Overview

Our kidneys filter waste and excess fluid from our bodies through urine. In end stage renal disease, kidneys lose their ability to filter, and as a result, fluids, electrolytes, and wastes can build up in the body. End-stage renal kidney disease requires dialysis or a kidney transplant to survive. But a patient can choose any treatment option to get symptoms under control.

Stages of End Stage Renal Disease.

There are five stages of kidney disease. To determine what stage a person is in, the doctor will do a blood test to check the glomerular filtration rate (GFR). GFR measures how much blood the kidneys filter per minute and is conveyed in millilitres per minute (mL/min). As GFR drops, kidney function also decreases.

A person has end-stage kidney disease when the kidneys are not working at a level to keep him/her alive. End-stage kidney disease usually occurs when kidney function falls below 15% of normal kidney function.

What are the symptoms of End Stage Renal Disease?

Muscle cramps
Swelling in your feet and ankles
Urinating more or less than normal
Trouble catching your breath
Itchy skin or rashes
Feeling sick to your stomach
Foamy, bubbly looking urine
Headaches
Nosebleed
Nausea, Vomiting
Loss of appetite

It's important to note that these symptoms can also be present in earlier stages of kidney disease and that not all people with ESRD will experience them.

Causes of End-Stage Renal Disease

ESRD is usually caused by a condition that weakens the kidney over time, eventually causing enough damage to reduce its function. Diabetes and high blood pressure are the most common causes of ESRD. In people with high blood pressure, the body pushes blood through the arteries with great force, which can damage the small blood vessels in the kidney.

Some less common causes are:

Genetic conditions such as polycystic kidney disease
Glomerulonephritis
Urinary tracts conditions
Autoimmune conditions

Some common causes when a kidney may fail suddenly are:

Severe urinary tract problems
Reduced blood flow to the kidney
Heart attack
Drug misuse and illegal drug use

Diagnosis of End Stage Renal Disease

To assess whether a person has kidney failure, doctors run tests to see how well their kidneys work. For example, a person is diagnosed with ESRD when their kidney function is less than 15% of normal. The doctor will also check the levels of albumin and creatinine in the patient's urine, which affect kidney function. To confirm the diagnosis of ESRD, the doctor may also recommend the following:

Kidney ultrasound
kidney biopsy
Blood tests to check electrolyte levels, creatinine and urea in the blood.

Treatment of End-Stage Renal Disease

It is a serious condition that requires ongoing treatment to manage symptoms and prevent further complications. The main treatments for ESRD include:

Kidney Transplant
Dialysis
Supportive care

Kidney Transplant

Kidney transplantation is the best and most effective form for patients with end-stage renal disease (end-stage kidney disease, stage 5 kidney disease). This treatment option is recommended for individuals with End Stage Renal Disease (ESRD) who are eligible for transplantation. Transplant surgery involves placing a healthy kidney from a donor.

Types of Kidney Transplants are

Deceased donor Kidney Transplant
Preemptive Kidney Transplant
Living donor Transplant

Risks of Kidney Transplant

While a kidney transplant is generally considered a safe and effective treatment option for people with End Stage Renal Disease (ESRD), like any surgery, it does come with some risks. Some of the potential risks of a kidney transplant include the following:

Rejection of the kidney by the immune system
Infection
Surgical complications
Side effects of medications

Eligibility For Kidney Transplant

There are a few conditions that can prevent you from being eligible for a kidney transplant, such as

Alcohol or drug abuse
Dementia or poorly controlled mental illnesses
Severe heart disease
Active or recently treated cancer
Any condition resulting in decreased life expectancy in nearby future

Dialysis

Dialysis is a medical treatment for End Stage Renal Disease (ESRD) that helps remove waste and excess fluid from the blood when the kidneys can no longer function properly.

There are two types of dialysis:

Hemodialysis- This type of dialysis involves using a dialyser to filter the blood. During hemodialysis, blood is drawn out of the body through a tube, passed through the dialyser, and then returned to the body through another tube. This process usually takes about 3-4 hours and is typically done thrice weekly. Before starting this procedure, you will go through a minor surgical process to access the bloodstream, and you may have the following:
- Arteriovenous fistula (AV fistula)
- Arteriovenous graft (AV graft)

Peritoneal dialysis- This type of dialysis involves using the lining of the abdomen (peritoneum) as a filter. A sterile solution called dialysate is placed into the abdomen through a catheter, which helps to draw waste and excess fluid from the blood into the peritoneal cavity. After a few hours, the solution is drained from the abdomen and replaced with a fresh solution. This process can be done at home and is typically done daily.

Risks of Dialysis

Infection: People with ESRD are more susceptible to infections due to their weakened immune system, and the risk of infection is further increased with dialysis treatment.

Supportive or palliative care- If you choose not to undergo a kidney transplant or dialysis, you may choose palliative or supportive care to help you manage your symptoms and recover.

This approach can involve managing pain, addressing emotional or spiritual needs, and ensuring the patient is at peace with his/her condition. Patients must discuss their options with their healthcare providers and loved ones to determine the best action for their needs and circumstances.

Kidney failure can be serious and even fatal if not treated with dialysis or replacement. Death can happen quickly or take months or years. Supportive care may include symptom management, measures for your comfort, and end-of-life planning.

Other Treatments

Other than kidney transplant and dialysis, other treatments are less commonly used, such as:

Medicines known as phosphate binders help prevent phosphorus levels from becoming too high
Treatment for anaemia such as iron pills, blood transfusions, and extra iron in the diet
Medicines to control blood pressure

Vaccinations

Hepatitis B vaccine
Flu vaccine
Pneumonia vaccine (PPV)

When to Consult a Doctor?

You can also get in touch with the expert Nephrology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during injuries, health disorders or any other health concern.

Conclusion

Dialysis is a critical treatment option for individuals with kidney failure or end-stage renal disease (ESRD). The duration of dialysis can vary, with some individuals requiring it long-term and others utilising it as a bridge to kidney transplant. Various types of dialysis are available, and patients can choose the setting that suits their needs best. Some individuals may prefer to receive dialysis at home, while others may opt to receive treatment at a dialysis centre or hospital. Working closely with a healthcare provider can help determine the most appropriate type of dialysis and setting for each individual.