<s>[INST] My mum suffer of CKD,stage 4, she is diabetic,high pressure and I would like to know,if I give her baking soda with a bit of water will make her worst or better. I dont want my mother to get to stage 5. Only 20% of her kidney is working. She has anemia, she is pale. I would like to know if I controller her with a good diet she will be ok. Do You think she will need to get ready for dialysis or doesn't needed at this stage. What can she eat? [/INST] Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Your mother is at stage 4 CKD and looking at her condition it does not seems that she will need dialysis any time soon. Yes you can give her baking soda as in CKD the body is in acidic condition and baking soda will lower the acidosis in body. You need to take care of certain things to avoid going her into stage 5. You need to avoid certain food items like potatoes, tomatoes, green leafy vegetables, and brinjal. You need to avoid nephrotoxic drugs most commonly NSAIDs. You need to keep her blood pressure and sugar levels in control even after doing all this there is still chances of her going into stage 5. Hemodialysis has certain indications which include urea levels above 200 causing uremic encephalopathy, very high potassium levels, fluid overload, severe acidosis. If she developed any of these conditions she might end up on dialysis. Hope I have answered your query. Let me know if I can assist you further. </s>