From the Guidelines
Kidney failure, which requires dialysis or transplantation, is typically considered to occur at Stage 5 chronic kidney disease (CKD), defined by a glomerular filtration rate (GFR) of less than 15 mL/min/1.73m², as indicated by the most recent guideline 1.
Definition and Diagnosis
This stage is characterized by the kidneys having lost about 85-90% of their function, leading to uremia and symptoms such as nausea, vomiting, itching, fatigue, and confusion. The diagnosis of kidney failure is based on a composite assessment of a person’s symptoms, signs, quality of life (QoL), preferences, level of GFR, and laboratory abnormalities, as recommended by the KDIGO 2024 clinical practice guideline 1.
Treatment and Management
Treatment decisions between dialysis (either hemodialysis or peritoneal dialysis) and kidney transplantation depend on multiple factors including patient age, comorbidities, and personal preference. Some patients may initially choose conservative management without dialysis, focusing on symptom control. The KDIGO guideline suggests initiating dialysis if the presence of one or more of the following situations is evident: symptoms or signs attributable to kidney failure, inability to control volume status or blood pressure, progressive deterioration in nutritional status refractory to dietary intervention, or cognitive impairment 1.
Key Considerations
Regular monitoring of kidney function through blood tests measuring creatinine, BUN, electrolytes, and GFR is essential for tracking disease progression and determining the optimal timing for renal replacement therapy. Additionally, planning for preemptive kidney transplantation and/or dialysis access should be considered in adults when the GFR is <15–20 ml/min per 1.73 m2 or risk of KRT is >40% over 2 years, as recommended by the KDIGO guideline 1. Some key points to consider in the management of kidney failure include:
- Initiating dialysis based on a composite assessment of a person’s symptoms, signs, QoL, preferences, level of GFR, and laboratory abnormalities 1
- Considering planning for preemptive kidney transplantation and/or dialysis access in adults when the GFR is <15–20 ml/min per 1.73 m2 or risk of KRT is >40% over 2 years 1
- Regular monitoring of kidney function to determine the optimal timing for renal replacement therapy 1
From the Research
Definition of Kidney Failure
Kidney failure, also known as end-stage renal disease (ESRD), is the final stage of chronic kidney disease (CKD) where the kidneys are no longer able to perform their functions, such as filtering waste and excess fluids from the blood [ 2 ].
Stage of Chronic Kidney Disease Considered Kidney Failure
The stage of CKD considered kidney failure is stage 5, also known as end-stage renal disease (ESRD) [ 3 ]. At this stage, the kidneys have lost nearly all their ability to do their job effectively, and as a result, the body accumulates wastes, excess water, and other toxins [ 2 ].
Treatment Options for Kidney Failure
Treatment options for kidney failure include:
- Dialysis: either hemodialysis or peritoneal dialysis, which removes metabolic waste and excess body water and rebalances electrolytes to sustain life [ 2 ]
- Kidney transplant: a surgical procedure to replace the failed kidney with a healthy one from a donor [ 4 ]
Key Considerations
Key considerations for determining the best treatment option for kidney failure include: