This is the second article in a two part Continuing Education (CE) series on managing patients with Chronic Kidney Disease (CKD). The first CE article addressed the management of patients during CKD stages 1 to 3. This article will focus on the management of patients during CKD stages 4 to 5. Nephrology nurses and other healthcare professionals play an important role in the monitoring and management of the many physical symptoms that patients present with during stages 4 to 5. During these stages the healthcare team must provide psychological support along with educating patients and their families/carers regarding their treatment options including renal replacement therapy, conservative treatment and withdrawal of dialysis.