The 5 Stages of Kidney Failure

The kidneys are important organs that help remove toxins, waste material and surplus fluids from the body.

It also plays a critical role in regulating the blood chemicals and blood pressure, keeping the bones healthy, and stimulating red blood cells production.

When our kidneys fail to function correctly, it affects the body's muscles, nerves, and other tissues.

What’s the difference between chronic kidney disease (CKD) and kidney failure?

Chronic kidney disease (CKD) is a condition whereby the kidneys are damaged and their ability to filter waste and fluid out of the blood is damaged. This causes waste to build up in the body.

Kidney failure or end-stage renal disease (ESRD) is a condition whereby the kidneys have stopped working well enough, so the patient has to go on a dialysis or a kidney transplant to survive.

What are the symptoms and signs of kidney disease?

The symptoms are not visible at an early stage of kidney disease; however, visible signs are noticed as time goes by and the condition worsens. Some of the symptoms include:

Tiredness and having less energy
This is one of the common signs of kidney disease. Dysfunction of the kidneys results in toxic build-up in the blood. This can cause people to feel fatigued and make it difficult to concentrate.
Difficulty falling asleep
Sleep apnoea is common among those with chronic kidney problems. When the kidneys aren't working properly, toxins will build up in the blood as they cannot be eliminated through urine.
Dry and itchy skin
This is a common symptom if your kidneys are not working properly. Dryness and itchiness in the skin can signify bone or mineral disease accompanied by kidney troubles.
Muscle cramps
The imbalance of electrolytes is caused due to impaired kidney function. This causes poor levels of phosphorus and calcium, resulting in muscle cramping.
Poor appetite
This is a general symptom caused as a result of toxin build-up due to reduced kidney function.
Swollen feet and ankles
Reduction in kidney function can cause sodium retention resulting in swelling of ankles and feet.
Frequent urge to urinate
Feeling an urge to urinate at night could signify kidney disease. This occurs mainly because the filters of the kidney get damaged, increasing the urge to urinate.
Blood in the urine
Properly functioning kidneys retain the blood cells while filtering waste materials from the blood. However, if the kidney filters are not correctly working, the red blood cells leak out into the urine.
Puffiness around the eyes
Damaged kidney filters may leak proteins into the urine, causing puffiness around the eyes.
Urine is foamy
Excessive bubbles in the urine indicate that the proteins are depleted through the urine. This sometimes may appear like scrambled eggs and require many flushes to go away.

How is kidney disease diagnosed?

Here are some diagnostic methods for kidney disease:

Blood test
This is done to determine creatinine levels, a waste product in your blood.
Your doctor will analyse the results along with other factors such as:
- Age
- Gender
- Height and weight
- Ethnicity
A specific formula is then applied to take into account the above factors along with blood creatine levels to estimate glomerular filtration rate (eGFR).
Healthy kidneys should be able to filter 90 ml/min.
Urine test
Urine tests are done to:
- Determine the presence of protein or blood in the urine
- Check the creatinine and albumin levels in the urine and albumin: creatinine ratio, or ACR
Other tests
Some of the other tests to determine your kidney health are:
- Kidney biopsy - A sample of kidney tissue is taken out using a needle and observed under a microscope to check for damage
- Imaging systems - Ultrasound scan, CT scan and MRI scan to see the inner portion of kidneys

What are the causes of kidney failure?

The two main causes of kidney problems are diabetes and high blood pressure. Sometimes, the kidneys also fail due to some other reasons, such as:

Polycystic kidney disease
Damage caused due to physical injuries
Pyelonephritis or recurrent kidney infection
Prolonged obstruction in the urinary tract, caused due to cancers, kidney stones or other prostate issues
Inflammation in the kidney tubules of related areas (interstitial nephritis)
Glomerulonephritis, when there is an inflammation of the kidney's filtering units
Vesicoureteral, which is a medical condition that results in the urine being held back in the kidneys

What are the stages of kidney failure?

In general, there are five stages of kidney failure, which can be determined through specific tests.

The treatment methodology depends on the patient’s stage of kidney failure.

Stage	Description
Stage 1 - Healthy kidney function	This stage does not show any damage or problem with the kidneys. The eGFR value is 90 or more. The symptoms are mild, and tests might indicate the presence of protein in the urine.
Stage 2 - Mild decline in kidney function	Here, the damages are mild, and the eGFR values are between 60 and 89. The kidney will still be functioning as normal, but tests might show the presence of protein in the urine.
Stage 3 - Moderate decline in function	From this stage onwards, waste starts to build up in the blood as the kidneys are not properly filtering out waste and extra fluid in the blood. This may cause other health problems such as tiredness, bone diseases, and high blood pressure. Additional symptoms such as excessive tiredness and swelling in hands and feet may also appear. The eGFR value will be between 30 and 59.
Stage 4 - Severe decline in kidney functionality	At this stage, more toxins and fluid build-up in the blood. As a result, the patient faces health problems such as heart and bone diseases, and high blood pressure. In this stage, the eGFR value drops between 15 and 29. Additional symptoms such as swelling in the feet, lower back and hands may occur. The patient might need to undergo dialysis at this stage.
Stage 5 - Complete failure of the kidneys	This is a life-threatening stage in which the toxins in the blood build up excessively. As a result, the patient gets very sick and might need dialysis or a kidney transplant for survival. The eGFR value will be 15 or lower, indicating the stoppage of kidney function. Some of the symptoms include excessive tiredness, nausea, vomiting, and swelling in the feet.

What are the treatment methods for kidney failure?

The two commonly used treatment options for kidney failure are:

Kidney transplant

It is a surgical method in which a damaged kidney is removed and replaced with a healthy one. A live donor with a matching blood type is required in this case.

After a successful transplant, the patient can avoid undergoing dialysis. However, he will need to take anti-rejection medication for the rest of his life.

Dialysis

This is the immediate option to save a patient's life when his kidney fails. In this method, the body's toxic waste and excess fluids are artificially removed.

Dialysis is generally of two types.

Haemodialysis - In this procedure, two needles are placed in the arm, which will be attached to the haemodialysis. The toxic blood is pumped into the dialyser, filtered, and returned to the body. This process is continued three times a week.
Peritoneal dialysis - In this method, a catheter (soft plastic tube) is placed into the stomach by surgery. Through the catheter, a sterile cleansing fluid is pumped into the abdomen. Once the filtering process is completed, the fluid leaves the body through the catheter.

What is the life expectancy in people with chronic kidney problems?

It depends on three key factors:

The stage at which the person has been diagnosed
Age of the person
Gender of the person

A person in stages 1, 2 and 3 has a longer lifespan than a person in the 4th or 5th stage.

A 40-year-old woman diagnosed with a stage 2 chronic kidney disease can live for another 34 years, while a 40-year-old man can only expect to live for another 30 years.

However, if the kidney problem is detected at an early stage, there are multiple advanced treatments available, and the person is expected to live longer.

The life expectancy of a person with stage 4 kidney problems

Research indicates, that with efficient treatment, a person in stage 4 kidney failure may live another 14.5 years to 16.5 years.

The life expectancy of a person with stage 5 kidney problems

Data published by the National Kidney Foundation indicates that a person is stage 5 kidney disease may live up to another 5 to 10 years.

Another research shows that patients whose eGFR value is between 15-29mL may live for another 9-10 years.

Book an appointment at Pantai Hospital

In a nutshell, chronic kidney disease has no cure, but early detection, a healthy lifestyle, and proper treatment may prolong your life once diagnosed.

If you or a loved one is at risk of chronic kidney disease, contact us for an appointment with a Nephrology specialist at your nearest Pantai Hospital.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.

References

Teresa K. Chen,Daphne H. Knicely and Morgan E. Grams (1 Oct 2019) Chronic Kidney Disease Diagnosis and Management at https://jamanetwork.com/journals/jama/article-abstract/2752067 [Accessed 11 Mar 2022]
Robert Thomas,Abbas Kanso and John R. Sedor (2 June 2008) Chronic Kidney Disease and Its Complications at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2474786/ [Accessed 11 Mar 2022]
Simon DS Fraser and Tom Blakeman (1 June 2016) Chronic kidney disease: identification and management in primary care at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5087766/ [Accessed 11 Mar 2022]
National Kidney foundation at: https://www.kidney.org/news/newsroom/fsindex [Accessed 11 Mar 2022]
WHO article on kidney disease https://www.who.int/bulletin/volumes/96/6/17-206441.pdf [Accessed 11 Mar 2022]
Life expectancy with chronic kidney disease: an educational review, Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5203814/ [Accessed 11 March 2022]
Chronic kidney disease and life expectancy, Available at https://pubmed.ncbi.nlm.nih.gov/22442392/ [Accessed 11 March 2022]
Dialysis, Available at https://www.kidney.org/atoz/content/dialysisinfo [Accessed 11 March 2022]