Chronic Kidney Disease, End-Stage Renal Disease, and Dialysis

close up of a dialysis machine

Kidneys, each just the size of a computer mouse, filter all the blood in the body every 30 minutes. They work hard to remove wastes, toxins, and excess fluid. They also help control blood pressure, stimulate production of red blood cells, keep your bones healthy, and regulate blood chemicals that are essential to life. Kidneys that function properly are critical for maintaining good health. More than one in seven American adults are estimated to have chronic kidney disease (CKD). There are five stages of kidney failure, all determined by the functionality of your kidneys and how well they filter your blood. Stage 5 is called End-Stage Renal Disease (ESRD). Once diagnosed with ESRD, you will require a treatment called dialysis, or a kidney transplant to survive. The two main causes of ESRD are type 2 diabetes and high blood pressure.

What is chronic kidney disease (CKD)?

Chronic Kidney Disease (CKD), also known as kidney failure, develops when a person’s kidneys become damaged and may not clean the blood as well as healthy kidneys. If kidneys do not work well, toxic waste and extra fluid accumulate in the body and may lead to high blood pressure, heart disease, stroke, and even death. There are five stages of CKD. Each defined by the person’s glomerular filtration rate (GFR) or estimated glomerular filtration rate (eGFR). As defined by the CDC “Glomerular filtration is the process by which the kidneys filter the blood, removing excess wastes and fluids. GFR is a calculation that determines how well the blood is filtered by the kidneys, which is one way to measure remaining kidney function. GFR is usually estimated (estimated GFR or eGFR) using a mathematical formula that compares a person's size, age, sex, and race to serum creatinine levels.”

The stages of CKD as defined by the CDC and the American Academy of Family Physicians are as follows:

  • Stage 1 eGFR ≥90 ml/min/1.73 m2.  Kidney damage with normal or increasing GFR
  • Stage 2 eGFR 60-89 ml/min/1.73 m2.  Kidney damage with mild reduction in kidney function
  • Stage 3 eGFR 30-59 ml/min/1.73 m2.  Moderate reduction in kidney function.
    • Stage 3a 45-59 mL/min.   Mildly to moderately decreased GFR.
    • Stage 3b 30-44 mL/min.   Moderately to severely decreased GFR.
  • Stage 4 eGFR 15-29 ml/min/1.73 m2. Severe reduction in kidney function.
  • Stage 5 eGFR <15 ml/min/1.73 m2. (or dialysis). Kidney Failure.

Not all patients with kidney disease progress to stage 5 kidney failure. CKD has varying levels of seriousness. If left untreated, CKD can progress to stage 5 and cause early cardiovascular disease. Additional definitions related to kidney disease can be found in the CDC's Kidney Disease Surveillance System Glossary.

People living with Chronic Kideny Disease (CKD) and people at risk for CKD can lower their risk for kidney failure with the help of their healthcare providers by getting tested yearly, making lifestyle changes, and taking medicine as needed. For more information on CKD, please visit the CDC's website for Fact Sheet for Chronic Kidney Disease (CKD) in the United States for 2023.

What is end-stage renal disease (ESRD)?

ESRD, also sometimes called End Stage Kidney Disease (ESKD) is when you have reached stage 5 CKD. This means that kidney damage is severe, and your kidneys no longer work well. When ESRD happens, dialysis or a kidney transplant is needed for survival. There is no cure for kidney failure, but with treatment it is possible to live a long and productive life.

What is dialysis?

When the kidneys are healthy and functioning properly, they act as a natural filter/waste system for blood. When the kidneys are no longer able to perform this function on their own, and if kidney transplant is not available, treatments using an artificial kidney (dialyzer) to clean your blood will be necessary. This process is called dialysis.

Hemodialysis uses a machine to pump blood through a filter outside of the body and returns filtered blood into the body. Peritoneal dialysis uses the lining of the belly to filter wastes and extra fluid from the body.

Where would my family or I receive dialysis?

Freestanding Dialysis Centers

Freestanding dialysis centers are licensed healthcare facilities that provide hemodialysis treatments to patients with ESRD. These centers often provide training for patients and their care partners for home treatment as well. This training not only teaches patients and care partners how to provide dialysis treatments, but also provides training on infection prevention, and emergency preparedness.

 

Hospitals

Hospitals are not a routine option for dialysis. Hospitals are only used for acute or emergency purposes. The same type of treatment received at home or in the dialysis center would be given, but it would only be for the duration of the hospital stay.

 

Long-term Care (LTC)/ Skilled Nursing Facility (SNF)/ Rehabilitation

Although it is not common, there are many of these types of inpatient facilities that also have hemodialysis on site. In the event that they do not have an on-site center, patients needing dialysis would be transported to a freestanding center for treatment during their stay.

 

Home

Many people meet the qualifications to have dialysis at home. Dialysis at home can be performed in the following ways:

  • Peritoneal Dialysis (PD) is more flexible and can be done at home, at work, or even while traveling. PD can be performed with exchanges throughout the day, or continuously at night while sleeping.
  • Home Hemodialysis is performed by using a smaller version of the machine used in a freestanding center, but in the home with a care partner who has been trained by the staff at the dialysis center.

With both options patients will still need to have monthly and/or quarterly visits with the dialysis center care team. Often these require patients to go into the center, but sometimes home visits are also warranted.