End-Stage Renal Disease Requiring Dialysis Access
The deterioration of kidney function, or renal disease, remains a major medical problem throughout the world. High blood pressure and diabetes adversely affect the kidney. Initial renal disease is often asymptomatic, but it can easily progress to end-stage renal disease requiring dialysis. Patients undergoing dialysis need an arteriovenous or peritoneal access placed. These access shunts can become clotted and at times need revision or thrombectomy.
Definition of End-Stage Renal Disease
The extent of renal disease is defined by how well the kidneys filter toxins. The glomeruli are very small clusters of blood vessels where the blood is actually filtered within the kidney. The level of renal disease is graded by glomerular filtration rate or GFR. The definition of end-stage renal disease, also called chronic kidney disease stage five, is 15 ml/min of GFR (glomerular filtration rate). These patients usually require dialysis.
Anatomy of End-Stage Renal Disease
The kidneys are responsible for removing toxins from the body. When the kidneys become damaged and no longer are able to appropriately filter blood and exchange electrolytes patients require dialysis. A nephrologist or kidney doctor will help manage medications to maximize renal function.
Causes of End-Stage Renal Disease
There are multiple reasons why patients develop end-stage renal disease. Some patients have congenital issues such as a horseshoe kidney or polycystic kidney disease. Other patients develop kidney damage over time from conditions such as hypertension, diabetes, or HIV. Elevated glucose levels in diabetic patients can damage the glomeruli. Elevated blood pressures can also damage renal function. Certain medications may have a toxic effect and must be eliminated if possible.
Symptoms of End-Stage Renal Disease
Patients with renal disease can quickly progress to failure. Symptoms include:
- Extreme fatigue
- Loss of appetite
- Abnormal heart rhythm due to electrolyte problems
- Heart failure
- Edema (swelling)
Diagnosis of End-Stage Renal Disease
Diagnosis of End-Stage Renal Disease is mostly based on the glomerular filtration rate. Using blood tests, physicians can measure the GFR. A nephrologist will decide when and how to start dialysis.
Prevention of End-Stage Renal Disease
Patients need to maintain a healthy weight and adequately manage their chronic medical conditions. It is imperative for diabetics to achieve adequate glucose control. Those with elevated blood pressure should strive to keep blood pressure readings within normal limits. Patients should see their physicians regularly, and stay away from nephrotoxic medications.
Am I At Risk?
Patients with high blood pressure and diabetes are always at risk for renal disease. Patients with intrinsic renal disease, even without other chronic diseases are also at risk. Those with certain genetic disease such as polycystic kidney disease are also at risk of renal failure requiring dialysis.
Dialysis is the initial treatment of renal failure. A nephrologist will decide if peritoneal dialysis or hemodialysis is the best fit for a patient. Ultimately, a renal transplant eliminates the need for dialysis. However, not all patients are candidates and the waiting list can be extensive.
To learn more about treatment procedures for this condition please visit the following:
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