What Is End-Stage Kidney Failure?

Normal kidneys filter around 170 litres of blood every day and cleanse the body from accumulated waste products and also provide hormones like Vitamin D (for bone health), erythropoietin (for haemoglobin) and renin (for blood pressure).

Chronic kidney disease (CKD) is due to a gradual loss of kidney function from various diseases like diabetes, hypertension and others.

According to an international study in the Lancet, CKD is one of the leading causes of death. CKD leads to fluid and waste build-up, resulting in conditions such as high blood pressure and kidney failure (end-stage kidney disease).

In case of kidney failure, kidneys function below 15 per cent of their normal capacity which means they are unable to meet the body’s needs of excreting waste products as well as other functions of the kidney – leading also to anaemia & bone disease. ESKD prevalence in India varies from 151-232 per million population, thus a huge health problem for the growing population in our country.

How to identify it

One may not experience significant signs or symptoms in the early stages of CKD. However, the warning signs can become more prominent as the condition progresses to end-stage kidney disease and these include:

• Nausea
• Vomiting
• Loss of appetite
• Fatigue and weakness
• Sleep problems
• Changes in how much you urinate
• Decreased mental sharpness
• Muscle twitches and cramps
• Swelling of feet and ankles
• Persistent itching
• Chest pain if fluid builds up around the lining of the heart
• Shortness of breath if fluid builds up in the lungs
• High blood pressure that is difficult to control and
• Complications that may arise from this condition
• Fluid retention leading to swelling in the arms and legs, high blood pressure, or fluid in the lungs (pulmonary oedema)
• Sudden rise in potassium levels in the blood leading to an impairment in the heart's ability to function
• Heart and blood vessel disease and
• Weak bones and an increased risk of bone fractures
• Anaemia
• Decreased sex drive, erectile dysfunction or reduced fertility
• Damage to the central nervous system, which can cause difficulty in concentrating, personality changes or seizures and coma
• Decreased immune response, increasing vulnerability to infection
• Pregnancy complications for the mother and risk foe the developing foetus
• Treating end-stage kidney failure

The primary goal of managing CKD is to delay the need for dialysis or transplant. However, if once kidney failure is developed, then the best treatment for kidney failure is kidney transplantation. If a kidney transplant cannot be done because of the non-availability of a compatible donor then dialysis is initiated in symptomatic patients.

Dialysis is of two kinds --- haemodialysis and peritoneal dialysis. Hemodialysis involves using a machine for processing blood to filter out waste. The clean blood is thereafter given back to the body. This method is usually conducted three times a week and it takes four hours for each session. Peritoneal dialysis, on the other hand, can be done at home by placing a catheter in the abdomen and putting 2 litres of solution into the abdomen that can later be removed after 3-4 hours and this cycle repeated 3-4 times every day. It can also be conducted overnight as the patient sleeps through an automated machine.

A kidney transplant is the best treatment for kidney failure in terms of longevity of life, quality of life and cost as compared to dialysis. 10-year patient survival in kidney transplant is 85-90 per cent vs 20 per cent on dialysis. The donor kidney can come from a living or deceased donor. Kidney patients across ages can opt for a transplant. However, it is important that patients meet the health criteria for undergoing a transplant. Every patient should also undergo a medical and psychosocial evaluation to ensure they are a good candidate for a transplant. The evaluation helps detect potential problems, so they can be addressed before transplant. The time after surgery is equally critical to ensure that the transplant is a success. Undertaking measures such as consumption of a healthy diet, regular exercise, avoiding stress, having a positive outlook, taking regular medication as prescribed by the doctor, undergoing monitoring for any signs of infections and staying hydrated is important.

Kidney transplantation in India has come a long way in the last five decades in terms of overcoming surgical complexities, since the first successful transplant in 1971. A successful transplant has many benefits such as improving the patient’s quality of life, lowering the risk of mortality and decreasing lifestyle restrictions. However, though most transplants are successful and last for many years, the duration varies from person to person. Some patients may also require more than one kidney transplant during a lifetime. Therefore, it is advisable to consult a doctor to decide on the best course of treatment for end-stage kidney failure.

(The author is chairman, nephrology, Kidney and Urology Institute, Medanta)