by Kimberly Allen, RN
End stage renal failure or ESRD is the final stage for a variety of renal as well as urological diseases. ESRD is a significant health problem in the US. There are currently over 600,000 Americans suffering from ESRD with more than 80% of them being dependent on Medicare for their care. Treatment for ESRD accounts for at least 25% of the Medicare budget, with dialysis alone accounting for over $40 billion annually. Now, with CMS, the Centers of Medicare and Medicaid Services, proposing to cut approximately 10% of funding to care for dialysis patients there are concerns that both access to and quality of care will be significantly impacted.
So at what point does your renal disease become ESRD? As a rule when your kidney function has fallen to less than 10% you will receive an official diagnosis of ESRD. At this point your kidneys re no longer able to effectively filter the waste products from able to effectively filter the waste products from your blood therefore it accumulate. When waste and fluid accumulate to levels that are unhealthy it makes you feel sick. The accumulation of fluids also causes edema and this edema can be throughout your entire body from your feet and legs to your lungs and your face. When your kidneys are unable to function not only your electrolyte levels. Electrolytes are essential to good health and are in a delicate balance. When that balance is altered it can affect you in several ways including an abnormal heartbeat and confusion. Your kidneys also produce certain hormones including the parathyroid hormone and erythropoietin which signals your body to produce red blood cells. If your kidneys are unable to produce these hormones a variety of health issues can develop including anemia. Renin is an enzyme produced by the kidneys that helps to regulate certain electrolytes as well as your blood pressure. When your kidneys are not functioning properly not only will you have an alteration in your electrolyte balance your blood pressure can increase to dangerous levels. Diabetes and hypertension are the most common causes of ESRD in the US.
The symptoms you most likely will experience in ESRD include a general overall feeling of being sick with nausea and vomiting as well as loss of appetite and headaches. Your kidneys will produce very little to no urine and you will notice swelling not only in your feet and ankles but in your face, especially around your eyes. Due to the electrolyte imbalance you will also most likely experience muscle cramps as well as tingling in your hands and feet and changes in the color of your skin.
The only treatment for ESRD is dialysis or kidney transplant. There are 2 types of dialysis, peritoneal and hemodialysis. Hemodialysis is used much more often than peritoneal dialysis and some believe it’s more effective. In hemodialysis, your doctor will create an access point to your blood. Your blood is then removed from your body and put through a special filter containing solutions that assist in removing the accumulated waste products from your blood and then returned to your body. Most hemodialysis treatments are done in a special dialysis center three times a week. The process usually takes 3 to 4 hours every visit. However, today many people requiring long term dialysis can be taught to do their treatments in their home. A nurse that is trained in dialysis can teach both you and a caregiver how to handle the equipment and place the needle into the access site as well as how to monitor the machine and your blood pressure during the treatment. They will also instruct you on how to clean the equipment as well as keep records and order supplies. You and any caregivers will also be taught to care for your graft or fistula. Once you have started dialysis you will also need to make changes in your diet. Because your diet is a major part of your plan of care your doctor will have you work with a dietitian.
A kidney transplant is the only other option currently available to treat ESRD. Kidney transplants are one of the most common transplant operations in the US. Only one kidney is needed to replace the two diseased ones. Kidneys can be donated either from a living relative or non-relative as well as from a deceased donor. Research indicates that approximately 90% of kidney transplant recipients survive at least 3 years after transplant compared to 50% of patients receiving dialysis after 3 years.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.