Stage 5 Chronic Kidney Disease (CKD)

Stage 5 CKD means you have kidney failure (also known as end-stage kidney disease or ESKD).

People with stage 5 CKD have an estimated glomerular filtration rate (eGFR) less than 15 for 3 months or more (confirmed with repeat testing to make sure you don’t have acute kidney injury) or they are on dialysis. Another way to think about these numbers is your kidneys are working less than 15% of what the average two healthy kidneys in a young person can do. For this reason, people with stage 5 CKD will need dialysis or a kidney transplant to survive.

In stage 5 CKD, you are at the highest risk for heart disease (even if your urine albumin-creatinine ratio (uACR) is lower than 30). As your uACR number goes up, your risk of developing heart disease also goes up.

Many people living with stage 5 CKD also have one or more complications from kidney disease. These complications include:

• Anemia (low levels of red blood cells)
• Metabolic acidosis (buildup of acid in the blood)
• Mineral and bone disorder (when blood levels of calcium and phosphorus are out of balance leading to bone and/or heart disease)
• Hyperkalemia (high levels of potassium in the blood)

In stage 5 CKD, it is important to have regular check-ups with your healthcare professional to continue to monitor for these complications, especially if you are on dialysis. Each of these complications can be monitored with simple blood tests ordered by your healthcare professional.

Symptoms are common in stage 5 CKD and can include:

• Urinating (peeing) less often than usual or not at all
• Itchy and/or dry skin
• Feeling tired
• Trouble concentrating
• Numbness or swelling in your arms, legs, ankles, or feet
• Achy muscles or cramping
• Shortness of breath
• Nausea and/or vomiting
• Loss of appetite
• Trouble sleeping
• Breath smells like ammonia (also described as urine-like or “fishy”)

Now is still a great time to make healthier lifestyle choices:

• If you smoke and/or use tobacco products, stop. Smoking can limit your access to some treatment options for kidney failure, such as kidney transplant. It also increases your risk for other serious health problems, including high blood pressure, heart disease, cancers, and stroke.
• Exercise regularly. Remember, it’s okay to start slowly – taking short walks is a great way to begin. You will want to check with your healthcare professional first to make sure it is safe for you to exercise.
• Sleeping well is important, too. Try to get enough sleep so you are well-rested.
• If you are overweight, losing weight through a balanced diet and physical activity can help improve your health in many ways.
• Find ways to reduce and manage stress in your life.

Dialysis and kidney transplant are the only two treatments for people with kidney failure. You also have the option to choose not to pursue either option, also known as “conservative management”. A brief overview of each option is available below.