Managing Stage 4 Chronic Kidney Disease in a 55-Year-Old: The Power of Early Intervention and Long-Term Care

Understanding a Real-World Case of Advanced Kidney Disease

In the realm of chronic disease management, early detection and consistent care can make all the difference. This article explores the journey of a 55-year-old male diagnosed with stage 4 chronic kidney disease (CKD), highlighting how timely medical intervention, combined with disciplined lifestyle adjustments, led to stabilized health outcomes. While personal details have been anonymized for privacy, the clinical insights remain valuable for patients and caregivers navigating similar challenges.

Patient Profile at a Glance

Age & Gender: 55-year-old maleDiagnosis: Stage 4 Chronic Kidney Disease with comorbiditiesHospital: Peking University People's HospitalDate of Admission: December 2021Treatment Plan: Multidrug regimen including Roxadustat capsules, Furosemide tablets, Spironolactone, Arotinolol hydrochloride, Benidipine hydrochloride, Doxazosin mesylate sustained-release tablets, and Compound α-Ketoacid tabletsDuration: Two-week inpatient treatment followed by ongoing outpatient monitoringOutcome: Significant improvement in lab markers, controlled blood pressure and glucose levels, reduced edema, and overall stabilization of renal function

Initial Assessment: Recognizing the Warning Signs

The patient presented with a complex medical history spanning two decades. He had been living with type 2 diabetes for 20 years, during which time he developed diabetic retinopathy—confirmed via fundus fluorescein angiography—and underwent laser surgery due to retinal hemorrhage. Two years prior to this visit, routine urinalysis revealed proteinuria (0.72g/day), and his serum creatinine was mildly elevated at 61 µmol/L.

Progression of Symptoms Leading to Diagnosis

Six months before admission, his condition worsened: serum creatinine rose to 110 µmol/L, albumin dropped to 29 g/L, and urine tests showed +++ protein. A kidney biopsy confirmed diabetic nephropathy. In the month leading up to hospitalization, swelling in both lower limbs intensified significantly, accompanied by severe hypertension reaching 200/110 mmHg. Upon evaluation, we identified long-standing hypertension and diabetes as key contributors to his declining kidney function. Given the severity of symptoms and lab results, a diagnosis of stage 4 CKD was established—a critical point where proactive management becomes essential to delay progression to end-stage renal disease.

Comprehensive Treatment Strategy: Addressing Multiple Complications

Upon admission, comprehensive blood work revealed alarming imbalances: serum albumin had plummeted to 23.9 g/L, potassium levels were low at 2.94 mmol/L, and creatinine soared to 284 µmol/L. Estimated glomerular filtration rate (eGFR) was only 20.57 mL/min/1.73m²—well below normal—indicating severely impaired kidney function. Additionally, 24-hour urinary protein excretion reached 16.64 g/day, signaling massive protein loss, while generalized edema and uncontrolled hypertension posed immediate risks.

Targeted Therapeutic Interventions

To address these complications systematically, a multi-pronged pharmacological approach was implemented:

• Anemia Management: Roxadustat capsules were introduced to stimulate erythropoiesis, addressing anemia commonly seen in advanced CKD due to decreased erythropoietin production.
• Fluid Overload Control: Strict sodium and fluid restriction was enforced, along with a dual diuretic strategy using Furosemide and Spironolactone to manage volume overload and reduce peripheral edema.
• Blood Pressure Optimization: Hypertension, largely driven by fluid retention, was managed with a combination of Arotinolol (beta-blocker), Benidipine (calcium channel blocker), and Doxazosin (alpha-blocker) to achieve target BP without overburdening the kidneys.
• Nutritional Support: Compound α-Ketoacid tablets were prescribed to improve nitrogen balance, support protein metabolism, and reduce uremic toxin buildup—critical for preserving remaining kidney function.

Measurable Improvements After Two Weeks of Care

After two weeks of structured inpatient therapy, the patient demonstrated marked clinical improvements. Edema resolved significantly under strict dietary control and diuretic use. Blood pressure stabilized within the ideal range—systolic readings consistently between 130–140 mmHg and diastolic between 80–90 mmHg. Laboratory parameters also trended positively: albumin levels began to recover, electrolyte imbalances corrected, and proteinuria showed signs of reduction.

With stable vitals and improved biochemical profiles, the patient was discharged with clear follow-up instructions. Bone metabolism markers remained within acceptable limits, suggesting no acute secondary hyperparathyroidism or mineral bone disorder flare-up—an important consideration in late-stage CKD.

Ongoing Care: Essential Guidelines for Sustained Health

While short-term outcomes are encouraging, long-term success depends on adherence to several key practices:

1. Prioritize Rest and Prevent Illness

Avoid physical exhaustion, exposure to cold environments, and potential infections. Even minor illnesses can trigger inflammatory responses that strain compromised kidneys. Also, steer clear of known nephrotoxic agents, including certain antibiotics, NSAIDs, and contrast dyes unless absolutely necessary and under supervision.

2. Monitor Vital Health Metrics Regularly

Patients should track daily blood pressure and blood glucose readings, especially given the dual burden of diabetes and hypertension. Monitoring weight fluctuations, urine output, and any recurrence of swelling helps detect fluid retention early. Adherence to a low-sodium, low-fat, high-quality protein diet tailored for diabetics is crucial—not just for kidney protection but also for cardiovascular health.

3. Maintain Medication Compliance

Do not alter dosages or discontinue medications without consulting a healthcare provider. Each drug plays a specific role in managing anemia, fluid balance, blood pressure, and metabolic stability. Skipping doses or self-adjusting prescriptions can reverse progress rapidly.

4. Adopt a Kidney-Friendly Diet

Focus on whole grains, lean proteins, fresh vegetables, and low-glycemic fruits. Avoid processed foods, fried items, sugary beverages, and high-fat snacks that exacerbate insulin resistance and promote inflammation. Working with a registered dietitian experienced in renal nutrition can provide personalized meal planning support.

Clinical Reflections: Why Prevention and Persistence Matter

This case underscores a vital truth: even at stage 4 CKD, meaningful interventions can halt or slow disease progression. While the patient's kidney function cannot be fully restored, proper management has created a window of opportunity to preserve quality of life and delay dialysis.

The Role of Holistic Patient Engagement

Beyond medication, patient education and empowerment are foundational. Follow-up visits should never be viewed merely as opportunities to refill prescriptions. Instead, they must serve as dynamic check-ins where clinicians assess evolving needs—adjusting medications based on eGFR trends, electrolyte panels, hemoglobin levels, and nutritional status.

Equally important is addressing root causes. For diabetic patients, tight glycemic control remains one of the most effective ways to protect kidney function. Similarly, maintaining optimal blood pressure reduces intraglomerular pressure, minimizing further damage to delicate filtration units.

In conclusion, managing advanced chronic kidney disease requires more than reactive treatment—it demands a proactive, integrated strategy combining medical science, nutritional guidance, and behavioral change. With consistent care, many patients can live fuller, healthier lives despite significant diagnoses.