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
If in any doubt then consider e-Advice