Not the end, but a New Beginning: End Stage Renal Disease (ESRD)

Christopher BrownDr. Christopher Brown

As discussed in the February 2016 blog, chronic kidney disease (CKD) is the progressive decline in kidney function that affects 26 million Americans. This condition can progress to the point that the kidneys can no longer support life. The medical name for this condition is End Stage Renal Disease (ESRD), commonly known as kidney failure. The condition is the 5th and last stage of CKD occurring typically when the kidney function or eGFR is under 15.   There are over 700,000 people in the United States with ESRD. Unfortunately like so many other medical conditions, the incidence in the African American community is much higher than in other populations (see image 1).

Image 1 taken from NIH website http://www.niddk.nih.gov/health-information/health-statistics/Pages/kidney-disease-statistics-united-states.aspx#6

Image 1 taken from NIH website
http://www.niddk.nih.gov/health-information/health-statistics/Pages/kidney-disease-statistics-united-states.aspx#6

Most people with CKD have a medical specialist called a nephrologist or kidney doctor who is following the kidney function with the goal of slowing the progression of CKD and delaying the onset of ESRD and the need for dialysis or a kidney transplant.  While there have been attempts to educate the public to raise awareness about CKD and ESRD, approximately 1 in 3 people who start dialysis have not seen a kidney specialist before developing ESRD.

When the kidneys can no longer support life, a person with ESRD can experience a wide range of symptoms.   Some symptoms are non-specific such as fatigue.  Other people may have problems with controlling fluid and develop swelling of their legs and feet or shortness of breath from fluid build up in the lungs.    Other signs that are more specific to severe kidney failure are a change in taste such that a person avoids meat or experiences a metallic taste when eating meat.  Some people can develop a condition called ‘uremic frost’ where there is a severe build up of toxin in the body that is comes out of the pores and dries on the skin (see photo).These signs and symptoms are called uremia and are indications that a person may need urgent dialysis.

Photo of an example of uremic frost.   Taken from Wikipedia. https://en.wikipedia.org/wiki/Uremic_frost

Photo of an example of uremic frost. Taken from Wikipedia.
https://en.wikipedia.org/wiki/Uremic_frost

Like CKD, ESRD is diagnosed with blood-work.   The lab tests along with the signs and symptoms that a person tells the doctor are used to make a decision about when to start dialysis or refer someone for a renal transplant.  The two labs that are used for the diagnosis of ESRD are the creatinine level which is used to calculate the kidney number (eGFR) and the BUN which is a waste product that can help with the decision of when to start dialysis.  Other labs that might be abnormal from the decreasing function of the kidney are as follows;

Phosphorus (high)

Potassium (high)

Vitamin D  (low)

Hemoglobin (low – anemia)

Sodium (low)

ESRD is when a person requires replacement of the functions of the kidney.  Replacement of the function of the kidney  can be referred to as renal (kidney) replacement therapy and takes the form of dialysis or kidney transplantation and is necessary for survival. While ESRD is the end of the life of the kidneys, it is a new beginning for the person with kidney failure. Whether the person chooses dialysis or is able to receive a kidney transplant that person’s new beginning will include significant changes in lifestyle to remain healthy.  However, if properly managed, a person with dialysis or a kidney transplant can lead a fulfilling and productive life.  The next two blogs will discuss dialysis and kidney transplantation to provide more insight into these two lifesaving therapies.

For more information please visit one of the websites below and be sure to check out the next blog which will go into details about dialysis.

www.kidney.org

www.cdc.gov

www.usrds.org

www.niddk.nih.org

 

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