In the late stage of CKD (3b, 4 and 5) the functioning of your kidneys is severely reduced

Due to your kidneys’ loss of ability to perform all their important functions excess body water and waste products build up in your blood. This is called uraemia. 


In this late stage of CKD, it is important to do everything to slow down the progression through to complete kidney failure. If the kidney fails, that means if the function of the kidney is reduced to less than about 10 to 15% of the normal kidney function, the loss must be replaced by dialysis or a kidney transplant. The exact GFR when to start dialysis depends on many factors (e.g. underlying kidney disease, malnutrition, uraemic symptoms etc.). Please follow your doctor’s advice.

Stage 3b CKD

Stage 3 CKD is divided into stage 3a and stage 3b. Stage 3b belongs to the late stage of CKD. A person with stage 3b CKD has moderate kidney damage and the GFR is at 30-44 ml/min.

Common symptoms that can appear in this CKD stage can include low blood count, malnutrition, bone pain, tingling or numbness of nerves, difficulties in concentrating and a generally reduced sense of well-being.

Stage 4 CKD

At stage 4 CKD, the kidney has advanced damage leading to a GFR of only 15-30 ml/min. In addition to the symptoms mentioned before, some of the most common symptoms in stage 4 CKD are bone disease, restless legs, itchy skin and anaemia. Anaemia means that you have a shortage of red blood cells which can cause fatigue, difficulties when trying to concentrate, loss of appetite, swelling, especially in the legs and around the eyes, shortness of breath and pale skin. 

Stage 5 CKD

A person with stage 5 CKD has kidney damage resulting in a decreased GFR of 15 ml/min or less. The kidneys have lost almost all their ability to work efficiently. Eventually, the kidney disease has reduced the kidneys’ functions to a level where a replacement therapy becomes necessary.

What should I know?

In the late stage of CKD, you and your doctor will try everything to slow down the progression through to complete kidney failure. The right diet and treatment are more important than ever.

CKD Nutrition

In addition, you should start thinking about renal replacement therapy; learn about the different options you have early enough to allow sufficient time for the necessary preparations. There are three different treatment options available to replace some of the lost kidney function:

Kidney transplantation
Peritoneal dialysis

What can I do?

In order to delay renal replacement as long as possible, but to allow for all possibilities at the same time, you can do the following: 

  • See a nephrologist on a regular basis.
  • See your doctor if you encounter changes in your health (e.g. cold or flu-like symptoms, unusual, new or worsening symptoms).
  • Learn more about the different kidney replacement therapies and together with your doctor decide which one is the most suitable for you. Get started in time with the necessary preparations.
  • Take all your medications as prescribed by your doctor. They are very important for your health and well-being. Especially in case of diabetes and/or high blood pressure be in control and follow the prescribed treatments.
  • Adjust your diet (see a dietician for specific recommendations).
  • Stop smoking.
  • Reduce your alcohol intake.
  • Stay fit with regular physical exercises.
  • Learn about lifestyle changes to expect and ask questions.
  • Be an active participant in your kidney care.
Related topics

Find out how the kidneys remove excess body water and waste products 24 hours a day.

There are many clinics and hospitals that offer haemodialysis treatment.