End-Stage Kidney Disease
At stage 5 of kidney disease, your kidneys function at less than 10% of their ability. Caused most commonly by diabetes and hypertension, ESKD is a life-threatening condition that requires immediate medical attention. Treatment options at this stage include dialysis or a kidney transplant, which can increase your life expectancy by up to 20 years.
The kidneys play a key role in your body’s ability to eliminate waste and water. If you have chronic kidney disease (CKD), this takes a beating as your kidneys lose their ability to function properly. In the US, this is a common condition among older adults and affects around 26 million people.1 Chronic kidney disease is classified into 5 stages, with each stage denoting the severity of damage to the kidneys. End-stage kidney disease – also called kidney failure, stage 5 kidney disease, or end-stage renal disease (ESRD) – is the final stage.2
What Happens In End-Stage Kidney Disease?
A patient has reached end-stage kidney disease when the kidneys are no longer able to fulfill the day-to-day requirements of the body. The kidneys now function at less than 10% of their normal ability.3 In this stage, the kidneys are damaged beyond repair and need external assistance like dialysis or donor kidneys to survive. The progress between stages is usually gradual and happens over a span of 10–20 years.4
Symptoms Of End-Stage Kidney Disease
As your kidneys deteriorate, you may show symptoms like:
- Weight loss
- Loss of appetite
- Dry skin
- Blood in the urine
- Swollen ankles
Some other less common symptoms include:
- Skin and nail changes
- Bone pain
- Muscle cramps
- Poor concentration
- Sexual dysfunction
- Sleep problems5
Causes Of End-Stage Kidney Disease
Kidney failure can often be the result of certain medical conditions that cause chronic kidney disease and damage the kidneys over many years. These include:
- Diabetes and hypertension: These are the primary reasons for kidney failure. In diabetes, the excess glucose in the blood can damage the tiny filters in the kidneys.
- High blood pressure: This can damage the blood vessels in the kidneys, resulting in inefficient filtration of toxins.
- Autoimmune diseases: These include conditions like lupus and IgA nephropathy.
- Polycystic kidney disease: This genetic condition involves cysts that grow in the kidneys and interfere with normal kidney functions.
- Chronic infections or blockages in the urinary tract.
- A severe blow or injury to the kidneys.
- Excessive use of painkillers.6
Diagnosing Kidney Damage And End-Stage Kidney Disease
A simple blood or urine test is enough for a basic evaluation of your kidney health. However, if you already have chronic kidney disease or have been diagnosed with it after initial blood tests, your doctor may order imaging tests or a biopsy of the kidneys to evaluate the damage and decide on a suitable treatment path.
Blood tests: Blood tests look for serum creatinine, glomerular filtration rate (GFR), and blood urea nitrogen (BUN).
- Creatinine is a chemical waste produced by muscle metabolism. When your creatinine levels are high, it is a sign that the kidneys are not functioning optimally.
- GFR measures whether your body is effectively excreting wastes and fluids. GFR is calculated from serum creatinine levels based on your age, weight, and race. A normal GFR is greater than 90. GFR below 15 means end-stage kidney disease and indicates that dialysis or transplants are required.
- Urea nitrogen is the waste that your body produces when proteins are broken down. A normal value of BUN is between 6 and 20. BUN level rises with a decrease in kidney efficiency.7
Urine tests: Urine tests can detect most abnormalities in the kidneys, such as chronic kidney disease, kidney stones, and bladder infections. The amount of protein in the urine, if any, can indicate kidney disease, too.8
Imaging tests: A CT scan or ultrasound may be ordered to check for abnormalities or obstructions like stones, tumors, or cysts in the kidneys. A renal ultrasound also determines the size and shape of the kidneys.9
Kidney biopsy: A small piece of the kidney tissue is removed with a needle or during surgery and examined under the microscope to check for any abnormal cells or cancer in the kidneys.10
After Being Diagnosed: Treatment For End-Stage Kidney Disease
After your tests confirm end-stage kidney disease, you’ll go through kidney replacement therapy (KRT), which mainly involves both dialysis and a kidney transplant. In dialysis, a machine takes the place of your kidneys. It pumps out the blood, cleans it, and pumps it back into the body. Dialysis is a lifesaving treatment, yet it performs only about 10% of the kidneys’ normal functions. This makes it only a temporary treatment until a match for a kidney donor is found.
Since dialysis is an intensive treatment, it can be rather punishing to the body and may come with undesirable consequences like anemia, heart disease, bone disease, nerve damage, or infection. Consequently, the average life expectancy of a person undergoing dialysis is about 5 years. With a transplant, life expectancy increases to up to 20 years.11
That’s not all, though. While a kidney transplant involves major surgery with a long recovery period, patients often find that it provides a better quality of life. They will often have more energy and fewer restrictions on their diet. Patients who’ve had a transplant are more likely to return to their former way of life than patients on dialysis.12
How To Prevent End-Stage Kidney Disease
Once your kidneys are damaged, there is no going back. The only way forward is to prevent further damage through treatment and lifestyle changes. The promising news is that chronic kidney disease progresses to end-stage kidney disease in only 1 out of 50 cases.13 This means, if you’re at the beginning stages of kidney disease, you can help lower your risk of end-stage kidney disease in the future. It’s crucial to check your kidney health routinely, especially if you suffer from chronic kidney disease, type II diabetes, hypertension, or high cholesterol.
Managing diabetes, hypertension, and cholesterol levels are imperative. Since chronic kidney disease is often linked with high potassium and calcium levels, a low-fat and low-salt diet is your best bet. A plant-based diet that is low in sodium and potassium is especially beneficial.14 Keep an eye on your protein intake, alcohol consumption, and painkiller usage, and avoid smoking.
Alternative Remedies For Chronic Kidney Disease
Baking soda is being studied as a remedy that could prevent chronic kidney disease from progressing. In a randomized, controlled clinical study, 129 adult patients were given oral sodium bicarbonate for 2 years. The results were positive: The rate of loss in kidney function reduced significantly, as did the number of patients progressing to end-stage kidney disease. And there was no effect on blood pressure.15
Dandelion leaves are a natural diuretic that can help remove toxins from your body and lower blood pressure levels. In fact, Native Americans have traditionally used dandelion leaves to treat kidney disease. It is important, however, to consult a physician before consuming dandelion leaves. Although considered safe, it could trigger allergic reactions.16
Asparagus has natural compounds like glycosides and saponins that have diuretic and blood-purifying properties. This can work against hypertension and preserve kidney function.17
Ayurvedic remedies like goksuradi guggulu, rasayana churna, niruha basti, and varunadi kvatha can help lower creatinine and albumin levels in your blood, thus reducing the need for dialysis. In a clinical trial in India, 100 patients with symptoms of chronic renal failure were administered the four compounds for a month. At the end of the test period, all the patients showed an improvement of over 50% in all symptoms. While albuminuria, blood urea, and serum creatinine levels went down, urine output and hemoglobin levels went up.18
New Treatments Under Study For Chronic Kidney Disease
Cell-based therapy: Since current treatment methods for chronic kidney disease, such as dialysis, cannot restore normal kidney function, there is a constant search for better and more restorative treatment paths. Cell-based therapy is an ongoing field of research that is showing great promise in returning a diseased kidney to its normal state. Clinical trials have already demonstrated the possibility of improving kidney functions through cell infusion.
Whole organ bioengineering: For end-stage kidney disease patients, kidney transplantation is still a challenging issue because of the complications that can arise as well as the short supply of donor kidneys. To overcome this problem, exciting research is underway to bioengineer whole kidneys that can be used for transplants.
Although both areas of study are progressing steadily, there is still a long way to go before these treatment methods become part of mainstream medical practice.19
If you’ve been diagnosed with end-stage kidney disease, don’t lose heart. Make an appointment with a nephrologist right away. Work closely with them to come up with a suitable management plan for your condition, so you can continue to lead a near-normal life.
References [ + ]
|1, 6.||↑||About Chronic Kidney Disease. National Kidney Foundation.|
|2, 4, 5.||↑||End-stage kidney disease. U.S. National Library of Medicine.|
|3.||↑||What Is ESRD? End Stage Renal Disease (ESRD) National Coordinating Center (NCC).|
|7, 8.||↑||Tests To Measure Kidney Function, Damage And Detect Abnormalities. National Kidney Foundation.|
|9.||↑||End Stage Renal Disease (ESRD). John Hopkins Medicine.|
|10.||↑||End Stage Renal Disease (ESRD). John Hopkins Medicine.|
|11, 12.||↑||The Benefits of Transplant versus Dialysis. Harvard Medical School Teaching Hospital.|
|13.||↑||Chronic kidney disease. National Health Service.|
|14.||↑||PLANT PROTEIN REDUCES MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS. National Kidney Foundation.|
|15.||↑||de Brito-Ashurst, Ione, Mira Varagunam, Martin J. Raftery, and Muhammad M. Yaqoob. “Bicarbonate supplementation slows progression of CKD and improves nutritional status.” Journal of the American Society of Nephrology 20, no. 9 (2009): 2075-2084.|
|16.||↑||Dandelion. University of Maryland Medical Center.|
|17.||↑||Sanae, Matsuda, and Aoyagi Yasuo. “Green asparagus (Asparagus officinalis) prevented hypertension by an inhibitory effect on angiotensin-converting enzyme activity in the kidney of spontaneously hypertensive rats.” Journal of agricultural and food chemistry 61, no. 23 (2013): 5520-5525.|
|18.||↑||Patel, Manish V., S. N. Gupta, and Nimesh G. Patel. “Effects of Ayurvedic treatment on 100 patients of chronic renal failure (other than diabetic nephropathy).” Ayu 32, no. 4 (2011): 483.|
|19.||↑||Chung, Hyun Chul, In Kap Ko, Anthony Atala, and James J. Yoo. “Cell-based therapy for kidney disease.” Korean journal of urology 56, no. 6 (2015): 412-421.|