Chronic Kidney Disease (CKD) Stage 5
Dr. Satish Balan
KIMSHEALTH Trivandrum
Nephrology,Kidney Transplant
Chronic Kidney Disease (CKD) Stage 5
CKD stage 5 is often referred to as ESRD, end-stage renal disease or kidney failure. It is the last stage of kidney disease in which the kidneys have nearly lost all of their abilities to perform their functions, and the GFR drops to less than 15 mL/min/1.73 m². This implies that the kidneys can no longer drain out the toxic wastes and fluid from the blood, which leads to toxin collection in the body.
Symptoms of CKD Stage 5
Symptoms of renal failure include:
- Feeling fatigue and weakness
- Nausea and vomiting due to accumulation of waste in the blood
- Loss of appetite
- Difficulty breathing due to fluid accumulation
- Edema in the extremities, face, and abdomen
- Pruritis or itching
- Little to no urine or passing very dark-colored urine
- Muscle cramps or twitches due to low levels of electrolytes
- Central nervous system symptoms such as confusion, inability to focus, and even seizures can occur from the toxin affecting the brain.
- Metallic taste in the mouth
- Anemia
Diagnosis
Symptoms and lab tests of CKD 5 can help diagnose it. These include:
Blood Tests a. Glomerular Filtration Rate (GFR): This is the best indicator of renal function. In stage 5 CKD, the GFR drops below 15 mL/min/1.73 m². b. Serum Creatinine: An increase in serum creatinine is indicative of renal impairment. Blood Urea Nitrogen (BUN): A raised BUN level means the kidneys are not efficiently removing waste. c. Electrolyte Imbalance: The potassium, calcium, and phosphorus levels would be abnormal.
Urine Tests a. Proteinuria: This is an excess of proteins in urine. It indicates damage to the kidney. b. Urinalysis:Blood or abnormal cells in urine could be detected Imaging Tests c. Ultrasound:This can reveal the size and shape of the kidneys which can be shrunken in CKDS. d. CT or MRI Scans: This may be carried out to define the anatomy of the kidneys and their surrounding organs.
Kidney Biopsy A biopsy may sometimes be taken to study the kidney tissue and determine why there is chronic renal failure.
Management
The management of CKD stage 5 consists of making lifestyle modifications, medicines and medical therapies such as dialysis or renal transplant.
Dialysis
- Hemodialysis: Through a machine, blood is filtered outside the body for waste products and excess fluids. It is done 3 to 4 times a week or more, depending on the need.
- Peritoneal Dialysis: This is a procedure whereby fluid is infused into the abdomen. It allows waste products to get sucked out through the fluid and drained. It is usually done at home.
Kidney Transplant
Another option for managing kidney disease is a kidney transplant. In this, the diseased kidney is replaced by a healthy one from a donor, be it a living or deceased individual. Long-term medications are is most often required post surgery.
Medications
Medical management is limited to providing symptomatic relief to patients. These include strengthening bones with vitamin supplements, managing anaemia with ESAs, diuretics to manage fluid accumulation and oedema, and making dietary changes.
Managing Underlying Conditions
Kidney failure impacts the existing medical conditions or disorders that cause it. These include diabetes and heart disease. Some patients may need palliative care without aggressive treatment, such as a transplant, since they might not be ideal candidates for surgery.
Conclusion
Patients with stage 5 CKD are to be followed up monthly with a nephrologist and have scheduled laboratory tests to check the status of their kidneys, electrolytes, and overall health. Gentle exercises that maintain muscle mass and cardiovascular health are essential. Medications like ibuprofen should be avoided.
Such a patient and family will require an extended level of psychological support, as disease CKD stage 5 is a chronic condition. In addition to this, the patient could require counselling and therapy depending on the specific situation involved.
The stage 5 CKD prognosis depends on the patient's overall health, secondary conditions, and whether treatments such as dialysis or a kidney transplant are available. If kidney failure is untreated, it will lead to death. However, with proper medical care, patients can still live a full life, but their lifestyles and ongoing medical treatment must be altered.
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