Stage 4 Kidney Disease: eGFR & Creatinine
Defined by eGFR 15–29 — G4.
Medically reviewed by Dr. Rishi Kumar Kafle, MBBS, MD, FASN · Last reviewed June 2026
Stage 4 chronic kidney disease is defined by an eGFR of 15–29 mL/min/1.73m² (category G4) — severely decreased kidney function. It is not defined by a single creatinine value.
What Stage 4 Means
At stage 4, filtration is severely decreased. Kidney function is low enough that planning for later treatment usually begins, and care is typically shared with a kidney specialist (nephrologist).
Stage 4 is serious but not an emergency by itself. With specialist care, the pace of change can often be slowed, and there is time to plan ahead calmly.
Where Stage 4 Sits
The five CKD stages run from G1 (best filtration) to G5 (kidney failure). Stage 4 corresponds to category G4, with an eGFR of 15–29 mL/min/1.73m². The scale below shows how it compares with the other stages — see all of them side by side on the CKD stages page.
| Stage | eGFR range | This page |
|---|---|---|
| Stage 1 (G1) | ≥ 90 | |
| Stage 2 (G2) | 60–89 | |
| Stage 3 (G3a/G3b) | 30–59 | |
| Stage 4 (G4) | 15–29 | You are here |
| Stage 5 (G5) | < 15 |
Why eGFR, Not a Single Creatinine
Stage 4 is defined by eGFR, not by a raw creatinine value, because creatinine varies with muscle mass, age, and sex. The same creatinine reading can reflect very different kidney function in a young, muscular person and an older, smaller adult. eGFR adjusts for these factors and standardises the result to an average-sized body, so it places everyone on the same scale. That is why staging — including category G4 — uses eGFR rather than the creatinine number on its own.
How Albuminuria Refines the Picture
The stage describes filtration, but risk also depends on how much albumin is leaking into the urine. A urine albumin-to-creatinine ratio sorts this into A1 (under 30 mg/g), A2 (30–300 mg/g), or A3 (over 300 mg/g). Two people both at stage 4 can sit at quite different risk depending on their albuminuria — which is why the KDIGO heat map grades risk by combining the GFR category with the albuminuria category rather than using either alone.
How Stage 4 Is Confirmed
A diagnosis of stage 4 chronic kidney disease is not made from a single blood test. The eGFR has to stay in the G4 range for at least three months before it counts as CKD, because filtration can dip for short-term reasons — dehydration, a recent illness, or a new medicine — and then recover. So a first result in the stage 4 range usually leads to a repeat test rather than an immediate diagnosis. If the value holds, your clinician confirms the stage and pairs it with an albuminuria category to complete the picture. This three-month rule is the same across every stage and is what separates lasting kidney disease from a temporary change.
Symptoms at Stage 4
Many people at stage 4 feel completely well and have no symptoms — the change is found on a routine blood test rather than because something feels wrong. When symptoms do appear in chronic kidney disease, they tend to come only at lower filtration levels and can include tiredness, swelling in the legs or around the eyes, changes in how much urine is passed, or poor appetite. Because these signs are non-specific and have many possible causes, they are not used to judge the stage on their own. The absence of symptoms does not rule out CKD, which is exactly why the eGFR blood test matters. Any new or worsening symptom is best discussed with your clinician rather than self-assessed.
Tracking Stage 4 Over Time
A stage is a snapshot, but kidney care is about direction. What matters most is whether your eGFR is holding steady or slipping over months to years. A value that stays put within stage 4 is reassuring, even at a lower stage, while one that is falling prompts a closer look and may lead to a change in management. Your clinician usually reviews a series of results — eGFR together with albuminuria, blood pressure, and any underlying cause such as diabetes — rather than reacting to one reading. Keeping a record of your past values and comparing each new result against the normal range is the most useful thing you can do with the number.
What to Do Next
At stage 4, care usually focuses on specialist follow-up, careful medication review, managing complications such as anaemia or bone health, and preparing for treatment options for the future.
- Confirm the eGFR is sustained over at least three months before it is called CKD.
- Check albuminuria with a urine albumin-to-creatinine ratio, which refines risk.
- Review medications that may need dose adjustment as filtration falls.
- Track the trend over time — a stable value is reassuring, while a falling one prompts a closer look.
- Discuss the result with your clinician alongside your age and overall health.
A single reading rarely tells the whole story. If your most recent eGFR was below range, see what a low eGFR means, and remember that staging reflects a sustained value rather than one test.