Definition and Overview

End-stage renal disease (ESRD) refers to a condition wherein the kidneys lose their ability to perform their function. It is very serious. It can significantly reduce a patient’s quality of life. Many cases lead to death.

The kidneys are vital organs. They remove wastes and excess fluid from the blood. When they stop working properly, wastes and excess fluid accumulate inside the body. This can lead to a number of complications. It can cause damage to the heart, blood vessels, and the central nervous system.

ESRD patients require regular dialysis. This procedure takes over the function of the kidneys. It involves the use of a machine to clean the patient’s blood. The treatment often lasts about four hours and must be done at least three times every week.

ESRD patients are candidates for a kidney transplant. This is a better option than a lifetime of dialysis. But getting a kidney donor can be very difficult. Many patients have to wait several months or even years to get a donor.

Causes of Condition

ESRD starts with kidney damage that worsens over a span of years. Any damage to the kidneys is permanent. It is often caused by diseases and disorders. These include diabetes (both types 1 and 2) and high blood pressure. Other causes include damage to the kidneys’ filtering units and tubules. ESRD can also result from polycystic kidney disease, recurrent kidney infections, and autoimmune diseases.

Key Symptoms

Many patients do not show any signs during the early stage of kidney damage. They start to notice symptoms when their kidneys fail to filter the blood efficiently. This causes dangerous levels of wastes, fluid, and electrolytes to build up inside the body. This can cause nausea, vomiting, and fatigue. Other signs include loss of appetite and significant weight loss.

As the condition worsens, the patient may develop heart problems (due to the increased levels of potassium in the blood) and seizures (when the central nervous system is involved). Other complications include anaemia, recurrent infections, and an increased risk for bone fractures.

Who to See and Treatment Available

Kidney damage can be difficult to diagnose in the early stages due to lack of symptoms. As such, high-risk patients are advised to undergo regular screening. The sooner their condition is caught, the better is their prognosis. ESRD can be avoided or at least delayed by making healthy lifestyle changes. Patients must become more active and eat a well-balanced diet. It is also important for them to maintain an ideal weight. They must also ensure that their underlying medical conditions (such as diabetes and high blood pressure) are kept under control.

Patients are treated by kidney specialists. Tests and procedures used to diagnose the condition include blood and urine tests. These are used to measure the amount of waste products in the blood. They also measure the levels of protein albumin in the urine. If the results of these tests suggest any abnormality, the doctor will order imaging tests to obtain pictures of the kidneys. These images can show any abnormal changes in the kidneys’ size and structure. A kidney biopsy is also often used. This involves taking a sample of kidney tissue for further study. This test helps doctors determine the extent of the disease.

Kidney disease has five stages, which is determined based on the glomerular filtration rate (GFR). This represents the amount of blood that the kidneys are able to filter each minute. It is recorded as milliliters per minute (mL/min). The lower the GFR, the higher the stage of kidney disease. A patient is diagnosed with ESRD (stage 5) if his or her GFR is less than 15%.

Patients diagnosed with ESRD are immediately placed on dialysis. This procedure takes over the function of the kidneys. It uses a machine designed to clean the blood. Patients may be placed on either peritoneal dialysis or haemodialysis. In haemodialysis, two needles are inserted into a vein in the arm. One is used to allow blood to flow into a filter. The other needle is used to return the filtered blood to the body. The procedure itself does not hurt. However, patients may request for a numbing medicine if they feel uncomfortable each time the needles are inserted.

In peritoneal dialysis, a permanent catheter is inserted into the abdominal cavity. The cleaning solution is drained through the catheter in the area that surrounds the internal organs. The solution is left in place for a number of hours before it is drained out. The process is repeated 4-5 times a day, every day.

While undergoing dialysis, patients are advised to make healthy lifestyle changes. They are advised to work with a dietitian and to exercise on a regular basis. Patients also receive supportive care. They are treated for the complications of their condition. The goal of this treatment is to make sure that they feel better.

The other treatment option for ESRD is a kidney transplant. This surgical procedure involves replacing the diseased kidney with a healthy kidney from a living or deceased donor. Although it is the more invasive option, it is a better alternative to a lifetime of dialysis.

But the process of getting a kidney is often a long, arduous process. Patients are placed on a waiting list. Most of them have to wait several months or even years before they get a donor kidney. Once a donor kidney becomes available, the surgery is carried out. It involves placing the donor kidney in the lower abdomen. It is then attached to the blood vessels and the ureter. After surgery, patients are given medications to prevent their immune system from attacking the new kidney.

Recovery time after a kidney transplant often takes between three to eight weeks. Patients are closely monitored during this time. They will need to undergo regular blood tests to ensure that their new kidney is working properly.

References:

  • Kidney failure: Choosing a treatment that’s right for you. National Institute of Diabetes and Digestive and Kidney Diseases. http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/kidney-failure-choosing-a-treatment-thats-right-for-you/Pages/facts.aspx.

  • Inker LA, et al. KDOQI US commentary on the 2012 clinical practice guideline for the evaluation and management of CKD. American Journal of Kidney Diseases.

  • Chronic kidney disease (CKD) and diet: Assessment, management and treatment. National Kidney Disease Education Program. http://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/a-z/Documents/ckd-diet-assess-manage-treat-508.pdf.

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