The two kidney bean-shaped organs are about the size of two fists, located below the rib cage on both left and right sides. The kidneys are extremely valuable to the body, as they excrete waste products, maintain fluid and electrolyte balance, and produce hormones. And if their function becomes compromised, the rest of the body may be too. Particularly in end-stage renal disease, the kidneys are essentially on their last leg, suggestive of critical treatment to sustain life. But what truly is end-stage renal disease, what causes it, and how may it be prevented?
What Is End-Stage Renal Disease?
Also clinically recognized as end-stage kidney disease, end-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD). Kidney disease is a gradual progression and measured based on the glomerular filtration rate (GFR), or estimated glomerular filtration rate (eGFR), the measure of kidney function and determinate of kidney disease stage. The five stages are broken down as follows:
*Adapted from Krause’s Food and Nutrition Care Process
Causes and Symptoms
Although an acute injury can trigger ESRD quickly, common CKD progression generally passes gradually through the stages. Making it to stage 5 is mostly related to uncontrolled diabetes and hypertension, as consistently high blood sugars and pressures can damage the kidney’s anatomy, therefore disrupting its physiology. Other causes and risk factors of ESRD include kidney stones, congenital abnormalities, certain types of cancer, lupus, glomerulonephritis (inflammation of the kidney’s filters, known as glomeruli), and a family history of the condition. Common symptoms of ESRD include:
- Malaise (a general ill feeling) and weakness
- Nausea and vomiting
- Loss of appetite and weight loss
- Muscle cramps
- Dry and itchy skin
- Metallic taste in mouth
- Neurologic impairment
Treatment and Management
As indicated in stage 5, ESRD requires treatment, as the kidneys are no longer able function effectively. Primary treatment options include dialysis or kidney transplant while considering diet, psychological support, or palliative care:
In ESRD, dialysis is required to excrete the waste products and maintain fluid balance. Without dialysis treatment, the toxic byproducts start to build and are more than likely fatal.
When it comes to ESRD, kidney transplantation is the only alternative treatment to dialysis. In fact, a successful kidney transplant can allow you to live the way you previously did prior to kidney disease. Qualifying candidates may further require immunosuppressant therapy to best ensure a successful transplant. You can find more on kidney transplantation here.
Considerable diet recommendations are established by the National Kidney Foundation during ESRD and dialysis treatment. Nutritional considerations include monitoring sodium, phosphorus, potassium, and fluids that are further detailed here. Supplementation with micronutrients may also be warranted.
Especially in seniors or chronically ill patients, offering them palliative care may be the best option. The focus of palliative care is to relieve the symptoms and stress of a serious illness, ultimately to improve quality of life.
End-stage renal disease can be considerably stressful, no matter the decision of treatment. Psychological support may be justified to alleviate stress or reduce the risk of depression. Family members and close friends may also benefit from structured counseling, especially if they assist in the provision of care.
Currently, 90 percent of end-stage renal disease patients have chronic diabetes and hypertension, making the two conditions absolutely imperative to highlight. Ultimately, preventative measures start by preventing diabetes and hypertension, predominantly through a healthy lifestyle. But if they are to develop, it is then imperative to manage and control the status of the conditions. Additionally, early detection and treatment can reduce kidney disease progressing into end-stage renal disease or kidney failure.