End stage renal disease (ESRD) – Kidney Care Center

End-stage renal disease (ESRD)

Overview

End-stage kidney disease, alternatively known as end-stage renal disease or kidney failure, emerges when the progressive decline in kidney function, characteristic of chronic kidney disease, reaches an advanced phase. In this advanced stage of renal disease, the kidneys cease to effectively perform their vital role in meeting the body’s requirements.

The most crucial function of your kidneys is to filter out waste products and surplus fluids from your bloodstream, which are then eliminated through urine. However, in the absence of proper kidney function, there is a risk of dangerous accumulation of electrolytes, fluids, and waste materials within the body.

In the presence of end-stage renal disease, essential interventions such as dialysis or kidney transplantation become necessary for sustaining life. Nonetheless, an alternative option is available in the form of conservative care, which focuses on symptom management and seeks to optimize the quality of life for the duration that remains.

Symptoms

During the early stages of CKD (chronic kidney disease), noticeable symptoms might be absent. As chronic kidney disease advances towards the end-stage renal phase, indications and manifestations that could arise encompass:

Loss of appetite
Nausea and Vomiting
Fatigue and weakness
Changes in the amount and frequency of urination
Chest pain due to the build-up of fluid around the lining of the heart
Breath shortness due to fluid buildup in the lungs
Swollen feet and ankles
Hypertension (high blood pressure) that is difficult to control
Decreased mental sharpness
Headaches
insomnia or difficulty in sleeping
Cramps and muscle pull

Continuous itching
Metallic taste

Indications and manifestations of kidney disease frequently lack specificity, implying that they can also be attributed to other health conditions. Since the kidneys possess a compensatory ability to compensate for diminished function, noticeable signs and symptoms might remain absent until irreversible harm has transpired.

Causes

The onset of kidney disease takes place when an ailment or circumstance hampers the proper functioning of the kidneys, leading to a gradual deterioration of kidney health over the span of several months or years. In some cases, the progression of kidney damage still continues even after the underlying health condition is resolved. Conditions and diseases that can lead to kidney disease include:

Type 1 or type 2 diabetes
High blood pressure
Autoimmune diseases
Kidney stones
Glomerulonephritis — an inflammation of the kidney’s filtering units (glomeruli)
Polycystic kidney disease or other inherited kidney diseases
Interstitial nephritis is an inflammation of the kidney’s tubules and surrounding structures
Long-term obstruction of the urinary tract can occur due to conditions such as an enlarged prostate, kidney stones, and certain types of cancers.
Vesicoureteral reflux is a condition characterized by the backward flow of urine from the bladder into the kidneys.
Pyelonephritis (Recurrent kidney infection)

Risk Factors

Several factors contribute to an elevated likelihood of the accelerated progression of chronic kidney disease towards end-stage renal disease. These factors encompass:

Uncontrolled diabetes, with improper regulation of blood sugar levels, is a condition that impacts the glomeruli, which are the kidney structures responsible for filtering wastes from the blood.

Polycystic kidney disease
Other kidney diseases that are inherited
High blood pressure
Tobacco use
Asian, Black, Hispanic, Pacific Islander, or American Indian heritage
Family history of kidney failure
Old age
Intake of medicines that cause kidney damage

Complications

Once kidney damage takes place, it cannot be reversed. Potential complications may impact nearly any bodily system and include:

Retention of fluids, potentially resulting in swelling in the limbs, elevated blood pressure, or accumulation of fluid in the lungs (pulmonary edema)
Sudden elevation of potassium levels in the bloodstream (hyperkalemia), which could impede the heart’s functionality and pose a life-threatening risk
Cardiovascular ailments
Weakened bones and heightened susceptibility to bone fractures
Anemia
Decreased libido, erectile dysfunction, or reduced fertility
Impairment of the central nervous system, leading to difficulties in concentration, alterations in personality, or seizures
Reduced immune response, rendering the individual more susceptible to infections
Pericarditis, that is a inflammation of the protective sac surrounding the heart

Complications during pregnancy that pose hazards for both the mother and the developing fetus
Malnourishment
Irreparable harm to the kidneys culminating in end-stage kidney disease, ultimately necessitating dialysis or a kidney transplant for survival.

Diagnosis and Tests

Individuals diagnosed with chronic kidney disease typically seek care from a specialized physician known as a nephrologist. Your healthcare provider takes the following tests:

Blood tests are conducted to quantify waste products like creatinine and urea in your bloodstream.
Urine tests are employed to evaluate the presence of protein albumin in your urine. 
Imaging tests,  like ultrasound, MRI, or CT scans, are utilized to assess kidney health and detect any anomalies.
Removing a sample of kidney tissue (biopsy), involving the extraction of kidney tissue for microscopic analysis, may be performed to determine the specific kidney disease type and extent of damage.

These tests may be periodically repeated to enable your healthcare provider to monitor the progression of your kidney disease.

Stages of Kidney Disease

There are five stages of kidney disease. To ascertain the specific stage of the condition, your healthcare provider conducts a blood test aimed at evaluating your glomerular filtration rate (GFR). This metric quantifies the volume of blood that your kidneys filter within a minute and is expressed in milliliters per minute (mL/min). A decrease in GFR corresponds to a decline in kidney functionality.

When your kidneys reach a point where they are no longer able to sustain life, it’s termed end-stage renal disease. Typically, this condition arises when kidney function drops below 15% of normal kidney function. As part of the staging process for kidney disease, your healthcare provider may also assess the presence of protein in your urine.

Kidney disease stage

GFR, mL/min

Kidney function

Stage 1

90 or above

Healthy kidney function

Stage 2

60 to 89

Mild loss of kidney function

Stage 3a

45 to 59

Mild to moderate loss of kidney function

Stage 3b

30 to 44

Moderate to severe loss of kidney function

Stage 4

15 to 29

Severe loss of kidney function

Stage 5

Less than 15

Kidney failure

Source: National Kidney Foundation

Treatment and Medication

End-stage renal disease treatments include:

Kidney transplant
Dialysis
Supportive care

Kidney transplant:

A kidney transplant involves a surgical procedure where a healthy kidney is implanted from either a living or deceased donor into an individual whose own kidneys are no longer operating effectively. This procedure is often chosen as the preferred treatment for end-stage renal disease, in contrast to a lifetime dependent on dialysis.

The journey toward a kidney transplant is a process that requires time. It encompasses the search for a suitable donor, whether living or deceased, whose kidney closely matches the recipient’s. Subsequently, a surgical operation is performed to place the new kidney in the lower abdominal region, connecting the blood vessels and ureter – the tube connecting the kidney to the bladder – to enable the new kidney’s functionality.

Following the surgery, a hospital stay of several days to a week might be necessary. Regular follow-up appointments become part of your routine to monitor your recovery progress upon discharge. You may be prescribed various medications to prevent rejection of the new kidney and minimize the risk of post-surgery complications, such as infections.

Upon a successful kidney transplant, the newly transplanted kidney assumes the role of filtering your blood, eliminating the need for ongoing dialysis treatments.

Dialysis:

Dialysis serves to supplement the function of your kidneys when they are unable to perform their tasks adequately. It involves tasks such as eliminating excess fluids and waste products from your bloodstream, restoring electrolyte balance, and assisting in regulating blood pressure. Dialysis options encompass peritoneal dialysis and hemodialysis.

Peritoneal dialysis. During peritoneal dialysis, the blood vessels within your abdominal lining, known as the peritoneum, take on the role of your kidneys with the assistance of a fluid that cycles in and out of the peritoneal space. This form of dialysis is conducted within the comfort of your home.
Hemodialysis. Hemodialysis involves a machine that aids in kidney function by filtering out harmful waste, salts, and excess fluid from your blood, performing a task akin to your kidneys. Hemodialysis can be administered at a designated center or in your own residence. Lifestyle adjustments may be necessary for successful dialysis, including adhering to specific dietary guidelines.

Palliative care:

 If you opt not to undergo a kidney transplant or dialysis, palliative or supportive care is an alternative route to managing symptoms and enhancing your well-being. Palliative care can also complement kidney transplants or dialysis. Without either treatment option, kidney failure advances and can eventually lead to death. The timeline for this progression varies, potentially occurring swiftly or over months to years. Supportive care encompasses symptom management, measures to ensure comfort and end-of-life planning.

Prevention

As part of your kidney disease treatment, your healthcare provider might suggest a specialized diet to ease the strain on your kidneys and support their function. Consulting a registered dietitian with expertise in kidney disease can provide insight into modifying your diet for kidney health. Based on your circumstances, kidney function, and overall well-being, your dietitian may recommend the following:
Avoid products with added salt. Reducing sodium intake by avoiding products containing added salt, such as convenience foods, canned soups, and fast food. Salted snacks, canned vegetables, processed meats, and cheeses should also be limited.
Choose lower potassium foods. Choosing lower-potassium foods during meals. High-potassium foods like bananas, oranges, potatoes, spinach, and tomatoes should be moderated. Opt for low-potassium alternatives like apples, cabbage, carrots, green beans, grapes, and strawberries. Be cautious of salt substitutes containing potassium, which are generally unsuitable for individuals with kidney failure.
Limit your protein. Controlling protein consumption based on the daily grams estimated by your dietitian. High-protein sources like lean meats, eggs, milk, cheese, and beans should be balanced. Conversely, low-protein options like vegetables, fruits, bread, and cereals are encouraged.

Prognosis

While healthcare providers cannot cure kidney failure, they can manage its life-threatening nature. Dialysis or a kidney transplant can extend your life span, address symptoms, and manage complications, enabling you to continue enjoying your preferred activities.