@vpgh9246 Wow, this goes back a few years. aP stands for Associated Puritis and deals with severe itching for some such as myself at that time who had itching throughout my face and back, and much worse at night, causing some sleepless nights. I remember going to urgent care, an allergist and then a dermatologist who gave me an RX for Gabapentin, which cleared up the itching. If your husband has severe itching with Stage 4, talk to your nephrologist first, and if needed, follow up with my mentioned steps. I have found, like many others on this forum, for many years, a good habit to follow at any stage, is diet, exercise, and water. Get a baseline marker with your husband's nephrologist and stay close to that marker with your continuous lab work. My own personal opinion at stage 4 is to get a true kidney function test at any of the 3 Mayo Clinics or other educational research hospitals and get tested for iothalamate or iohexol exams, only because one kidney may be functioning better than the other, and your nephrologist may have some options. Obviously, I wish the best outcomes for your husband, you, and your family.