End Stage Renal Disease

Your kidneys are crucial to your health. They filter out waste products from your blood, remove excess fluids and help balance certain chemicals in your body. (Read about "Kidney Disease") When they are damaged by disease or injury, they lose the ability to do their job. Unfortunately, kidneys cannot heal themselves. Any damage is usually irreversible. We are lucky however, because we have more kidney power than we need. Most people are born with two kidneys, but can function easily with just one. However, if you lose 85 to 90 percent of your kidney function, you enter what is called end stage renal disease (ESRD). At that point, you need help. There are only two choices according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), dialysis and transplantation. (Read about "Transplants")

Causes of ESRD

When the kidneys fail, it can be sudden (acute) or it can develop gradually and get worse over time (chronic). Chronic kidney failure may exist for years. As it progresses, the result can be ESRD.

The number one cause of both chronic kidney failure and end stage renal disease, according to NIDDK, is diabetes. (Read about "Diabetes" "Diabetes and Kidney Disease") NKF says 25 percent of all cases (and 35 percent of new cases of kidney failure each year) are the result of diabetes. The problem is that the excess sugar in the blood stream damages the nephrons. The medical term is diabetic nephropathy.

The number two cause of ESRD is high blood pressure, according to NKF. (Read about "Hypertension: High Blood Pressure" "Blood Pressure and Kidney Disease") High blood pressure results in some 30 percent of the cases in the United States. The tiny blood vessels in the kidneys are damaged and can no longer effectively filter out the waste in our blood. It can also be a double whammy of sorts for diabetics because many also have high blood pressure.

Some other major causes of ESRD according to NIDDK and NKF are:

• PKD or polycystic kidney disease, an inherited condition that results in cysts that eventually take over the kidney. (Read about "Polycystic Kidney Disease")
• Injury or trauma that can cause muscle damage and breakdown and result in sudden failure of the kidneys.
• Poisons, some over-the-counter painkillers may cause kidney damage if taken over long periods of time. Ask your doctor if this should be a concern for you. (Read about "Medicine Safety")
• Untreated infections or other disease such as cancer. (Read about "Urinary Tract Infections" "Kidney Cancer")

Complications

As if kidney failure wasn't enough, there are other complications of ESRD, particularly for the young. According to NIDDK, 90 percent of people undergoing dialysis suffer a bone disease called renal osteodystrophy. (Read about "Bone Loss and Kidney Disease") Children suffer problems because they are still growing bones. It can result in deformities. The elderly, especially women can also suffer more because they are already at risk for osteoporosis. (Read about "Osteoporosis") Some kidney patients also suffer from anemia (Read about "Anemia"). This is the result of the kidneys decreased ability to make EPO, which helps the bone marrow make red blood cells.

Peripheral neuropathy is another potential complication of end stage renal disease. (Read about "Peripheral Neuropathy") Another complication involves an elevation of blood potassium. (Read about "Vitamins & Minerals") Severe deviation of potassium, in either direction from its normal range, can be life threatening. The kidneys are in charge of controlling this delicate range.

Dialysis

Dialysis is used to treat ESRD. It is also used when kidneys fail temporarily (acute kidney failure), perhaps during an infection or as the result of an injury.

There are two types of dialysis, according to the National Kidney Foundation (NKF):

• hemodialysis
• peritoneal dialysis

Both methods cleanse the blood without using the kidneys. Both require effort on the part of the patient and making the choice of which to use is something that requires consultation with your doctor and with other caregivers, including family and friends, who may be required to help.

Hemodialysis

Hemodialysis involves a machine that is used to filter the blood, an artificial kidney if you will. Before you start hemodialysis an entrance to your blood vessels has to be created. NKF says this is usually done by minor surgery to your arm or leg. Sometimes an artery and a vein (Read about "Vascular System") are joined under your skin to create a bigger blood vessel called a fistula. Occasionally, according to NKF, a small plastic tube is inserted to connect the artery and the vein; this is called a graft. The actual treatment usually occurs at a hospital or dialysis center. NIDDK says the treatments can occur at home, but a trained person is still required to help. The time required varies on the amount of kidney function left and other factors. NKF and NIDDK both say, most people can expect to spend 2 to 4 hours, three times a week, connected to the kidney machine. During that time you can read, write, watch TV, as long as you stay in one place.

Peritoneal dialysis

Peritoneal dialysis happens inside your body, in the abdomen. A short tube, called a catheter is placed into your belly. A fluid, called dialysate, fills your abdominal cavity through the catheter. Waste is drawn from the blood vessels that line the walls of the abdomen. The dialysate is then removed and clean dialysate is put in. NKF says there are several kinds of peritoneal dialysis but the two major ones are:

• Continuous Ambulatory Peritoneal Dialysis (CAPD)
• Continuous Cycling Peritoneal Dialysis (CCPD)

CAPD is the only type of dialysis done without a machine, according to NKF. NIDDK calls it the most common type of peritoneal dialysis. You do the work yourself, putting the dialysate into your body, draining it out a few hours later, disposing of it and then putting in new fluid.

CCPD is almost the same thing, except a machine does the exchange while you are sleeping.

Diet

Diet can have an impact on whatever type of dialysis is chosen. If you go on dialysis, NKF and NIDDK recommend consultation with a dietitian and your doctor. Dialysis patients must monitor their intake of protein and fats, as well as sodium, potassium and fluids. Each individual has different needs and problems and must be handled on a case by case basis. It is imperative that you discuss the situation with your healthcare team. Diet is also important because NIDDK says that 90 percent of all dialysis patients have bone problems. (Read about "Bone Loss and Kidney Disease")

Transplants

ESRD is not reversible. There are times when the kidneys will stop functioning for a period of time and then regain function, but that is not ESRD. The kidneys do not repair themselves, according to NKF, and while dialysis is very successful, it does create limits for the patient. Kidney transplants are becoming more and more common. NKF says that some 11,000 people will get transplants this year. Another 24,000 are waiting for new kidneys. Because we are born with more kidney power then we need, we don't have to get two new kidneys in a transplant. One will be enough. (Read about "Transplants")

There are three basic sources for kidney transplants, according to NIDDK:

• a blood relative who shares genetic material (Read about "Genetics")
• a person who recently died but had healthy kidneys
• another living person who is not a blood relative

NIDDK points out that it's important that the blood and the tissues of the donor and the patient match as closely as possible. That helps to keep the body from rejecting the new kidney.

Waiting for a kidney can take a long time. There aren't enough donors to go around. A donation from a suitable living donor happens much quicker. NIDDK says the operation takes from 3 to 6 hours, with a hospital stay of up to 2 weeks following. A living donor can expect to spend a week or less in the hospital. If you receive a transplant, you will most likely be given anti-rejection drugs and should follow your doctor's orders carefully for the rest of your life.

Kidney transplants have a high success rate. NIDDK says 75 to 80 percent of transplants, that come from people who died, are still working a year later. The rate is even higher for people who are related. There are limits however. The kidney can be rejected by your body and there are people who have to get a second transplant.

Once again diet can be important. Your doctor will map out a diet for you. It is imperative that you follow it to help keep your new kidney healthy.

Related Information:

    Blood Pressure and Kidney Disease

    Diabetes and Kidney Disease