What Is Kidney Failure?

Kidney failure—also called end-stage renal disease—occurs when your kidneys can no longer perform their function. You can have kidney failure due to many underlying health conditions, including diabetes and high blood pressure. Over 800,000 people in the U.S. are living with kidney failure—and unfortunately, kidney disease is on the rise.

Although kidney disease often doesn’t cause any symptoms at first, untreated kidney failure can lead to serious problems, including seizures, coma, and death. However, you can manage the condition successfully with a kidney transplant or dialysis.

Types of Kidney Failure

Kidney failure can come on quickly or more gradually over a longer period of time. You might experience kidney failure due to acute (sudden) disease or chronic (long-term) disease.

Kidney Failure from Acute Disease

In acute kidney failure, your kidney can become damaged very quickly—sometimes in a matter of hours or a few days. This can happen when you develop a serious infection or sustain a kidney injury that rapidly stops your kidney from functioning normally.

Fortunately, acute kidney failure can be reversible and treatable with temporary dialysis. Other times the damage is more permanent. Seeing your healthcare provider as soon as you notice symptoms or sudden pain can help you get an earlier diagnosis, which can help get you started on treatment sooner.

Kidney Failure From Chronic Disease

If you develop kidney failure due to a chronic condition, it's likely you've had kidney problems for a longer period of time. Typically, people with chronic kidney disease have lived with their condition for at least three months. Unfortunately, long-term disease can increase your risk of kidney failure without the possibility of reversing your condition. 

However, if you receive an early diagnosis and have a treatment plan that is slowly helping you improve your symptoms, you and your healthcare provider may have more time to prepare for long-term treatment options for kidney failure, such as ongoing dialysis or a kidney transplant. 

Symptoms

Kidney failure symptoms occur when your kidneys are no longer functioning properly. Early-stage kidney failure doesn't always produce symptoms, even if your kidneys aren't working perfectly. However, as kidney failure progresses, you might experience the following symptoms:

• Anemia: Your kidneys aren't able to help your body produce normal red blood cells, which can cause symptoms such as shortness of breath, fatigue, and pale skin.
• Uremia: The function of your kidneys is to help remove waste from your body. However, when your kidneys aren't functioning well enough to eliminate waste, you can develop uremia, which produces symptoms such as nausea and vomiting, fatigue, muscle cramps, trouble thinking, and seizures.
• Fluid imbalance: If your kidneys aren't able to get rid of excess fluid through your urine as they are normally able to, you can develop symptoms like swelling in the arms and legs, high blood pressure, and a serious complication that causes fluid in your lungs.
• Electrolyte problems: Kidney failure can change the level of important electrolytes in your body (e.g., potassium, sodium, calcium). As a result, you may experience a change in heart rhythms, confusion, and weakness in your muscles and bones.
  

Causes

Many different types of problems can cause your kidneys to no longer perform their basic functions. The following underlying health conditions can contribute to kidney failure:

• Diabetes
• Very low blood pressure
• Side effects of certain medications such as Capoten (captopril) or Advil (ibuprofen)
• Kidney infections
• Hydronephrosis (excess backup of urine in the kidney) due to a kidney stone
• Inflammation of the kidneys
• Uncontrolled high blood pressure
• Genetic causes of kidney disease, such as polycystic kidney disease or Alport disease
• Autoimmune disorders such as lupus
• Congenital (present at birth) abnormalities of the kidneys

Risk Factors

Certain factors can also increase your risk of kidney disease and accelerate how quickly your kidneys fail. These risk factors include:

• Being assigned male at birth
• Smoking tobacco
• Eating a high salt and high protein diet
• Having underlying health conditions such as diabetes, hypertension, and cardiovascular disease

Diagnosis

If you have an underlying kidney condition or are experiencing symptoms of kidney problems, it's best to see your healthcare provider as soon as possible for proper testing. Your provider will generally start by conducting a physical exam and asking about your medical history. They can also order other diagnostic tests including:

• Blood tests to check for abnormalities in your electrolyte levels
• Hemoglobin A1C to test for diabetes
• Urine tests to assess general kidney health
• Ultrasound to identify structural abnormalities in your kidneys
• Kidney biopsy (if necessary) to understand the specific cause of your condition, once kidney disease is known

Another important test that healthcare providers can use is the eGFR (estimated glomerular filtration rate). This can measure how much creatinine is cleared by your kidneys, which can signify how well your kidneys are functioning.

Treatment

Your exact treatment plan will depend on the underlying cause of your kidney failure and the severity of your condition. The goal of treatment for kidney failure is to improve the function of the kidneys as much as possible and treat complications.

This can include:

• Reducing dehydration with fluids or overhydration with diuretics
• Removing the use of medications that are toxic to the kidney
• Managing blood pressure
• Treating complications such as anemia and electrolyte abnormalities

However, some people with kidney failure may also need long-term or permanent treatments to replace the work the kidneys can no longer do. These treatments may include:

• Kidney transplant: Receiving a kidney from a living or deceased donor to replace the kidney(s) in your body that is no longer functioning properly. However, you will still need to take medications every day to keep your immune system from rejecting your kidney.
• Hemodialysis: Hemodialysis is a medical procedure that helps your body filter waste and excess fluid from your blood. You will be hooked up to a dialysis machine that connects to your arm and will be required to come in for dialysis treatments at a clinic multiple days a week.
• Peritoneal dialysis: A different type of dialysis that uses your stomach lining to filter blood inside of your body. This dialysis can be performed at home but will require you to undergo treatment multiple times a day.
• Supportive care: Unfortunately, not all types of end-stage kidney failure are treatable. In such cases, some people with kidney failure decide to not continue with their treatment. Instead, the healthcare team provides supportive care to make the person feel comfortable during their final days.
  

How to Prevent Kidney Failure

Sometimes, acute kidney failure can't be prevented. However, if you have a chronic kidney condition that increases your risk of kidney failure, there are some things you can do to reduce your risk of kidney failure or delay the time it takes until your kidneys start to fail.

This may include:

• Lowering blood pressure through lifestyle changes and medication
• Reducing your blood sugar or maintaining a healthy range if you have diabetes
• Treating related underlying conditions such as heart disease
• Practicing healthy habits such as getting enough sleep, eating a nutritious diet, practicing stress management techniques, participating in daily exercise, and increasing your water intake

Related Conditions

People with kidney failure have a higher risk of developing other conditions. These include:

• Heart attack and heart failure
• Stroke
• Abnormal heart rhythms
• High blood pressure
• Depression

If you have one of the above health conditions or receive a diagnosis for kidney disease and are worried about your risk of developing related conditions, talk to your healthcare provider about your concerns. They can help you find a treatment plan and educate you about prevention strategies to keep symptoms at bay.

Sometimes, depression can occur because of the medical challenges of undergoing kidney failure and the change in your quality of life. If you think you may need extra emotional support, ask your provider for a referral to a mental health professional. Taking care of your mental health during this time is just as important as following your treatment plan.

Living With Kidney Failure

Without treatment, kidney failure is fatal. People who get kidney transplants tend to live longer than those living long-term on dialysis.  On average, people live for five to ten years after starting dialysis, but many people live much longer.

Fortunately, although dialysis is expensive, it is not usually unaffordable. In the U.S., people who need dialysis are eligible to enroll in Medicare, and the government pays 80% of dialysis costs for most people.

Dialysis can be a stressful change that requires major adjustments. But many people successfully adapt and lead fulfilling lives. Talk to your healthcare provider on ways to improve your overall quality of life while living with your condition. They may suggest ideas such as participating in light activities or hobbies you enjoy, spending time with loved ones, and practicing stress management techniques.