What is kidney failure?

• Kidney failure (renal failure) means one or both of your kidneys no longer function well on their own. Kidney failure is sometimes temporary and develops quickly (acute). Other times it’s a chronic (long-term) condition that slowly gets worse.
• Kidney failure is the most severe stage of kidney disease. It’s fatal without treatment. If you have kidney failure, you may survive a few days or weeks without treatment.

What do the kidneys do?

• Your kidneys are bean-shaped organs about the size of your fist. They sit under your ribcage, toward your back. Most people have two working kidneys, but you can live well with only one kidney as long as it’s working correctly.
• Kidneys have several jobs. One of the most important jobs is helping your body eliminate toxins. Your kidneys filter your blood and send waste products out of your body in urine (pee).
• When your kidneys don’t work correctly, waste products build up in your body. If this happens, you’ll feel sick and eventually die without treatment. Many people can manage kidney failure with the proper treatment.

Who does kidney failure affect?

• Kidney failure can affect anyone. However, you may be at a higher risk of developing kidney failure if you:

• Have diabetes.
• Have high blood pressure (hypertension).
• Have heart disease.
• Have a family history of kidney disease.
• Have abnormal kidney structure.
• Are Black, Hispanic, Native American, Alaska Native or First Nation.
• Are over 60.
• Have a long history of taking pain relievers, including over-the-counter products such as non-steroidal anti-inflammatory drugs (NSAIDs).

How common is kidney failure?

• Kidney failure affects over 750,000 people in the United States each year. It affects around 2 million people worldwide.

What happens when kidney failure starts?

• There are kidney disease stages according to your estimated glomerular filtration rate (eGFR).
• Your eGFR is a calculation of how well your kidneys filter substances. A normal eGFR is about 100. The lowest eGFR is 0, which means there’s no remaining kidney function.
• The stages of any kidney disease include:

• Stage I : Your GFR is higher than 90 but below 100. At this stage, your kidneys have mild damage but still function normally.
• Stage II : Your GFR may be as low as 60 or as high as 89. You have more damage to your kidneys than in stage I, but they still function well.
• Stage III : Your GFR may be as low as 30 or as high as 59. You may have mild or severe loss of kidney function.
• Stage IV : Your GFR may be as low as 15 or as high as 29. You have severe loss of kidney function.
• Stage V : Your GFR is below 15. Your kidneys are nearing or at complete failure.

Symptoms and Causes

What are the first warning signs of kidney failure?

• Many people experience few or no symptoms in the early stages of kidney disease. However, chronic kidney disease (CKD) may still cause damage even though you feel fine.
• CKD and kidney failure symptoms vary between people. If your kidneys aren’t working properly, you may notice one or more of the following signs:

• Extreme tiredness (fatigue).
• Nausea and vomiting.
• Confusion or trouble concentrating.
• Swelling (edema), particularly around your hands, ankles or face.
• Peeing more often.
• Cramps (muscle spasms).
• Dry or itchy skin.
• Poor appetite or food may taste metallic.

What are the most common causes of kidney failure?

• Diabetes and high blood pressure are the most common causes of chronic kidney disease and kidney failure.
• Unmanaged diabetes can lead to high blood sugar levels (hyperglycemia). Consistently high blood sugar can damage your kidneys as well as other organs.
• High blood pressure means blood travels forcefully through your body’s blood vessels. Over time and without treatment, the extra force can damage your kidneys’ tissue.
• Kidney failure usually doesn’t happen quickly. Other CKD causes that may lead to kidney failure include:

• Polycystic kidney disease (PKD) : PKD is a condition you inherit from one of your parents (inherited condition) that causes fluid-filled sacs (cysts) to grow inside your kidneys.
• Glomerular diseases : Glomerular diseases affect how well your kidneys filters waste.
• Lupus : Lupus is an autoimmune disease that can cause organ damage, joint pain, fever and skin rashes.

• Kidney failure can also develop quickly because of an unexpected cause. Acute kidney failure (acute kidney injury) is when your kidneys suddenly lose their ability to function. Acute kidney failure may develop within hours or days. It’s often temporary.
• Common causes of acute kidney failure include:

• Autoimmune kidney diseases.
• Certain medications.
• Severe dehydration.
• A urinary tract obstruction.
• Untreated systemic diseases, such as heart disease or liver disease.

Is kidney failure contagious?

• No, kidney failure isn’t contagious. You also can’t spread conditions that cause CKD to another person.

Diagnosis and Tests

How is kidney failure diagnosed?

• A healthcare provider may use a variety of kidney function tests to evaluate your kidneys and diagnose kidney failure. If the provider suspects you’re at risk of kidney failure, common tests include:

• Blood tests : Blood tests show how well your kidneys remove waste from your blood. A provider will use a thin needle to withdraw a small amount of blood from a vein in your arm. Technicians will then analyze your blood sample at a lab.
• Urine tests : Urine tests measure specific substances in your pee, such as protein or blood. You’ll pee into a special container at a provider’s office or a hospital. Technicians will then analyze your urine sample at a lab.
• Imaging tests : Imaging tests allow a provider to look at your kidneys and the surrounding areas to identify abnormalities or blockages. Common imaging tests include kidney ultrasound, CT urogram and MRI.

Management and Treatment

How is kidney failure treated?

• Kidney failure treatment depends on the cause and extent of the problem.
• Treatment for a chronic medical condition can slow down the progression of kidney disease. If your kidneys gradually stop working, a healthcare provider may use a few different methods to track your health and maintain kidney function as long as possible. These methods may include:

• Regular blood tests.
• Blood pressure checks.
• Medication.

• If you’re in kidney failure, you need treatment to keep you alive. There are two main treatments for kidney failure.

Dialysis

• Dialysis helps your body filter blood. There are two types of dialysis:

• Hemodialysis : In hemodialysis, a machine regularly cleans your blood for you. Most people get hemodialysis three to four days a week at a hospital or dialysis clinic.
• Peritoneal dialysis : In peritoneal dialysis, a provider attaches a bag with a dialysis solution to a catheter in your abdominal lining. The solution flows from the bag into your abdominal lining, absorbs waste products and extra fluids and drains back into the bag. Sometimes people can receive peritoneal dialysis at home.

Kidney transplant

• A surgeon places a healthy kidney in your body during a kidney transplant to take over for your damaged kidney. The healthy kidney (donor organ) may come from a deceased donor or a living donor. You can live well with one healthy kidney.

Can a person recover from kidney failure?

• Yes, you can recover from kidney failure with proper treatment. You may need treatment for the rest of your life.

How long can you live with kidney failure?

• Without dialysis or a kidney transplant, kidney failure is fatal. You may survive a few days or weeks without treatment.
• If you’re on dialysis, the average life expectancy is five to 10 years. Some people can live up to 30 years on dialysis.
• If you have a kidney transplant, the average life expectancy if you receive a kidney from a living donor is 12 to 20 years. The average life expectancy if you receive a kidney from a deceased donor is eight to 12 years.

What medications are used to treat kidney failure?

• Depending on the cause of your kidney disease, a healthcare provider may prescribe one or more of the following medications:

• Angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB). These medications help lower your blood pressure.
• Diuretics : These help remove extra fluid from your body.
• Statins : These help lower your cholesterol levels.
• Erythropoietin-stimulating agents : These help build red blood cells if you have anemia.
• Vitamin D and calcitriol : These help prevent bone loss.
• Phosphate binders : These help remove extra phosphorus in your blood.

Prevention

How can I prevent kidney failure?

• Though kidney failure and CKD aren’t reversible, you can take steps to help preserve your kidney function. Healthy habits and routines may slow down how quickly your kidneys lose their ability to function.
• If you have CKD or kidney failure, it’s a good idea to:

• Monitor your kidney function.
• Keep your blood sugar levels in normal range if you have diabetes.
• Keep your blood pressure levels in a normal range.
• Avoid using tobacco products.
• Avoid foods high in protein and sodium.
• Go to every regularly scheduled appointment with your healthcare provider.

Outlook / Prognosis

What can I expect if I have kidney failure?

• There isn’t a cure for kidney failure. However, with proper diagnosis and treatment, you may still live a long life without drastic changes to your quality of life.

Living With

When should I see a healthcare provider?

• Contact a healthcare provider if you have kidney failure risk factors, including:

• High blood pressure, changes in your peeing habits, swelling, brain fog and nausea or vomiting.
• Diabetes.
• A family history of kidney disease.
• A past kidney injury.
• You regularly take NSAIDs.

What questions should I ask a healthcare provider?

• How do you know that I have kidney failure?
• If I don’t have kidney failure, what other condition might I have?
• What is the cause of my kidney failure?
• What kind of dialysis do you recommend?
• Am I a good candidate for a kidney transplant?
• What medications do you recommend?
• Should I make any changes to my diet?
• How often do I need to come in for treatment?