Stage 5 of Chronic Kidney Disease
(End Stage Renal Disease, End Stage Kidney Disease)
What is stage 5 kidney disease?
Treating kidney failure with an eGFR less than 15
If your eGFR is less than 15 and you haven’t discussed your treatment options, talk to your kidney doctor (nephrologist). You’ll want to have a plan in place with the best dialysis treatment option for you. You and your kidney doctor will determine the right time for you to start dialysis based on your eGFR, uremic symptoms, and the treatment option that’s best for you. This is also a good time to understand whether you are a good candidate for a kidney transplant.
Starting dialysis will help you feel your best and prevent hospital stays. If you are waiting for a transplant, dialysis also helps you be your healthiest while you wait.
Symptoms of stage 5 CKD (ESRD)
Many people do not experience symptoms of kidney disease until the later stages when kidney damage has occurred. Possible stage 5 kidney disease symptoms and signs include:
- Nausea, loss of appetite, and weight loss as toxins build up
- Shortness of breath from anemia or fluid buildup in the lungs
- Difficulty concentrating or confusion due to the impact of toxins on the brain
- Metallic taste in the mouth or bad breath (also known as ammonia breath)
- Fatigue—possibly caused by anemia
- Abnormal thyroid levels
- Swelling in your hands/legs/eyes/lower back
- Lower back pain
Treatment options for stage 5 kidney disease
At this advanced stage, treatments including dialysis or a kidney transplant will likely be needed to prolong your life and keep your body healthy and chemically balanced. With ESRD, it’s important to work with your nephrologist to determine which treatment option may best fit your lifestyle.
Many people start dialysis while they wait for a kidney transplant. If your nephrologist determines that it’s time for you to start dialysis, you have several options to choose from. Some dialysis treatments can be done from the comfort of home, providing greater flexibility and control.
Peritoneal dialysis (PD), for example, allows you to gradually add dialysis to your daily life with as little as one treatment session per day. PD allows the flexibility to do treatment sessions at home without the added complexity of using a machine. Talk to your doctor about whether PD is a good fit for you.
It’s important to remember that treatment should fit into your life—not the other way around. The best treatment for you is the one that makes sense for your individual lifestyle and health needs.
Dialysis
Dialysis is a life-extending treatment that gets rid of unwanted toxins, waste products, and excess fluids in your body, by filtering your blood. There are two types of dialysis that can be done at home: peritoneal dialysis (PD) and hemodialysis (HD). HD can also be done in-center, and some centers also offer hemodiafiltration, an advanced treatment that combines HD with additional filtration.
Your nephrologist will decide when the best time is for you to start dialysis. You will want to talk about the type of dialysis treatment that is best for you. For many people, PD offers the most gradual and gentlest start to treatment. PD may be able to preserve your existing kidney function and reduce ESRD symptoms to help you feel better with as little as one treatment session per day. If you start with PD, you’ll learn how to do dialysis at home and have the added flexibility to schedule PD treatments around your daily life.
As your ESRD progresses, you will need additional dialysis treatments, and the type of dialysis that’s best for you may change. Adjusting your dialysis treatments to match your body’s needs will help you be ready for a kidney transplant when the time comes.
- Peritoneal dialysis (PD)
PD uses the blood vessels in the lining of your abdomen—the body's natural filter—along with a solution called dialysate to filter and clean your blood. With this method, blood never leaves your body. Peritoneal dialysis can be done manually or with a machine at home, at work, or while traveling. - Hemodialysis (HD)
HD filters your blood through a dialysis machine to remove toxins, waste, and excess fluid. Blood flows into the machine, gets filtered, and returns to your body. HD can be performed in your home or in a dialysis center.
Kidney transplant
Steps to take at stage 5 kidney disease
See a nephrologist regularly
It's important to have your lab values and symptoms monitored closely to track progression. Continue to see your primary care doctor and any other specialists to monitor any other health conditions.
Meet with your insurance coordinator
When preparing for treatment, make sure you have your best possible health insurance coverage. Before making any changes to your plan, talk to your insurance coordinator to help you understand your health coverage options.
Continue following a kidney-friendly diet
A healthy stage 5 kidney disease diet may involve limiting or monitoring your intake of things like potassium, phosphorus, sodium, or fluids. If you plan to start dialysis, your dietary needs may change. Talk to your renal dietitian about which kidney-friendly foods are the best choices for you. Eating well can help you stay your healthiest and feel your best.
Prepare for treatment
If you've chosen home dialysis, prepare your treatment space and learn what to expect from your dialysis training. If you've chosen in-center dialysis, schedule a tour with your local dialysis center.
Build your support network
Reach out to people who care about you and can help support you. Friends, family, and your care team all want you to feel your best.
Stage 5 kidney failure life expectancy
ESRD is the end stage of kidney function—not the end stage of life. Life expectancy with ESRD can depend on many factors, including your treatment plan and overall health. While there’s no cure for kidney disease and loss of kidney function can’t be reversed, there are treatment options that can help you live well for decades.
Questions to ask your doctor about stage 5 kidney disease
Having an active role in your care is important. Think about making a list of questions for your doctor and kidney care team to make sure you have all the information you need.
What can I expect from kidney failure treatment?
There are several treatment options to help you feel your best and live a full life. Whether it’s a kidney transplant, dialysis at home, or dialysis in a center, your nephrologist can help you decide which treatment best fits your lifestyle.
Am I a candidate for a kidney transplant? If so, what do I need to do?
Your best chance for a successful transplant depends on certain factors. Talk to your nephrologist to see if you are a candidate. It's a good idea to start the planning process and begin searching for a kidney donor as soon as possible.
How do I manage a dialysis schedule if I am working?
Your nephrologist will work with you to find a treatment schedule that aligns with your health needs and lifestyle. Home peritoneal dialysis or home hemodialysis may give you the most flexibility.
Do I need to make changes to any medications I’m taking?
If you're living with diabetes or high blood pressure, your doctor may make adjustments to your medication. Make sure you discuss all medications, vitamins, and supplements you're taking with your doctor, as some may need to be avoided.
Frequently asked questions about stage 5 kidney disease (ESRD)
Moving forward with confidence
Remember, you are not alone. By working closely with your care team and embracing the resources available, you can continue to live a full life, maintain your well-being, and navigate the path ahead with confidence and peace of mind.
Which treatment option is right for you?
