What happens in end stage renal failure?

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2. About Kidney Disease
3. Kidney Disease Stages
4. Stage 5

Stage 5 kidney disease, or end stage renal disease (ESRD), occurs when your estimated glomerular filtration rate (eGFR) falls below 15, indicating that your kidneys are failing or close to failing. At this advanced stage, treatments like dialysis or a kidney transplant will likely be needed to prolong life and keep your body healthy and chemically balanced. At ESRD, it’s important to work with a kidney doctor (nephrologist) to determine which treatment option may best fit your lifestyle.

Many people do not experience symptoms of kidney disease until the later stages when kidney damage has occurred. Possible stage 5 kidney disease symptoms and signs include:

• Uremia (waste buildup in your blood)
• Fatigue—possibly caused by anemia
• Shortness of breath
• Nausea or vomiting

• Abnormal thyroid levels
• Swelling in your hands/legs/eyes/lower back
• Lower back pain

• See a nephrologist regularly—It's important to have your labs and symptoms monitored closely to track progression. Continue to see your primary care doctor and any other specialists to monitor any other health conditions.
• Continue following a kidney-friendly diet—A healthy stage 5 kidney disease diet may involve limiting or monitoring your intake of things like potassium, phosphorus, sodium, or fluids. If you plan to start dialysis, your dietary needs may change. Talk to your renal dietitian about which kidney-friendly foods are the best choices for you. Eating well can help you stay your healthiest and feel your best.
• Meet with your insurance coordinator—When preparing for treatment, make sure you have your best possible health insurance coverage. Before making any changes to your plan, talk to your insurance coordinator to help you understand your health coverage options.
• Prepare for treatment—If you've chosen home dialysis, prepare your treatment space and learn what to expect from your dialysis training. If you've chosen in-center dialysis, schedule a tour with your local dialysis center.
• Build your support network—Reach out to people who care about you and can help support you. Friends, family, and your care team all want you to feel your best.

• What can I expect from kidney failure treatment?
  There are several treatment options to help people with kidney failure feel their best and live a full life. Whether it's a kidney transplant, dialysis at home, or dialysis in a center, your doctor can help you decide which treatment best fits your lifestyle.
• Am I a candidate for a kidney transplant? If so, what do I need to do?
  Your best chance for a successful transplant depends on certain factors. Talk to your nephrologist to see if you are a candidate. It's a good idea to start the planning process and begin searching for a kidney donor as soon as possible.
• How do I manage a dialysis schedule if I am working?
  Your nephrologist will work with you to find a treatment schedule that aligns with your health needs and lifestyle. Home peritoneal dialysis or home hemodialysis may give you the most flexibility.
• Do I need to make changes to any medications I’m taking?
  If you're living with diabetes or high blood pressure, your doctor may make adjustments to your medication. Make sure you discuss all medications, vitamins, and supplements you're taking with your doctor, as some may need to be avoided.

If your nephrologist determines that it's time for you to start treatment, you have several options to choose from. It's important to remember that treatment should fit into your life—not the other way around. The best treatment for you is the one that makes sense for your individual lifestyle and health needs.  

Kidney transplant—A successful kidney transplant is closest to natural kidney function and is considered one of the most effective treatments for end stage renal disease (ESRD). With a kidney transplant you receive a new, healthy kidney from a living or deceased donor through surgery. Getting a kidney transplant requires good overall health, a good donor match, and the right timing. 

Dialysis—This life-extending treatment that rids your body of unwanted toxins, waste products and excess fluids by filtering your blood. There are two types of dialysis: peritoneal and hemodialysis.

• Peritoneal dialysis—Uses the blood vessels in the lining of your abdomen—the body's natural filter—along with a solution called dialysate to filter and clean your blood. With this method, blood never leaves your body. Peritoneal dialysis can be done with a machine or manually at home, at work, or while traveling.
• Hemodialysis—Filters out your blood through a dialysis machine to remove toxins, waste, and excess fluid. Blood flows into the machine, gets filtered, and is returned to your body. Hemodialysis can be performed in your home or in a dialysis center.

End-stage renal disease is the end stage of kidney function—not the end stage of life. Life expectancy with ESRD can depend on many factors, including your treatment wishes and your overall health. It's important to remember that you can live a full life with today's kidney failure treatments. While there’s no cure for kidney disease and kidney damage can’t be reversed, there are treatment options that can help people live well for decades.

Learn how to look after your kidney health and thrive—in a class that fits your life. Choose an educator-led or self-guided format.

A nephrologist, also known as a kidney doctor, is the most qualified doctor to help you manage kidney disease. Ask your doctor for a referral to a nephrologist when your eGFR is between 30-44.

What you eat and drink can affect your kidney health. Our resources and recipes can help you feel your best on a kidney diet.