This is when a patient’s kidneys are unable to remove wastes and excess fluid from the blood. Kidney failure is divided into two general categories, acute and chronic.  

Acute kidney injury occurs suddenly and may be the result of injury, loss of large amounts of blood, drugs or poisons. Kidneys may return to normal function if they are not too badly damaged.

Chronic kidney disease means kidney function has slowly worsened over a number of years and often the kidneys do not get better. When chronic kidney disease has progressed to end stage kidney disease (ESKD), it is considered irreversible or unable to be cured.

 

End Stage Kidney Disease (ESKD)
End stage kidney disease (ESKD) has many causes but no cure. When almost all kidney function is lost, one of the existing treatment types (renal replacement therapy) must be used to maintain life.  Specialist input from a skilled physician (renal physician, also called nephrologist) is necessary.

Renal replacement therapy is a treatment that removes wastes and excess fluid from the blood when patients’ kidneys are not able to do it on their own. It comes in a number of forms, both continuous and intermittent, involving filtration and dialysis. In acute kidney injury, the dialysis may only be needed for a few days or weeks while the kidneys recover. In some cases long-term dialysis and or a kidney transplant may be needed.

Regular blood tests and urine tests are necessary to see how fast your kidney problem is progressing. The renal physician will look at many issues, like your fluid balance, the concentration of waste products in your body and the influence of renal disease on many of your body's functions such as blood pressure and your bones, to name a few.

Together with the renal physician you will discuss when the moment has come to seriously think about one of the dialysis options, as mentioned below. The renal physician will then refer you to a predialysis educator. This is a nurse with special skills who will discuss with you the options that there are in dialysis. Looking at your specific situation, the nurse will discuss any problems connected with a type of treatment with your healthcare team and help you choose the best type for you and your medical condition.  Later, when you have been on dialysis for some time, or a transplanted kidney no longer works, you may decide to use another type of treatment e.g. you may start on peritoneal dialysis (PD) and then switch to haemodialysis (HD) in the unit or at home.