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Management of Stage 4 CKD eGFR 15 - 29

Usually, these patients will be under joint care, or will have been discussed with the Renal unit and a treatment plan decided.
 Routine follow up options would include blood test for Renal profile and FBC every 3 to 6 months 

General management as for Management Stage 3 CKD

The main tasks are monitoring for any deterioration in eGFR and treatment of complications and preparation for dialysis where appropriate.

  • Change in eGFR - 3 monthly check on eGFR (ask for Renal profile on blood form)
  • Strict control of blood pressure
  • Monitor anaemia - 3 monthly check on Hb - EPO may be indicated if Hb < 11g/dl
  • Control of acidosis - sodium bicarbonate may be recommended by renal unit

Monitor Calcium, Phosphate and PTH - secondary hyperparathyroidism is common and is managed by phosphate binding agents, diet advice and vitamin D analogues under renal unit advice

Regular medication review to ensure appropriate to renal function, and avoidance of nephrotoxic agents

Download Management Guidelines CKD Stage 4


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