What Is End-Stage Kidney Disease?

Your kidneys are two bean-shaped organs that sit on either side of your spine in your lower back. These organs are responsible for filtering waste products out of your blood. Then, they send that waste to the bladder for elimination through your urine. The kidneys can become damaged through injury or illness, reducing their ability to filter the blood effectively.

Kidney disease is a condition in which your kidneys are not working as well as they should.

Kidney disease has five stages, progressing in severity from stage 1 through stage 5. Stage 5 kidney disease means the kidneys are barely functioning or may not be functioning at all. Stage 5 is also known as end-stage kidney disease or end-stage kidney failure.

While it's possible to live a healthy and active life with only one kidney, having two non-functioning kidneys is life-threatening.  Learn about the stages of kidney disease, what symptoms to expect in end-stage kidney failure, and treatment options available that may help prolong life. 

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What are the stages of kidney disease?

Kidney disease is a medical condition in which your kidneys cannot filter your blood effectively. Many factors may cause kidney disease, but two of the most common causes are diabetes and high blood pressure. Kidney disease may also result from additional health conditions, like repeated urinary tract infections, lupus, an enlarged prostate, renal stones, and others. 

Kidney disease can be either acute or chronic. Acute kidney disease¹ happens when the kidneys fail in fewer than seven days. Chronic kidney disease occurs over time as your kidneys gradually lose their ability to filter the blood.

While it's not possible to reverse kidney damage, treatments may help slow the progression of the disease and help you retain some of your kidney function. Chronic kidney disease affects around 37 million Americans.²

Many people in the beginning stages of kidney disease aren't aware of their condition. A doctor may discover it during routine blood tests, even without symptoms. In later stages, symptoms become more apparent as the kidneys lose their ability to filter the blood or stop working altogether. As the disease progresses, people with kidney disease may start to notice symptoms such as: 

  • Feeling more tired than normal

  • Experiencing dry and itchy skin

  • Needing to pass urine more often than normal

  • Passing urine that is bloody or foamy

  • Swelling in the lower extremities

  • Loss of appetite

These symptoms may become worse as kidney function declines. Kidney disease has five stages, defined by how well the kidneys work. Kidney disease may not progress to the later stages if diagnosed and treated early. Doctors measure your kidney function with an estimated glomerular infiltration rate (eGFR) blood test.³

This test rates your kidneys’ functioning compared to how well your doctor expects them to perform based on age, sex, and general health. With this blood test, your doctor can determine which stage of kidney disease you are experiencing: 

Stage 1

  • eGFR of 90 or higher

  • The kidneys work nearly as well as they would under healthy circumstances, with few or no symptoms.

Stage 2 

  • eGFR between 60 and 89

  • There is mild kidney damage, but they can still filter blood. Some symptoms may be evident. 

Stage 3 

This stage is broken down into two substages: 

Stage 3a

  • eGFR between 45 and 59

  •  There is mild to moderate kidney damage, with some noticeable symptoms such as feeling tired or blood in the urine. 

Stage 3b

  • eGFR between 30 and 44

  • The symptoms may start to become more apparent as moderate to severe kidney damage occurs. 

Stage 4

  • eGFR between 15 and 29

  • Damage to the kidneys is now severe, and they may be close to failing.

Stage 5

  • eGFR is less than 15

  • Kidney damage is severe, and the kidneys may not work at all during this stage.

Stage 5 is also known as an end-stage renal disease (ESRD) or end-stage kidney disease (ESKD).

What happens when the kidneys fail completely?

Kidney failure is the final stage of kidney disease. Because there is no way of reversing kidney damage, you’ll need to work with your doctor to create a treatment plan.

Recommended treatments involve replacing the function of your kidneys with dialysis or switching your kidney with a healthy one through a kidney transplant.

The kidney's primary function is to filter waste out of your blood. During kidney failure, the organs can no longer perform this vital function. As a result, waste and excess fluids build up in the system, leading to fatigue and swelling of the feet and ankles.

The longer the waste builds up in the body, the more severe the symptoms become. Eventually, the body may have unsafe levels of waste that can become life-threatening.

Your doctor can help you develop a care plan to treat some of the symptoms caused by kidney failure. Renal failure will result in death within a few weeks without additional treatment. You will need to pursue dialysis or transplant options to prolong your life.

What are the treatment options for kidney failure?

When you experience kidney failure, you'll work with a nephrologist, a doctor specializing in kidney care. They will help you determine the best course of action to take during end-stage kidney disease. Standard treatment options include dialysis and a kidney transplant.

However, neither treatment is suitable in some cases, and palliative care to manage the symptoms may be needed.

Dialysis

71%² of people with end-stage kidney disease in the US are on dialysis. Dialysis is a treatment that uses a machine to filter waste from your blood when your kidneys aren't able to do the job. It works by pumping your blood into the dialysis machine, removing the waste, and then pumping the clean blood back into your body.  

Different types of dialysis are available, and your nephrologist will help you determine which option is the best for you:

In-center dialysis

Treatment is done at a dialysis center, which may be a stand-alone clinic specializing in dialysis or a specialized clinic within your local hospital. Treatments happen several times a week and take a few hours.

At-home dialysis

Instead of a large dialysis machine at a clinic, this treatment plan employs a personal dialysis machine intended for home use. Your doctor will determine how often you should use the device, which may be daily for several hours. Your medical team will teach you how to use the machine safely; many people feel it’s easier and more convenient than in-center dialysis.

Peritoneal dialysis (PD) 

During peritoneal dialysis⁴ treatment, fluid is injected into your peritoneum, or the lining of your abdomen, through a catheter. The liquid absorbs waste and extra fluid from the body. Then, the fluid is removed from the body through the catheter.

A machine can help pump the fluid in and out of your body, which makes it possible to do these fluid exchanges at night. People who choose this option may need treatment sessions around six times daily.

Dialysis may not be the right choice for everyone. For example, it may not benefit patients over 75⁵ suffering from other health conditions, such as heart disease. Your doctor can work with you to determine if you’re a good candidate for dialysis. 

Kidney transplant

Dialysis can help you live longer with kidney failure, but it's not a cure. Likewise, a kidney transplant may not prevent kidney disease from coming back, depending on the cause. However, unlike dialysis, a kidney transplant reverses kidney damage. Over 22,000 kidney transplants were completed in the United States in 2020. 

Not everyone is a good candidate for a kidney transplant. Patients with a history of heart disease, obesity, or those who smoke may not be healthy enough to survive a major operation. These conditions would disqualify a patient from going onto the transplant list.

If you and your doctor believe this is the best treatment option for your end-stage kidney disease, they will refer you to a transplant team. This team will evaluate your condition to determine if you’re a good candidate for the procedure.

Every transplant center has unique requirements, so if you aren't a good candidate for one center, you may be able to work with another facility. You can also engage multiple transplant centers to increase your odds of a successful match. 

You will likely need to go through dialysis while waiting for a kidney transplant, as the median wait time to receive a kidney transplant is over four years. Once matched, your transplant organization will conduct a series of tests to ensure you and your donor are as closely matched as possible and increase the likelihood of a successful transplant.

A good match will reduce the risk of your body rejecting the new organ. Your wait may be longer or shorter depending on factors like: 

  • Your blood type

  • The urgency of your case

  • The duration of your kidney failure

  • Where you live

  • Your weight

A surgeon will replace your damaged kidney with a healthy one during a kidney transplant. A healthy kidney can come from either a living or deceased donor. Once the new kidney is transplanted, you must take specific medication to ensure your body doesn't reject the new organ.

You'll also need to work with a dietician to develop a meal plan focused on kidney health. Your medical team will carefully monitor your condition to ensure your new kidney is functioning well. They will also check for signs of kidney failure linked to your transplant. 

How long can a person live with kidney failure?

How long you live with kidney failure will depend on several factors, including: 

  • Your age

  • Your general health

  • The stage of kidney disease when diagnosed 

  • The treatment options you decide to use

  • How well your body responds to treatment options

Some people may not be eligible for dialysis or a kidney transplant. They may also decide that neither option is right for them. Without treatment, kidney failure will result in death within a few weeks. 

With dialysis, the average lifespan for someone with end-stage renal failure is between five and ten years. However, some patients live for as long as 30 years after renal failure, thanks to dialysis and other treatments.

The lowdown

The kidneys are two bean-shaped organs in your lower torso that help filter waste products from your blood. They can become damaged through illness or injury. However, the damage is most commonly linked to high blood pressure or diabetes.

When the kidneys are damaged, they lose their ability to filter waste from the blood, leading to a condition known as kidney disease. Kidney disease has five stages, with stage 5 being the most severe and kidney function below 15%. This stage is also known as end-stage kidney failure or end-stage renal failure.

Symptoms of kidney failure may include fatigue, nausea, swelling, bloody or foamy urine, and muscle cramps. Kidney damage is irreversible. However, if diagnosed in the early stages, it's possible to slow the development of kidney disease.

By stage 5, though, treatment options are usually limited to either dialysis or a kidney transplant. Without treatment, kidney failure will result in death within a few weeks. Those on dialysis live an average of five to ten years longer.

  1. Acute kidney disease and renal recovery: Consensus report of the acute disease quality initiative (ADQI) 16 workgroup (2017)

  2. Kidney disease statistics for the United States | NIH: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

  3. Kidney failure risk factor: Estimated glomerular filtration rate (eGFR) | National Kidney Foundation

  4. Peritoneal dialysis | NIH: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

  5. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5 (2007)

Other sources:

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