1st Revision: Isobel Lester Short Introductory Video
Introduction
Permanent loss of kidney function, known as chronic kidney disease (CKD), occurs over time. Once your kidneys are damaged, they cannot filter blood or perform other necessary functions to keep you healthy. Most patients with CKD die from other vascular diseases, not from CKD itself.(1)
With stage 5 CKD, your life expectancy is determined by factors such as your treatment preferences and general health. It is important to remember that today's kidney failure treatments can help you live a quality life.
There are five stages of CKD:
- Stages 1 and 2 are the mildest - where the kidneys are partially damaged and do not function properly.
- Stage 3 - around half of the kidney function is lost in this stage.
- Stage 4 - the kidneys become severely damaged. So, it is critical to slow the progression of CKD by sticking to your treatment plan and taking care of other issues like high blood pressure or heart disease.(2)
Stage 5 Chronic Kidney Disease
The final stage of chronic kidney disease is stage 5 CKD, where the kidneys are on the verge of failure, or they are already in kidney failure.(3)
The kidneys no longer perform its usual function, and you will need a kidney transplant or dialysis to live.
Common symptoms include; failure to regulate blood pressure, decreased bone strength, inability to create new red blood cells, swelling in the ankles or feet, trouble breathing, reduced appetite, and unintended weight loss.
Complications
Impaired kidney function can lead to many complications such as:(4)
- Anaemia: A lack of red blood cells may require injections of a growth factor called erythropoietin, a hormone that helps your body produce more red blood cells.
- Water retention: Your kidneys may not be as effective at removing fluid from your blood, causing it to build up in body tissues, leading to swelling in your ankles, feet, and hands. To reduce swelling, reduce your daily salt and fluid intake, including fluids in foods such as soups and yoghurt.
- High blood pressure: Aim to reduce blood pressure to below 140/90mmHg or 130/80mmHg if you have diabetes.
- High cholesterol: Some of the causes of kidney disease are the same as those of cardiovascular disease, including high blood pressure and high cholesterol.
- Bone problems: Your impaired kidneys cannot remove phosphate, which disrupts the balance of calcium in your body and leads to bone thinning.
How long can you live?
The factors that can influence your life expectancy with stage 5 CKD are:
Sex
Stage 1 CKD has a life expectancy of about 15 years for a 60-year-old person assigned male at birth. In the second, third, and fourth stages of CKD, this figure drops to 13 years, 8 years, and 6 years, respectively.
Stage 1 life expectancy is 18 years for a 60-year-old person assigned female at birth, while stage 2 is 17 years, and stage 3 is 11 years. In short, at all ages, people assigned female at birth have a slightly longer life expectancy than those assigned male.
However, during stages 4 and 5, these advantages disappear, and life expectancy for both sexes becomes nearly identical.(6)
Age
As age increases, life expectancy decreases. For a 70-year-old person assigned male at birth, their life expectancy for the first four stages of kidney disease would be 9 years, 8 years, 6 years, and 4 years, respectively.
Treatments
Lifestyle changes
CKD has no cure, but treatment can help relieve symptoms and prevent them from worsening. One of the objectives of lifestyle changes is to ensure that other medical conditions (e.g. diabetes, hypertension) are manageable and hence the effect of complications can be managed.(4)
- Quit smoking: Tobacco products contain many chemicals that damage DNA, and smokers have a higher risk of various diseases.
- Maintain a healthy weight: Obese people are more likely to develop kidney disease. Aim to keep your body mass index (BMI) within the normal range of 18.5 - 24.9.(5)
- Balanced diet: Eat more vegetables and fruits, and avoid processed foods. Limit sugar and salt intake to less than 6g (1 teaspoon) a day.
- Regular exercise: Attempt to do at least 150 minutes a week.
- Reduce alcohol: Do not drink more than six glasses of wine per week.
- Avoid NSAIDS: Such as ibuprofen, except when advised by a medical professional.
Dialysis
Dialysis is a method of removing waste products and excess fluid from the blood. Once it starts, it is usually required for the rest of your life. There are two main types of dialysis:(4)
- Haemodialysis involves diverting blood to an external machine where it is filtered before being returned to the body. It is usually performed three times a week, either in a hospital or at home.
- Peritoneal dialysis involves pumping dialysis fluid into a space within your stomach to remove waste products from the blood as they pass through vessels that line the inside of your stomach. It is typically performed at home several times a day or overnight.
Patients who start dialysis also have to deal with dialysis-related symptoms and ageing, and comorbidities such as diabetes.
Even in patients with no functional decline, dialysis can have no effect on prolonging a patient’s life and, at times, significantly reduces their quality of life.
As a result, it is important for the elderly, in particular, to make informed decisions with their healthcare practitioner - balancing the knowledge of a potential impact on quality of life with a therapy that could potentially prolong their life.(1)
Transplant
This is often the most effective treatment for stage 5 CKD but requires major surgery and the use of lifelong immunosuppressants to prevent your body from attacking the donor organ.
However, there is still a donor shortage, and you may have to wait months or years for a transplant, and you may need dialysis during the waiting time.(4)
Kidney transplant - survival rate
Survival rates for kidney transplants are very good. According to the National Kidney Foundation, patients in stage 5 CKD who chose dialysis treatment have a life expectancy of 5 to 10 years on average, although many patients have lived well on dialysis for 20 or even 30 years.
According to Donate Life America, patients with stage 5 CKD who chose kidney transplant, on average, find that a living donor kidney can function anywhere between 12 and 20 years, and a deceased donor kidney can improve quality of life for 8 to 12 years.(3)
FAQs
How long can you live with Stage 5 kidney failure and no dialysis?
Life expectancy without dialysis can range from days to weeks and depends on various factors, including the severity of symptoms and general health.
How long can an elderly person live with stage 5 kidney failure?
For a 70-year-old person assigned male at birth, their life expectancy for the first four stages of kidney disease would be 9 years, 8 years, 6 years, and 4 years, respectively.
Can your kidneys recover from stage 5?
There is no cure for kidney disease and kidney damage cannot be reversed.
What does it mean to have stage 5 kidney failure?
Your kidneys are on the verge of failure, or you are already in kidney failure.
Is there stage 6 kidney disease?
There are only five stages of chronic kidney disease.
Is kidney failure a painful death?
Not usually. As toxins build up in your blood, you will start to feel sleepy.
What do dialysis patients usually die from?
Sudden cardiac death is the most common cause of death among dialysis patients, accounting for 20% to 30% of all deaths.(7)
How long does it take to die when you stop kidney dialysis?
If you have been on dialysis for a long time, you will usually die within a few weeks because dialysis is your only source of kidney function.
What are the signs of dying from kidney failure?
Fatigue, drowsiness, inability to urinate, itchy skin, headache, changes in skin and nails, and difficulty breathing.
References
- Contributor NT. Assessing palliative care needs in end-stage kidney disease [Internet]. Nursing Times. 2008 [cited 2022 Jun 7].
- Key points: living with stage 4 kidney disease [Internet]. National Kidney Foundation. 2014 [cited 2022 Jun 7].
- What is stage 5 chronic kidney disease? [Internet]. Responsum Health. 2020 [cited 2022 Jun 7].
- Chronic kidney disease [Internet]. nhs.uk. 2017 [cited 2022 Jun 7].
- CDC. CDC Works 24/7 [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2022 Jun 7].
- Kidney disease life expectancy: the 5 stages [Internet]. Griswold Home Care. [cited 2022 Jun 7].
- Saravanan P, Davidson N. Risk Assessment for Sudden Cardiac Death in Dialysis Patients. Circulation: Arrhythmia and Electrophysiology. 2010;3(5):553-559
- NSAIDs [Internet]. nhs.uk. 2017 [cited 2022 Jun 7].
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