End Stage Kidney Disease (ESKD)...

...the "you know who" sings...


The Show Is Over 


  • In the early stages of CKD, renal replacement therapy is not needed.  While not fully functional, the beans can still 'hum' along.

  • Once at Stage 5, End Stage Kidney Disease or ESKD, the kidneys have actually failed to the point of needing the 'back-up singers' to take over.

  • There are basically three options (modalities) in place that are used as renal replacement therapies.  Of course nothing is available that can perfectly replace the original 'instrument'!

  • The guideline for starting a replacement 'mode' is based on remaining function at or below 15%, coupled with symptoms of ESKD.



Pump Up the Volume


  • Kidney failure can be supported by giving treatments called dialysis, which comes in two 'versions'.

  • The more 'popular' type is hemo (or blood) dialysis.

  • Most often done in an out-patient center, hemodialysis requires a way to access the blood stream.

  • Surgery to create grafts or fistulas (typical types of access) are usually placed in the arm.

  • A 'sharp' needle is used to get the blood.

  • Sometimes a catheter in a blood vessel is needed when the arm access is not mature ('flat').

  • Treatments are 'set' for 2-3 times a week and frequently last for 4 hours.

  • Dirty blood is 'pumped' out of the body, cleaned and returned using special equipment and a complex treatment prescription provided by the doctor.

  • 'Measured' excess fluid, along with waste material, are removed from the body.

  • Patients may choose to do this dialysis treatment at home, but it requires a 'duet' (two people) to learn how to administer the equipment.



The Beat of a Different Drum


  • The second type of dialysis therapy is called peritoneal (or belly) dialysis.

  • This is a treatment that is 'performed' by the patient at home.

  • Even thought it is a 'solo' gig, it is most desireable to have a family member or friend learn the procedure as well.

  • The filter in peritoneal dialysis is the lining of the abdominal cavity (called the peritoneum).

  • Special fluid is placed in the peritoneum through a catheter (tube) that has been surgically placed.

  • The fluid dwells for several hours and the filtration allows waste and excess fluid to be pulled into the space.

  • The cavity is then drained to remove the dirty fluid - and clean fluid is again put inside.

  • These exchanges can happen periodically throughout the day, or, by using a machine at night, while at 'rest'.



I've Got A New Song to Sing



  • The final modality to review is transplantation.

  • This ranks on the top of the 'charts' for best treatment type.

  • Most kidney donations come from accident victims, however, sometimes people will give a live donation to a friend or relative in need.

  • The most important step to determine if the kidney will work is the tissure typing.

  • Our bodies natural defense mechanism is to fight off foreign bodies, so a foreign kidney, even if a match, will create the body to go into rejection mode