CKD and End-Stage

Chronic Kidney Disease and End-Stage Renal Disease

Chronic kidney disease (CKD) is a progressive disorder in which the kidneys are damaged and unable to function properly. When the kidneys are not functioning properly to filter blood and remove waste, toxins, and excess fluid from the body, these start to build up in the body instead. Additionally, as excess fluid builds up in the body, urine production begins to decrease and blood pressure may begin to rise. There is a very tight correlation between hypertension and kidney disease. Hypertension, or high blood pressure, can damage the blood vessels throughout the body. Particularly sensitive to the damage caused by hypertension are the arteries around the kidneys. As the arteries are impacted, they do not feed blood to the kidneys as well as they should. Less blood flow means less blood being filtered.

There are five stages of CKD (including two CKD III substages): CKD 1, CKD 11, CKD III (CKD IIIA, CKD IIIB), CKD IV, and CKD V. Once the kidneys are unable to function at all to remove waste from the body, the patient is in end-stage renal disease (ESRD), which requires the patient to begin dialysis. CKD stages are based on a laboratory finding of the glomerular filtration rate (GFR). The GFR measures how much blood is being filtered by the glomeruli, which are the tiny filters in the nephrons of the kidney. The lower the GFR number, the worse the patient's kidney disease.

Unfortunately, CKD is irreversible. Treatment can slow the progression with diet, medication, and control of disease processes, such as diabetes and hypertension. Once the patient proceeds to ESRD or acute renal failure (discussed below), dialysis is required. Dialysis can be done in a hospital setting, an outpatient dialysis unit, a physician's office, or at home. There are two different types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis involves accessing the patient's blood stream via a special surgical tunnel and passing the patient's blood into an external machine that will remove the waste, toxins, and excess fluid. This is typically done 3-4 times a week for a minimum of four hours but can differ based on each patient and their unique circumstances. Peritoneal dialysis works by filling the abdomen with a fluid called dialysate. Dialysate works over an 8-to-24-hour period in the abdomen to pull toxins and wastes from the blood via osmosis. The fluid must then be drained from the abdomen.