The final stage of chronic kidney disease (CKD) is referred to as stage 5 CKD, end-stage kidney disease (ESKD), and end-stage renal disease (ESRD). At this stage, your kidneys are about to fail, or you’re already in kidney failure. At this point, your nephrologist (kidney doctor), family members, and spiritual advisor can help you decide the right course of action to take regarding further treatment. Here’s what you can anticipate from stage 5 CKD, including life expectancy with and without dialysis and/or transplantation. 

At Stage 5 CKD, your eGFR is at 15 ml/min or less, meaning that your kidneys are functioning at 15% or less, and kidney failure is imminent. When your kidneys fail to filter your blood, wastes build up in your blood and turn your body toxic. Other functions the kidneys perform will also cease, including:

• Regulating blood pressure
• Producing the hormone (erythropoietin) that contributes to making red blood cells
• Activating vitamin D to maintain good bone health

This stage of kidney disease will make you feel quite sick, and dialysis and/or a kidney transplant will be necessary in order to sustain life.

Extreme fatigue or tiredness is a common symptom of stage 5 CKD.

Common symptoms of stage 5 kidney disease, or kidney failure, include:

• Loss of appetite
• Nausea or vomiting
• Headaches
• Fatigue or tiredness
• Back pain
• Difficulty concentrating
• Itchiness
• Inability to urinate, or urinating very little
• Swelling (particularly in the ankles and around the eyes)
• Muscle cramping
• Trouble breathing
• Difficulty sleeping
• Tingling in hands and/or feet
• Changes in skin color, such as grey or yellow pallor
• Hyperpigmentation of skin, such as spots or splotches

If you have not done so already, you will need to see a nephrologist immediately to decide on a course of treatment, which would be either dialysis or a kidney transplant. In some instances, a person with ESKD will have both forms of treatment. If your kidneys have failed, you will need to be on dialysis for the rest of your life unless you have a kidney transplant.

• Dialysis helps clean your blood by removing waste that your kidneys can no longer remove on their own, as well as helping to maintain healthy levels of potassium, sodium, bicarbonate, and other chemicals, and control your blood pressure. There are two main types of dialysis: hemodialysis (HD) and peritoneal dialysis (PD). You can receive dialysis in a dialysis center or at home, and there can be some flexibility concerning the schedule.

With stage 5 CKD, you will eventually need a kidney transplant, or you will need to be on dialysis for the rest of your life.
(This image is from @peoplecreations on @Freepik.)

• A kidney transplant means you will receive a healthy kidney from a donor to replace your failed kidney. You will need to take anti-rejection medicines post-transplant to prevent your body from rejecting the healthy kidney. Most transplants are successful and last for many years. Some people, however, will need multiple transplants in their lifetime.

Neither form of treatment will cure your kidney disease; there is still no cure for CKD. Both of these methods, however, will extend your life expectancy and enable you to maintain a good quality of life.

• If you choose to start dialysis treatment, stage 5 kidney disease life expectancy is five to 10 years on average, though some patients have lived on dialysis for 20 years or more. 
• If you have a kidney transplant, a living donor kidney can function for 12 to 20 years, and a deceased donor kidney for 8 to 12 years. 

The average length of time spent on a kidney transplant waiting list for a deceased donor kidney is three to five years.

Supportive, or palliative, care is the choice to not pursue treatment—in this instance, specifically dialysis. This course of action, however, will only allow you to maintain your quality of life. It will not help with nor extend your life expectancy.

Without dialysis, the life expectancy for stage 5 kidney failure is not a hard and fast answer, as it varies depending on each kidney patient’s unique medical history. Generally, life expectancy without dialysis can be anywhere from days to weeks, which depends on:

• Amount of kidney function
• Severity of symptoms
• Overall medical condition

Without treatment, toxic waste and fluid will build up in your body, and there are medications you can be prescribed to manage this discomfort. You may also use ultrafiltration therapy to remove fluid buildup, making it easier for you to breathe.

If you or someone you love is currently in stage 5 CKD, Responsum for CKD can provide information, advice, and support, as well as the ability to connect with other CKD patients.