Kidney Failure

Kidney failure means both of your kidneys no longer function well on their own to keep you alive. It’s sometimes temporary and develops quickly (acute kidney failure). Other times, it’s a result of long-term chronic kidney disease (CKD). CKD slowly gets worse and progresses to chronic kidney failure. Another name for chronic kidney failure is end-stage kidney disease (ESKD). You may hear healthcare providers call it renal failure. “Renal” is another word for kidney.

Chronic kidney failure is deadly without treatment. If you have it, you may survive a few days or weeks without treatment. But with proper life-sustaining treatment, you can live with kidney failure.

About 750,000 people in the U.S. have kidney failure. It affects around 2 million people worldwide. Experts predict it may affect more than 1 million people in the U.S. by 2030.

What are the five stages of chronic kidney disease?

There are five stages of chronic kidney disease, according to your estimated glomerular filtration rate (eGFR). Your eGFR is a calculation of how well your kidneys work. A normal eGFR is above 60. But even with a normal eGFR, your provider may still diagnose you with CKD according to additional kidney tests. The lowest eGFR is 0, which means your kidney doesn’t function at all.

The five stages of CKD include:

• Stage I: Your eGFR is higher than 90. At this stage, your kidneys function normally. Your provider will only diagnose this stage if there are changes in other kidney tests. If you have no other signs of CKD, an eGFR higher than 90 is normal for you and doesn’t mean you have kidney disease.
• Stage II: Your eGFR may be as low as 60 or as high as 89. Your kidneys still function well. Your provider will only diagnose this stage if there are changes in other kidney tests. If you have no other signs of CKD, an eGFR in this range is normal for you and doesn’t mean you have kidney disease.
• Stage III: Your eGFR may be as low as 30 or as high as 59. You have mild to moderate loss of kidney function.
• Stage IV: Your eGFR may be as low as 15 or as high as 29. You have severe loss of kidney function. You may start developing some symptoms, but not always. If you have symptoms, they’re usually mild.
• Stage V: Your eGFR is below 15. Your kidneys are nearing or at complete failure. Generally, this is when you start to have symptoms.

What are the symptoms of kidney failure?

Many people don’t experience symptoms during the early stages of kidney disease. Symptoms usually start when you have kidney failure, and they may vary. They may include:

• Feeling very tired (fatigue)
• Nausea
• Vomiting
• Confusion or trouble concentrating
• Swelling (edema), especially around your hands, ankles or face
• Peeing less than usual or not peeing at all
• Cramps or muscle spasms
• Dry or itchy skin
• Not being very hungry, or food may taste metallic

Kidney failure causes

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

Unmanaged diabetes can lead to high blood sugar levels. If your blood sugar levels are usually high, it can damage blood vessels in your kidneys and other organs.

High blood pressure means blood travels forcefully through your body’s blood vessels. Without treatment, the extra force can damage your kidneys over time.

Other causes that may lead to kidney failure include:

• Polycystic kidney disease (PKD)
• Glomerular diseases, including IgA nephropathy and others
• Autoimmune kidney diseases, including lupus
• Genetic kidney diseases

Kidney failure can also happen quickly because of an unexpected cause. Acute kidney failure is when your kidneys suddenly stop functioning. It may develop within hours or days. It’s often temporary. Common AKI causes include:

• Severe dehydration
• A blockage in your urinary system
• Diseases that can affect your whole body, like sepsis, heart disease or liver disease
• Certain medications

Risk factors

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

• Have diabetes
• Have high blood pressure
• Have heart disease
• Have a biological family history of chronic kidney disease
• Have a congenital urological abnormality that affects your kidneys’ structure
• Are Black
• Are over 60
• Have a long history of taking pain relievers, including over-the-counter products like nonsteroidal anti-inflammatory drugs (NSAIDs)

Complications

Your kidneys have many different functions in your body. When you have kidney failure, you may develop complications like:

• High blood pressure
• Low red blood cell levels (anemia)
• Bone disease
• Fluid around your lungs and/or legs
• Electrolyte imbalance, including high potassium and high blood acid levels

How is kidney failure diagnosed?

Healthcare providers may use many different kidney function tests to check on your kidneys and diagnose kidney failure. If your provider thinks you’re at risk of kidney failure, they may recommend:

• Blood tests to see how well your kidneys remove waste from your blood
• Pee tests to see if you have protein or blood in your pee
• Imaging tests, like a kidney ultrasound, to look at your kidneys and surrounding areas

Can damaged kidneys be repaired?

No, you can’t repair or reverse kidney damage once you develop CKD. But proper treatment can slow it down and keep your kidneys working as long as possible.

How is kidney failure treated?

Healthcare providers can’t cure kidney failure. If you have end-stage kidney disease, you need treatment to keep you alive. The two main treatments for kidney failure are:

• Dialysis
• Kidney transplant

In some cases, you may choose not to do dialysis or seek a kidney transplant. You may opt for conservative treatment. It focuses on managing your symptoms and quality of life rather than adding more time.

If your kidneys gradually decline, providers may use a few different methods to track your health and keep your kidneys working as long as possible. These include:

• Regular blood tests
• Blood pressure checks
• Medications
• Changes to what you eat and drink

What medications treat kidney failure?

There are no medications that can treat kidney failure. But they can help slow down the progression of CKD or manage symptoms of kidney disease. Depending on the cause of your kidney disease, your healthcare provider may prescribe one or more of the following medications:

• ACE inhibitors, ARBs or other classes of blood pressure medications to help lower your blood pressure
• Diuretics to help remove extra fluid from your body
• Statins to help lower your cholesterol levels
• Erythropoietin-stimulating agents and iron supplements to help build red blood cells if you have anemia
• Vitamin D and calcium to help prevent bone loss
• Phosphate binders to help remove extra phosphorus from your blood

Can you recover from end-stage kidney failure?

You can’t reverse kidney disease or kidney failure. But with proper treatment, many people continue to live fulfilling lives. However, you’ll need treatment for the rest of your life.

When should I see my healthcare provider?

For most people, you should get annual kidney function testing with your primary care provider. But you may need testing more often according to your medical history. Your provider will let you know whether your kidney numbers are normal based on your blood test results.

You should see a provider if you have any symptoms of kidney disease. Let them know if:

• Anyone in your biological family has kidney disease
• You take NSAIDs often
• You’ve had kidney problems in the past

If they diagnose you with kidney disease, schedule an appointment with a kidney specialist (nephrologist). They can recommend the best treatment for you.

During your appointment, you may wish to ask:

• 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 what I eat?
• How often should I come in for treatment?

What can I expect if I have kidney failure?

There’s no cure for kidney failure. But with proper diagnosis and timely treatment, you may still live a good life.

Can kidney failure cause death?

Yes, kidney failure is fatal because kidneys are essential organs. But with proper, timely treatment, most people can live with kidney failure.

How long can a person live?

Your life expectancy depends on many different factors, including:

• The treatment you receive
• Your age
• Your overall health
• The cause of kidney failure

Many people on dialysis live for several years. Nearly 9 out of 10 people are still alive five years after a kidney transplant. Your healthcare provider will give you a better idea of what to expect according to your unique situation.

Can kidney failure be prevented?

Scheduling regular appointments with your healthcare provider can help prevent kidney disease that may lead to kidney failure. You can help keep your kidneys healthy by:

• Eating well-balanced foods
• Avoiding smoking and other tobacco products
• Being active for at least 30 minutes five days a week
• Maintaining a healthy weight for you
• Taking NSAIDs only as directed
• Limiting how much alcohol you drink
• Managing underlying conditions, like diabetes or high blood pressure

There are also steps you can take to help preserve kidney function if you have kidney disease. Good habits and routines may help delay how quickly your kidneys lose their ability to work.

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

• Keep track of 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 foods that have a lot of potassium or sodium.
• Schedule regular appointments with your healthcare provider.