Kidney Failure

What is kidney failure?

Kidney failure (renal failure) means one or both of your kidneys no longer function well on their own. Kidney failure is sometimes temporary and develops quickly (acute kidney failure). Other times, it’s a long-term condition that slowly gets worse over time (chronic kidney failure).

Kidney failure can worsen to the most severe stage, end-stage kidney disease (ESKD) which is deadly without treatment. If you have end-stage kidney disease, you may survive a few days or weeks without treatment. With the proper treatment, you can have a good quality of life while you manage kidney failure.

What do the kidneys do?

Your kidneys are bean-shaped organs about the size of your fist. They sit under your ribcage, toward your back. Most people have two working kidneys, but you can live well with only one kidney as long as it’s functioning well.

Kidneys have several jobs. One of the most important jobs is helping your body eliminate toxins. Your kidneys filter your blood and send waste products out of your body in urine (pee).

When your kidneys don’t work correctly, waste products build up in your body. If this happens, you’ll feel sick and eventually die without treatment. Many people can manage kidney failure with the proper treatment.

How common is kidney failure?

Kidney failure affects over 750,000 people in the United States each year. It affects around 2 million people worldwide.

What are the five stages of end-stage renal disease?

There are stages of kidney disease according to your estimated glomerular filtration rate (eGFR). This is a blood test.

Your eGFR is a calculation of how well your kidneys filter substances. A normal eGFR is above 90. The lowest eGFR is 0, which means there’s no remaining kidney function.

The five stages of any kidney disease include:

• Stage I. Your GFR is higher than 90. At this stage, your kidneys have mild damage but still function normally.
• Stage II. Your GFR may be as low as 60 or as high as 89. You have more damage to your kidneys than in stage I, but they still function well.
• Stage III. Your GFR may be as low as 30 or as high as 59. You may have mild or severe loss of kidney function.
• Stage IV. Your GFR may be as low as 15 or as high as 29. You have severe loss of kidney function.
• Stage V. Your GFR is below 15. Your kidneys are nearing or at complete failure. Generally, this is when you would start to have symptoms.

What are the first warning signs of kidney failure?

Many people experience few or no symptoms in the early stages of kidney disease. However, chronic kidney disease (CKD) may still cause damage even though you feel fine.

Kidney failure symptoms vary between people. If your kidneys aren’t working properly, you may notice one or more of the following signs:

• Extreme tiredness (fatigue)
• Nausea and vomiting
• Confusion or trouble concentrating
• Swelling (edema), particularly around your hands, ankles or face
• A change in how often you pee
• Cramps (muscle spasms)
• Dry or itchy skin
• Poor appetite, or food may taste metallic

What are the most common causes of kidney failure?

Diabetes and high blood pressure are the most common causes of chronic kidney disease and kidney failure.

Unmanaged diabetes can lead to high blood sugar levels (hyperglycemia). Consistently high blood sugar can damage your kidneys as well as other organs.

High blood pressure means blood travels forcefully through your body’s blood vessels. Over time and without treatment, the extra force can damage your kidneys’ tissue.

Kidney failure usually doesn’t happen quickly. Other causes that may lead to kidney failure include:

• Polycystic kidney disease (PKD). PKD is a condition you inherit from one of your parents that causes fluid-filled sacs (cysts) to grow inside your kidneys.
• Glomerular diseases. Glomerular diseases affect how well your kidneys filter waste.
• Autoimmune kidney diseases. Lupus is an autoimmune disease that can cause organ damage, joint pain, fever and skin rashes.

Kidney failure can also develop quickly because of an unexpected cause. Acute kidney failure (acute kidney injury) is when your kidneys suddenly lose their ability to function. Acute kidney failure may develop within hours or days. It’s often temporary.

Common causes of acute kidney failure include:

• Certain medications
• Severe dehydration
• A urinary tract obstruction
• Untreated systemic diseases, such as heart disease or liver disease

What are the risk factors for kidney failure?

Kidney failure can affect anyone. However, you may be at a higher risk of developing kidney failure if you:

• Have diabetes
• Have high blood pressure (hypertension)
• Have heart disease
• Have a family history of kidney disease
• Have abnormal kidney structure
• Are Black
• Are over 60
• Have a long history of taking pain relievers, including over-the-counter products such as nonsteroidal anti-inflammatory drugs (NSAIDs)

What are the complications of kidney failure?

The kidneys have many different functions in your body. When you have kidney failure, you may develop certain complications. Complications of kidney failure include:

• High blood pressure
• Anemia
• Bone disease
• Fluid around your lungs
• Nerve damage
• Electrolyte imbalance

But just because you have kidney failure doesn’t mean death is imminent. You can still manage the condition by following your provider’s treatment plan, which may include medications, lifestyle changes and limiting salt and certain foods. If you don’t follow your provider’s treatment plan, your kidneys will worsen and eventually lead to death.

Can end-stage kidney failure cause death?

Yes, end-stage renal failure can lead to death. With the right treatment, most people can live with kidney failure. It’s important to remember that there’s no cure for kidney failure. That means even with treatment, your kidneys won’t go back to functioning as they did before you had kidney disease. Treatment helps preserve whatever function is left in your kidneys, so they don’t decline as rapidly.

How is kidney failure diagnosed?

A healthcare provider may use a variety of kidney function tests to evaluate your kidneys and diagnose kidney failure. If the provider suspects you’re at risk of kidney failure, common tests include:

• Blood tests. Blood tests show how well your kidneys remove waste from your blood. A provider will use a thin needle to withdraw a small amount of blood from a vein in your arm. Technicians will then analyze your blood sample at a lab.
• Urine tests. Urine tests measure specific substances in your pee, such as protein or blood. You’ll pee into a special container at a provider’s office or a hospital. Technicians will then analyze your urine sample at a lab.
• Imaging tests. Imaging tests allow a provider to look at your kidneys and the surrounding areas to identify abnormalities or blockages. Common imaging tests include kidney ultrasound, CT urogram and MRI.

How is kidney failure treated?

Kidney failure treatment depends on the cause and severity of the condition. Healthcare providers can’t cure kidney failure, and the disease is life-threatening. But treatment can help you live longer and manage any symptoms or complications.

If your kidneys gradually stop working, a healthcare provider may use a few different methods to track your health and maintain kidney function as long as possible. These methods may include:

• Regular blood tests
• Blood pressure checks
• Medication

If you’re in end-stage kidney failure, you need treatment to keep you alive. There are two main treatments for kidney failure: dialysis and a kidney transplant.

Medications for kidney failure

Depending on the cause of your kidney disease, a healthcare provider may prescribe one or more of the following medications:

• Angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB). These medications help lower your blood pressure.
• Diuretics. These help remove extra fluid from your body.
• Statins. These help lower your cholesterol levels.
• Erythropoietin-stimulating agents. These help build red blood cells if you have anemia.
• Vitamin Dand calcitriol. These help prevent bone loss.
• Phosphate binders. These help remove extra phosphorus in your blood.

Dialysis

Dialysis helps your body filter blood. You can think of it as giving your kidneys some relief, so they don’t have to work as hard to do their job. There are two types of dialysis:

• Hemodialysis. In hemodialysis, a machine regularly cleans your blood for you. Most people with kidney failure get hemodialysis three to four days a week at a hospital or dialysis clinic.
• Peritoneal dialysis. In peritoneal dialysis, a provider attaches a bag with a dialysis solution to a catheter in your abdominal lining. The solution flows from the bag into your abdominal lining, absorbs waste products and extra fluids and drains back into the bag. Sometimes, people can receive peritoneal dialysis at home.

Kidney transplant

A surgeon places a healthy kidney in your body during a kidney transplant to take over for your damaged kidney. The healthy kidney (donor organ) may come from a deceased donor or a living donor. You can live well with one healthy kidney. If you receive a kidney transplant, you’ll be on medications for the rest of your life to prevent any harm to the transplanted kidney.

Can you recover from end-stage kidney failure?

It depends. With proper treatment, you can continue to live a happy, fulfilling life. But, you can expect to need treatment for the rest of your life. Remember, you can’t reverse kidney disease or kidney failure, you can only slow its progression.

How can I prevent kidney failure?

Though kidney failure and CKD aren’t reversible, you can take steps to help preserve your kidney function. Healthy habits and routines may slow down how quickly your kidneys lose their ability to function.

If you have CKD or kidney failure, it’s a good idea to:

• Monitor your kidney function
• Keep your blood sugar levels in the normal range if you have diabetes
• Keep your blood pressure levels in a normal range
• Avoid using tobacco products
• Avoid foods high in potassium and sodium
• Go to every regularly scheduled appointment with your healthcare provider

What can I expect if I have kidney failure?

There isn’t a cure for kidney failure. However, with proper diagnosis and treatment, you may still live a long life without drastic changes to your quality of life.

When should I see a healthcare provider?

Contact a healthcare provider if you have kidney failure risk factors, including:

• High blood pressure
• Changes in your peeing habits
• Brain fog
• Nausea or vomiting
• Diabetes
• A family history of kidney disease
• A past kidney injury
• You regularly take NSAIDs

What questions should I ask a healthcare provider?

Consider asking your provider the following questions about kidney failure:

• How do you know that I have kidney failure?
• If I don’t have kidney failure, what other condition might I have?
• What’s the cause of my kidney failure?
• Do I need dialysis?
• What kind of dialysis do you recommend?
• Am I a good candidate for a kidney transplant?
• What medications do you recommend?
• Should I make any changes to my diet?
• How often do I need to come in for treatment?

When is it time for hospice if you have kidney failure?

Deciding when it’s time for you or a loved one to receive hospice care is a personal decision. Your healthcare team can help you decide what’s best for your situation. The goal of hospice care is to provide comfort and support for people with end-stage diseases, like kidney failure. Hospice for kidney failure typically happens once treatments like dialysis or a transplant are ineffective or not possible.