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Kidney failure | |
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Other names | Renal failure, end-stage renal disease (ESRD), stage 5 chronic kidney disease[1] |
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A hemodialysis machine which is used to replace the function of the kidneys | |
Specialty | Nephrology |
Symptoms | Leg swelling, feeling tired, loss of appetite, confusion[2] |
Complications | Acute: Uremia, high blood potassium, volume overload[3] Chronic: Heart disease, high blood pressure, anemia[4][5] |
Types | Acute kidney failure, chronic kidney failure[6] |
Causes | Acute:
Chronic: [6] |
Diagnostic method | Acute: Chronic:
|
Treatment | Acute: Depends on the cause[7] Chronic: Hemodialysis, peritoneal dialysis, kidney transplant[2] |
Frequency | Acute: 3 per 1,000 per year[8] Chronic: 1 per 1,000 (US)[1] |
Kidney failure, also known as end-stage renal disease (ESRD), is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels.[2] Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly and can often be irreversible.[6] Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion.[2] Complications of acute and chronic failure include uremia, hyperkalemia, and volume overload.[3] Complications of chronic failure also include heart disease, high blood pressure, and anaemia.[4][5]
Causes of acute kidney failure include low blood pressure, blockage of the urinary tract, certain medications, muscle breakdown, and hemolytic uremic syndrome.[6] Causes of chronic kidney failure include diabetes, high blood pressure, nephrotic syndrome, and polycystic kidney disease.[6] Diagnosis of acute failure is often based on a combination of factors such as decreased urine production or increased serum creatinine.[3] Diagnosis of chronic failure is based on a glomerular filtration rate (GFR) of less than 15 or the need for renal replacement therapy.[1] It is also equivalent to stage 5 chronic kidney disease.[1]
Treatment of acute failure depends on the underlying cause.[7] Treatment of chronic failure may include hemodialysis, peritoneal dialysis, or a kidney transplant.[2] Hemodialysis uses a machine to filter the blood outside the body.[2] In peritoneal dialysis specific fluid is placed into the abdominal cavity and then drained, with this process being repeated multiple times per day.[2] Kidney transplantation involves surgically placing a kidney from someone else and then taking immunosuppressant medication to prevent rejection.[2] Other recommended measures from chronic disease include staying active and specific dietary changes.[2] Depression is also common among patients with kidney failure, and is associated with poor outcomes including higher risk of kidney function decline, hospitalization, and death. A recent PCORI-funded study of patients with kidney failure receiving outpatient hemodialysis found similar effectiveness between nonpharmacological and pharmacological treatments for depression.[9]
In the United States, acute failure affects about 3 per 1,000 people a year.[8] Chronic failure affects about 1 in 1,000 people with 3 per 10,000 people newly developing the condition each year.[1][10] In Canada, the lifetime risk of kidney failure or end-stage renal disease (ESRD) was estimated to be 2.66% for men and 1.76% for women.[11] Acute failure is often reversible while chronic failure often is not.[6] With appropriate treatment many with chronic disease can continue working.[2]