End stage renal disease (ESRD) is the last stage of kidney disease (stage 5) in which the kidneys cannot function any longer are unable to keep up with the daily needs of the body. At this stage, dialysis or a kidney transplant is necessary in order to treat the disease.
The role of the kidneys is to filter waste from blood and urine. In kidney disease, the kidney’s ability to do this becomes impaired. With each passing stage, kidney function progressively decreases, so waste cannot be expelled and builds up in the body.
Those with end stage renal disease have kidney function below 10 percent, meaning the kidneys are barely functioning or not functioning at all.
Kidney function is measured by glomerular filtration rate (GFR). In stage 5, the kidneys’ GFR is less than 15. To compare, healthy GFR is above 90.
Kidney disease develops when the kidneys become damaged and their function is impaired. There are many different reasons for this. For example, in diabetics, high levels of glucose circulating in the blood can put stress on the kidneys as it cannot be broken down or expelled, damaging the kidneys. Kidney disease is also more common in high blood pressure patients.
Other causes of kidney disease include a blockage of the urinary system such as kidney stones, inflammation of the filters to the kidneys, urine flowing into the kidneys – known as vesicoureteral reflux – and congenital defects.
Risk factors for kidney disease include diabetes, hypertension, family history of kidney disease, polycystic kidney disease, Alport syndrome, interstitial nephritis, kidney infection, and certain autoimmune conditions like lupus.
Complications resulting from ESRD include skin infections and dry skin, increased risk of infections, abnormal electrolyte levels, joint, bone and muscle pain, weak bones, nerve damage, changes in blood glucose levels, liver failure, heart and blood vessel problems, fluid buildup around the lungs, malnutrition, thyroid problems, anemia, stomach and intestinal bleeding, brain dysfunction and dementia, seizures, joint disorders, and fractures.
Symptoms of ESRD can vary greatly and can include:
ESRD is diagnosed through a series of tests to determine kidney function, including urinalysis, serum creatinine test, blood urea nitrogen test, and estimated glomerular filtration rate.
By combining the results of these tests, your doctor can determine how well your kidneys are functioning and determine the stage of your kidney disease. Poor results, especially low GRF, will indicate ESRD.
Once ESRD is diagnosed, your doctor will be monitoring you for some time to gauge your kidney condition at this point. It is rare that kidney disease is first initially diagnosed at the fifth stage.
In ESRD, kidney function is barely available, so dialysis or a kidney transplant is highly recommended. In dialysis, patients are hooked up to a machine filtering the blood and waste as the kidneys are unable to do so on their own. Another form of dialysis is known as peritoneal dialysis in which a solution is placed into the abdomen and later removed with a catheter.
For a kidney transplant, the diseased kidneys are removed and a donated one is then put in its place. You only need one healthy kidney to function, so kidney donors are often living.
Medications are also advised for ESRD as a means to control and manage other conditions that can contribute to worsened outcomes of the disease – for example, drugs for controlling blood pressure or diabetes. On the same note, lifestyle changes should also be implemented in order to improve underlying conditions and kidney function. For example, a patient may have to change their diet to ensure there is less waste being produced. They may also need to consume food that is easier for the kidneys to break down. Red meat is an example of a food that should be avoided as it is difficult for the kidneys to process. Reducing sodium and potassium is also advised as fluid levels can become unbalanced in kidney disease.