Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys no longer work.[1] It is divided into acute kidney failure (cases that develop rapidly) and chronic kidney failure (those that are long term).[5] Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, or confusion.[1] Complications of acute disease may include uremia, high blood potassium, or volume overload.[2] Complications of chronic disease may include heart disease, high blood pressure, or anemia.[3][4]
Causes of acute kidney failure include low blood pressure, blockage of the urinary tract, certain medications, muscle breakdown, and hemolytic uremic syndrome.[5] Causes of chronic kidney failure include diabetes, high blood pressure, nephrotic syndrome, and polycystic kidney disease.[5] Diagnosis of acute disease is often based on a combination of factors such as decrease urine production or increased serum creatinine.[2] Diagnosis of chronic disease is typically based on a glomerular filtration rate (GFR) of less than 15 or the need for renal replacement therapy.[6] It is also equivalent to stage 5 chronic kidney disease.[6]
Treatment of acute disease typically depends on the underlying cause.[7] Treatment of chronic disease may include hemodialysis, peritoneal dialysis, or a kidney transplant.[1] Hemodialysis uses a machine to filter the blood outside the body.[1] In peritoneal dialysis specific fluid is placed into the abdominal cavity and then drained, with this process being repeated multiple times per day.[1] Kidney transplantation involves surgically placing a kidney from someone else and then taking immunosuppressant medication to prevent rejection.[1] Other recommended measures from chronic disease include staying active and specific dietary changes.[1]
In the United States acute disease affects about 3 per 1,000 people a year.[8] Chronic disease affects about 1 in 1,000 people with 3 per 10,000 people newly develop the condition each year.[6][9] Acute disease is often reversible while chronic disease often is not.[5] With appropriate treatment many with chronic disease can continue working.[1]
Time Frame
Those undergoing kidney dialysis treatment possess a very general, average life expectancy of four years. But many scenarios come into play with some patients enjoying a bountiful life for as long as 25 years.
"We do not yet know how long patients on dialysis will live," says the National Kidney Foundation. "We think that some dialysis patients may live as long as people without kidney failure."
Statistics
However, there are more direct statistics available. Physicians estimate a patient's likelihood of survival by looking at the percentage chance of living one, two, five and 10 years after beginning treatment. This sort of formula is used among many diseases including heart disease, cancer and dialysis patients.
The National Institute of Diabetes and Digestive and Kidney Diseases reports the dialysis survival rate at close to 80 percent through one year, 64 percent through two years, 33 percent after five years and 10 percent through 10 years.
The best option for a patient waiting for a kidney is to receive one from a living donor:
Wait times for patients with living kidney donors are reduced from years to months, potentially avoiding dialysis
Transplant recipients have better outcomes with kidneys from living donors
Kidneys transplanted from living donors may last nearly twice as long as kidneys from deceased donors
About half of the transplants performed at Ohio State are performed with kidneys from living donors. Often living donors are family members, but a growing number are friends or co-workers. There are also people who choose to donate a kidney without having a specific recipient in mind. These extraordinary people are called non-directed or altruistic donors.
CLEVELAND, Ohio – Changes to the way the national kidney transplant wait list is administered will take effect next week, a move that will benefit people who typically wait longer than others for a new kidney.
Michael Brown of Euclid, who has been on dialysis since he was 20, said he'll be ready for a transplant when the call finally comes.
"The average wait for someone in Ohio is something like five years," said Brown, 31. He's been on the transplant wait list for three years.
Still, he said, "You never know. You never really know what's going to come available when."
On Dec. 4, the United Network for Organ Sharing, which maintains the country's transplant database, will enact new kidney transplant policies.
One of the criteria for matching someone on the wait list for a donor kidney is the length of time they have been on the list. For people who began dialysis before being added to the list, the new policy now calculates the waiting time from the date dialysis started.
Children who need a kidney transplant will remain at the top of the list because they face growth and developmental issues the longer they have to wait.
Brown is among the nearly 102,000 people in the U.S. - including more than 2,500 in Ohio - currently on the kidney wait list. When he was 20, he started dialysis after his kidney function – which had begun to decline when he was around 12 years old – dropped to 10 percent of normal function.
Kidney transplants in the U.S.
In 2013, 16,895 people in the U.S. – including 687 in Ohio – underwent a kidney transplant. One-third of patients nationally received a kidney from a living donor, but in Ohio, 48 percent of patients received a kidney from a living donor.
But as physically and mentally draining that dialysis is - three times a week, four-and-a-half hours at a time - Brown didn't explore the option of a kidney transplant right away.
Part of the delay, he said, was being told by physicians at another hospital that he was too heavy for transplant surgery.
Brown also said he has never been comfortable asking a friend of relative to donate a kidney to him.
Fear was another factor in his not pursuing a transplant.
"I've never had surgery before," he said. "Someone's organ being taken out of their body and put in your body, that's a jarring situation."
Over the years, Brown has lost about 30 pounds from his 6-foot-1 frame. And after changing physicians for his kidney care, and hearing about the benefits of transplant surgery, he began to look at things differently.
Three years ago, the transplant team at University Hospitals Case Medical Center – which performs a couple of kidney transplants each week - placed Brown on the kidney wait list. His wait, doctors told him, would be at least five years.
With the policy changes, Brown's credited wait time will be recalculated from three years to 11 years.
stopping dialysis
There may come a time when you feel you want to discontinue dialysis treatment. You may feel that dialysis is no longer maintaining or improving your quality of life. If this occurs, it is important to know that you have the right to make the decision to stop dialysis. However, before making this decision, it is important that you discuss it carefully with your loved ones and treatment team.
Can I really stop dialysis treatment if I want to?
Yes, dialysis patients are allowed to make decisions about stopping dialysis treatment. You are encouraged to discuss your reasons for wanting to stop treatment with your doctor, other members of your health care team and your loved ones before making a final decision.
If I ask to stop dialysis, how will the health care team at my unit respond?
The members of your health care team will want to have a clear understanding of why you made this decision (worsening health, specific treatment problems, depression) to determine if any improvements might be made that could affect your decision. Your doctor, social worker and nurse may all speak to you and encourage you to talk openly about your feelings.
