Kidney Failure

Kidney failure means your kidneys are no longer able to work well enough to keep you alive. With kidney failure, 85-90% of your kidney function is gone. People with kidney failure have stage 5 CKD (also known as end-stage kidney disease or ESKD).

People with kidney failure will need dialysis or a kidney transplant to survive.

Kidney failure is a result of a gradual loss of kidney function. Some people do not even know they have kidney disease until they reach kidney failure. This is because people with early kidney disease may not feel sick at all. Symptoms usually show up later in advanced disease and may 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

Healthy kidneys remove wastes and extra fluid from your body. They balance salts and minerals in your blood. They also help control blood pressure, make red blood cells, and keep bones strong. When kidneys go into kidney failure, they are unable to work as well as they should. As a result, wastes and excess fluid can build up in your body and make you feel sick.

The two main causes of kidney failure are diabetes and high blood pressure, which make up about two-thirds of cases. Other diseases can also lead to kidney failure, including IgA nephropathy, lupus nephritis, polycystic kidney disease, Fabry disease, and many others. Social and environmental factors also play a part in kidney disease.

Kidney failure can lead to other health problems or complications. Many people living with kidney failure have one or more complications. Kidney failure can increase your risk of heart disease or stroke. Other complications can 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)

Certain conditions can be both a cause and a complication (result) of kidney disease. These include high blood pressure, heart disease and stroke.

It is important to get regular check-ups to monitor these complications.

Urine and blood tests can check for signs of CKD. Estimated glomerular filtration rate (eGFR) is a blood test that checks how well the kidneys are filtering.

People with kidney failure have an eGFR of 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.

You may also need extra tests to monitor other conditions related to kidney disease.

There is no cure for kidney failure, but with treatment it is possible to live a longer and productive life.

Dialysis and kidney transplant are the two treatments for people with kidney failure. Dialysis treatments or a transplanted kidney will take over some of the work from your damaged kidneys and remove wastes and extra fluid from your body. This will make many of your symptoms better. You also have the option to choose not to pursue either option, also known as “conservative management.”

• Dialysis: There are two types of dialysis- hemodialysis and peritoneal dialysis. Both remove waste products and extra fluid from your blood. Hemodialysis uses an artificial kidney machine, while peritoneal dialysis uses the lining in the belly. Hemodialysis treatments can be done at your home or in a clinic. Peritoneal dialysis is usually done at your home.
• Kidney transplant: A kidney transplant is an operation that places a healthy kidney in your body.
• Conservative management focuses on your quality of life and managing symptoms without dialysis or a kidney transplant. Conservative management is also called comfort care, non-dialytic care, supportive care, or comprehensive conservative care.

There are many things to consider when choosing a treatment for kidney failure, including lifestyle, health problems or the need for someone to assist you. Your decision should be based on your medical history, a healthcare professional’s opinion, and on what you and your family want. Learning about your treatment choices will help you decide which is best for you.

The medicines you take may change when have kidney failure. Many, but not all, medicines are removed from the blood by your kidneys, so it is important to speak with your healthcare team to make sure your medicines continue to be effective and safe. Also, check with your healthcare team before starting any supplements, herbal medicines, or other over-the-counter therapies to make sure they are safe.

People with kidney failure may need to take medicines or supplements to manage certain complications, as needed. Therapies can include iron, calcium, vitamin D, or medicines that lower phosphorus or potassium in the blood.

The dose or timing of certain medicines may need to be adjusted for people on dialysis. Certain drugs can be removed faster with the dialysis process. Some drugs also have the potential to build up in the blood for people on dialysis.

People with a kidney transplant will need to take anti-rejection medicines (or immunosuppressants), which are drugs or medicines that lower the body's ability to reject a transplanted organ. Normally, the body fights off anything that isn’t part of itself, like germs and viruses. That system of protection is called the immune system. To stop the body from attacking or rejecting the donated kidney, anti-rejection medicines are needed to keep the immune system less active.

Nutrition and eating healthy are important parts of your health. Eating healthy generally includes having more fruits and vegetables, and eating foods that are less processed and as close to fresh as possible. A person with kidney failure may have their diet change over time. A dietitian can make recommendations and help you with any changes in the foods you eat.

People on dialysis will need to make sure they have the right amounts of protein and certain minerals. Protein can be lost with each dialysis treatment. As a result, people on dialysis may need to consume more protein. People on dialysis may also have to limit how much fluid is consumed. When kidneys do not work as well as they should, they are no longer able to remove extra fluid. If too much fluid builds up, it can have harmful effects on your health, such as difficulty breathing and swelling.

Generally, people with a kidney transplant do not have the same nutritional requirements or restrictions as do people on dialysis. Healthy eating is still important. You may need to change what you eat if you have any conditions such as high blood pressure or diabetes.