nut butters.
You should also avoid:
- Bran cereals and granola.
- Salt substitutes or “lite” salt.
- Molasses.
Canned fruits
Canned fruits usually have lower amounts of potassium than fresh ones. Be sure to pour off the juice before you eat the fruit.
Potatoes and sweet potatoes
Potatoes and sweet potatoes need special handling to allow you to eat them in small amounts. Peel them, cut them into small slices or cubes and soak them for several hours in a large amount of water.
When you’re ready to cook them, pour the soaking water off and use a large amount of water in the pan. Drain this water before you prepare them to eat.
What should I know about phosphorus in my diet if I follow a renal diet?
Phosphorus is another mineral that can build up in your blood when your kidneys don’t work properly. When this happens, calcium can be pulled from your bones and can collect in your skin or blood vessels. Bone disease can then become a problem, making you more likely to have a bone break.
Tips to limit phosphorus in your diet
Dairy foods are the major source of phosphorus in the diet, so limit milk to 1 cup per day. If you use yogurt or cheese instead of liquid milk, have only one container of yogurt or 1.5 ounces of cheese per day.
Some vegetables also contain phosphorus. Limit these to 1 cup per week:
- Dried beans.
- Greens.
- Broccoli.
- Mushrooms.
- Brussels sprouts.
Certain cereals should be limited to 1 serving per week. These are:
- Bran.
- Wheat cereals.
- Oatmeal.
- Granola.
White or Italian bread and low-salt crackers made with white flour have less phosphorus than whole-grain bread and crackers.
Soft drinks contain phosphorus, so only drink clear ones. Don’t drink Mountain Dew® (any kind), colas, root beers, Dr.Pepper® (any kind). Also, avoid Hawaiian Punch®, Fruitworks®, Cool® iced tea, and Aquafina® tangerine pineapple.
Beer also has phosphorus. Avoid all kinds.
A note from Cleveland Clinic
We all need to pay attention to what we eat. If you have kidney disease, following a renal diet gives you more control over how you feel. Work with your providers and dietitian because you’re the most important part of your healthcare team.