Symptoms and diagnosis

What is kidney failure or renal failure?

Kidney failure means that kidneys have failed and no longer work well enough to keep someone alive without dialysis or a kidney transplant. The word renal refers to kidneys, so you may see both of these words used. Therefore, kidney failure and renal failure mean the same thing—your kidney function is below 10% to 15% and you need renal replacement therapy to stay alive.

If your kidney failure happened suddenly, due to a reaction to medicine, an accident or other reason, that is called acute kidney failure. Sometimes with acute renal failure, kidney function can return after a time on dialysis; however, if kidneys are permanently damaged dialysis or a transplant will replace kidney function.

For most people kidney failure occurs after years of having chronic kidney disease. Your doctor may use the phrase end stage renal disease (ESRD) or Stage 5 chronic kidney disease (CKD) to indicate kidney failure. This is because chronic kidney disease has been divided into five stages by the National Kidney Foundation, so kidney failure is also called end stage or Stage 5.

The stages of chronic kidney disease are measured by the glomerular filtration rate (GFR) level. GFR indicates how much kidney function a person has. A GFR calculator is located on DaVita.com. If you know a person’s creatinine level, you can get the GFR level. The chart below shows the GFR level at each stage of kidney disease.

Stages of Chronic Kidney Disease
Stage	Description	GFR Level
Normal kidney function	Healthy kidneys	90 mL/min or more
Stage 1	Kidney damage with normal or high GFR	90 mL/min or more
Stage 2	Kidney damage and mild decrease in GFR	60 to 89 mL/min
Stage 3	Moderate decrease in GFR	30 to 59 mL/min
Stage 4	Severe decrease in GFR	15 to 29 mL/min
Stage 5	Kidney failure	Less than 15 mL/min or on dialysis

My doctor said I was in kidney failure but I still have 25% kidney function

While the pure meaning of kidney failure is that there is less than 10% to 15% kidney function, sometimes people will refer to the later stages of chronic kidney disease, including Stage 4, as kidney failure. Because chronic kidney disease happens over time, some people are able to slow the progression and prolong their kidney function or even avoid kidney failure. However, at Stage 4 your doctor will often begin talking with you about kidney failure.

Kidneys perform many jobs in the body including:

Cleaning toxins from the body
Balancing fluids in the body
Producing the hormone that signals bone marrow to make red blood cells
Keeping acidity, electrolytes and minerals in balance
Controlling blood pressure

At Stage 4 chronic kidney disease (CKD), renal function is declining and a person may feel symptoms of their renal failure, such as:

Feeling tired
Swelling in the face or ankles from too much fluid
Changes in urine frequency, color or if it’s foamy
Problems sleeping
Nausea or vomiting
Changes in the taste of food
Bad breath
Loss of appetite
Having trouble concentrating
Numbness or tingling in the fingers or toes
Itching

If you are in Stage 4 chronic kidney disease (CKD) there are choices you need to make regarding your treatment now, and once you get to renal failure. If you do not already have a nephrologist (a doctor who specializes in the care of kidneys and kidney disease), now is the time to find one. You can ask your doctor for a referral to a nephrologist. DaVita.com also has an online tool to help you find a kidney doctor.

Your nephrologist will manage your renal care. In addition to doing tests to determine the best treatment for you while you still have some kidney function, your nephrologist will explain about renal replacement therapy—dialysis and kidney transplant.

Dialysis and kidney transplant for treatment of renal failure

People who experience kidney failure are able to stay alive and enjoy a good quality of life due to renal replacement therapies. Dialysis and kidney transplantation along with certain medicines can replace the function of the kidneys. There are different types of dialysis therapies to consider depending on your lifestyle and physical needs. Your nephrologist will explain how dialysis works, discuss each treatment type and help you decide which one is right for you. If you would like a kidney transplant you will need to tell your nephrologist. You will not be automatically considered for a transplant; you have to ask. Your nephrologist will explain about getting on a waiting list for a cadaver kidney or finding a living kidney donor.

Hemodialysis options for kidney failure

Hemodialysis cleans the blood by removing it from the body, sending it through a filter known as a dialyzer or artificial kidney, and placing it back into the body. To get the blood out of and back into the body there needs to be an access. There are three types of access for hemodialysis: arteriovenous (AV) fistula, arteriovenous (AV) graft and catheter.

If you are in Stage 4, you may have time to have an AV fistula or AV graft surgically placed (usually in the arm or leg) and give it time to mature or heal before beginning hemodialysis. Kidney professionals recommend the AV fistula as the gold-standard access because it is created by directly attaching an artery and vein in your body. Because it is a natural part of the body, there are fewer complications, such as infection and clotting, than with the other access types. The graft is created by attaching an artery to a vein with a synthetic tube. The AV fistula may take a few months to mature, whereas the AV graft will take a few weeks to heal. Both of these access types allow for better blood flow than a catheter and are considered a permanent access.

People who are diagnosed with kidney failure in Stage 5 will begin dialysis immediately. In this case a catheter will be placed in the neck or chest so that the blood can be accessed for hemodialysis treatment. This temporary access can be used until a fistula or graft can be placed and has time to mature.

Hemodialysis can be performed in a dialysis center or at home. Those going to a dialysis center normally have three- to five-hour treatments three days a week. In some areas in-center nocturnal hemodialysis is available. For in-center nocturnal, patients go to the dialysis clinic three times a week and receive treatment for about six to eight hours during the night while they sleep.

At-home hemodialysis is now available in many areas across the country. Patients who choose this treatment have the flexibility of dialyzing at the time most convenient for them. In addition to the traditional three- to five-hour schedule for three days a week, at-home patients may choose nocturnal hemodialysis or short-daily hemodialysis. Short-daily hemodialysis is performed five to six days per week for about two to three hours each time.

Peritoneal dialysis options for renal failure

Peritoneal dialysis (PD) is done at home and does not require taking blood out of the body. PD removes toxins from the body by using the peritoneal membrane. The peritoneal membrane is a natural, semipermeable membrane lining inside the abdominal cavity. The peritoneal cavity holds dialysate (dialysis fluid), which allows waste and extra fluid to filter out of the bloodstream and into the cavity. After a time, the dialysate is drained and replaced with fresh fluid.

To perform peritoneal dialysis a flexible tube called a PD catheter is placed in the abdomen to get the dialysate into and out of the peritoneal cavity. The PD process of filling the peritoneal cavity with fresh dialysate, letting the fluid dwell in the abdomen for a time and then draining the dialysate is called an exchange. Peritoneal dialysis can be performed at night using a cycler machine (Automated Peritoneal Dialysis or APD) to perform exchanges, or done manually during the day (Continuous Ambulatory Peritoneal Dialysis or CAPD).

Diet and nutrition for renal failure

Diet is one of the most important treatments for renal failure. It is a treatment you control. In the earlier stages of chronic kidney disease, diet and lifestyle changes can help preserve kidney function. In the late stages of kidney failure, diet is used to prevent toxins from building up in the body between dialysis treatments.

In Stage 4 CKD a renal dietitian can help you determine what to eat based on your lab values, your medical condition and the symptoms you are feeling. The CKD non-dialysis diet is designed to help you prolong kidney function. Once you are in kidney failure your renal dietitian will meet with you regularly to go over your lab work and modify your diet based on the results. There are differences in the hemodialysis diet and the peritoneal dialysis diet because each dialysis treatment works in a different way.

Summary

Facing kidney failure can be daunting. By learning all you can about the later stages of chronic kidney disease and talking to your doctor or nephrologist about renal failure, you will be prepared to make sound decisions about your health and treatment.