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Stage 5 of Chronic Kidney Disease

A person with stage 5 chronic kidney disease (CKD) has end stage renal disease (ESRD) with a glomerular filtration rate (GFR) of 15 ml/min or less. At this advanced stage of kidney disease, the kidneys have lost nearly all their ability to do their job effectively, and eventually dialysis or a kidney transplant is needed to live.

Symptoms that can occur in stage 5 CKD include:

  • Loss of appetite
  • Nausea or vomiting
  • Headaches
  • Being tired
  • Being unable to concentrate
  • Itching
  • Making little or no urine
  • Swelling, especially around the eyes and ankles
  • Muscle cramps
  • Tingling in hands or feet
  • Changes in skin color
  • Increased skin pigmentation

Because the kidneys are no longer able to remove waste and fluids from the body, toxins build up in the blood, causing an overall ill feeling. Kidneys also have other functions they are no longer able to perform such as regulating blood pressure, producing the hormone that helps make red blood cells and activating vitamin D for healthy bones.

If you are diagnosed with stage 5 CKD, you will need to see a nephrologist immediately. This is a doctor who is trained in kidney disease, kidney dialysis and transplant. The doctor will help you decide which treatment is best for you— hemodialysis, peritoneal dialysis (PD) or kidney transplant—and will recommend an access for dialysis. Your nephrologist will develop your overall care plan and manage your healthcare team.

There are two types of dialysis: hemodialysis and peritoneal dialysis

Hemodialysis requires that an access be created to get the blood from your body to the dialyzer (artificial kidney) so it can be cleaned and then go back into your body. Because in stage 5 the kidneys are no longer working, dialysis must begin soon. A catheter will be placed into a vein in the neck, chest or groin. This is considered a temporary access. If you decide to remain on hemodialysis, your nephrologist will likely recommend you get a fistula created, which is a permanent access. To create a fistula, an artery and vein are surgically connected in the forearm. It takes a few months for the fistula to mature so that it can be used for dialysis. There is another type of access called a graft that uses artificial tubing to connect the artery and vein. It takes three to six weeks to heal so that it can be used for dialysis.

For PD, a catheter access is placed in the abdomen. PD is performed by running dialysate solution through the catheter into the peritoneum and then removing the solution after a time and replacing it with new dialysate. The peritoneal membrane that lines the peritoneum is a semipermeable membrane that does the filtering for the kidney. There are different methods of performing PD. Some people manually drain and fill their abdomen every four to six hours, which is called continuous ambulatory peritoneal dialysis (CAPD). Others use an automated machine, called a cycler, which works while they sleep and then do a manual exchange in the morning. This is called continuous cycler peritoneal dialysis (CCPD). There is another choice called nocturnal intermittent peritoneal dialysis (NIPD) where PD is performed at night while sleeping. With NIPD, no exchanges are done during the day.

Most people report feeling much better once they begin dialysis. As the toxins are removed from their blood and they receive medicines that replace the functions the kidneys can no longer perform, they find they can enjoy a good quality of life.

Changes in the diet

Once you begin dialysis, you will need to make changes in what you eat and drink. Your diet is a big part of your treatment, so you will be working with a dietitian who will coach you on how you should eat. Depending on the dialysis treatment you choose and your lab test results, your dietitian will help create a meal plan based on your individual requirements to keep you feeling your best. People on hemodialysis generally need to increase their protein, and limit fluids, sodium, potassium and phosphorus, and in some cases, calcium. Those who choose PD usually need to increase their protein and limit phosphorus, but may have fewer limits on fluid and potassium. Your dietitian will explain what foods are restricted and which ones are recommended on the renal diet.

A healthy diet for stage 5 CKD may recommend:

  • Including grains, fruits and vegetables, but limiting or avoiding whole grains and certain fruits and vegetables that are high in phosphorus or potassium
  • A diet that is low in saturated fat and cholesterol and moderate in total fats, especially if cholesterol is high or if you have diabetes or heart disease
  • Limiting intake of refined and processed foods high in sodium and prepare foods with less salt or high sodium ingredients
  • Aiming for a healthy weight by consuming adequate calories and including physical activity each day within your ability
  • Increasing protein intake to the level determined by the dietitian’s assessment of individual needs and to replace losses in the dialysis treatment
  • Taking special renal vitamins high in water soluble B vitamins and limited to 100 mg of vitamin C
  • Vitamin D and iron tailored to individual requirements
  • Limiting phosphorus to1000 mg or based on individual requirements
  • Limiting calcium to 2000 mg (no more than 1500 mg from calcium based phosphorus binders).
  • Limiting potassium to 2000 to 3000 mg or bases on individual requirements

Kidney transplant

If you wish to have a kidney transplant, tell your nephrologist. Your nephrologist will explain the process of how to get on a waiting list for a cadaverous kidney or how to find a living donor.

When at stage 5 CKD, either dialysis or a kidney transplant is necessary to continue living.

If you would like to see a doctor who specializes in the care of kidneys, called a nephrologist, you can use DaVita's Find a Kidney Doctor tool to locate a nephrologist in your area.

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