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A person with stage 5 chronic kidney disease has end stage renal disease (ESRD) with a glomerular filtration rate (GFR) of 15 ml/min or less. At this advanced stage of kidney disease, the kidneys have lost nearly all their ability to do their job effectively, and eventually dialysis or a kidney transplant is needed to live.

Symptoms of stage 5 CKD

Symptoms that can occur in stage 5 CKD include:

• Loss of appetite
• Nausea or vomiting
• Headaches
• Being tired
• Being unable to concentrate
• Itching
• Making little or no urine
• Swelling, especially around the eyes and ankles
• Muscle cramps
• Tingling in hands or feet
• Changes in skin color
• Increased skin pigmentation

Because the kidneys are no longer able to remove waste and fluids from the body, toxins build up in the blood, causing an overall ill feeling. Kidneys also have other functions they are no longer able to perform such as regulating blood pressure, producing the hormone that helps make red blood cells and activating vitamin D for healthy bones.

If you are diagnosed with stage 5 CKD, you will need to see a nephrologist immediately. This is a doctor who is trained in kidney disease, kidney dialysis and transplant. The doctor will help you decide which treatment is best for you—hemodialysis, peritoneal dialysis (PD) or kidney transplant—and will recommend an access for dialysis. Your nephrologist will develop your overall care plan and manage your healthcare team.

Dialysis treatments for people with stage 5 CKD

Most people report feeling much better once they begin dialysis. As the toxins are removed from the blood medicines replace the functions the kidneys can no longer perform, they find they can enjoy a good quality of life. There are two types of dialysis treatments for people with stage 5 kidney disease.

1. Hemodialysis: This treatment that can be done in a center or in a patient’s home with assistance from a care partner. A dialysis machine removes a small amount of a patient’s blood through a man-made membrane called a dialyzer, or artificial kidney, to clean out toxins that the kidneys can no longer remove. The filtered blood is then returned to the body.
2. Peritoneal dialysis (PD): Unlike hemodialysis, PD is a needle-free treatment and a care partner is not required to to help assist during treatment. PD can be performed at home or at work.

Kidney transplant is another treatment option

If you wish to have a kidney transplant, tell your nephrologist. Your nephrologist will explain the process of how to get on a waiting list for a cadaverous kidney or how to find a living donor.

When at stage 5 CKD, either dialysis or a kidney transplant is necessary to continue living.

Changes in the diet for people with stage 5 CKD

Once you begin dialysis, you will need to make changes in what you eat and drink. Your diet is a big part of your treatment, so you will be working with a dietitian who will coach you on how you should eat. Depending on the dialysis treatment you choose and your lab test results, your dietitian will help create a meal plan based on your individual requirements to keep you feeling your best. Your dietitian will explain what foods are restricted and which ones are recommended on the renal diet.

A healthy diet for stage 5 CKD may recommend:

• Including grains, fruits and vegetables, but limiting or avoiding whole grains and certain fruits and vegetables that are high in phosphorus or potassium
• A diet that is low in saturated fat and cholesterol and moderate in total fats, especially if cholesterol is high or if you have diabetes or heart disease
• Limiting intake of refined and processed foods high in sodium and prepare foods with less salt or high-sodium ingredients
• Aiming for a healthy weight by consuming adequate calories and including physical activity each day within your ability
• Decreasing calcium intake if necessary
• Limiting fluid intake
• Increasing protein intake to the level determined by the dietitian’s assessment of individual needs and to replace losses in the dialysis treatment
• Taking special renal vitamins high in water soluble B vitamins and limited to 100 mg of vitamin C
• Vitamin D and iron tailored to individual requirements

Find a doctor when you have stage 5 CKD

When a person learns he or she has stage 5 kidney disease, working with a nephrologist is necessary to ensure they have the right tools to treat their condition.