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Thursday, May 23, 2013
Although careful management of CKD may delay its progression, kidney disease may eventually progress to the point where renal replacement therapy (RRT), such as either dialysis or transplantation, is required. The stage at which the kidneys fail so that they can no longer sustain life unaided is known as "end stage renal disease," or ESRD.
How can we determine when someone has reached end stage renal disease, and when dialysis is needed? Although renal failure occurs gradually and there is usually no exact moment when it becomes clear that dialysis is needed, the patient's lab results provide an important guide.
BUN and Serum Creatinine - Two blood tests that are monitored in CKD patients are the BUN and serum creatinine [link], which reflect the kidneys' waste-excreting function.
Estimated Glomerular Filtration Rate (eGFR) - The filtering and waste-removal functions of the kidneys are also measured by the "estimated glomerular filtration rate" (eGFR), which can be calculated by a formula [link].
The kidneys have reached the stage of needing help when:
Eventually the deterioration of lab values is accompanied by the onset of symptoms of advanced kidney failure and ESRD, such as the following:
Not all of these symptoms occur in a single patient, and not all occur at the same time. In general, the aim of managing a patient with CKD is to arrange to start dialysis as renal function declines to end stage (as measured by the lab tests above) but before the patient actually develops the symptoms of ESRD, or "uremia."
Many research studies are underway to help us learn about End Stage Renal Disease. Would you like to find out more about being part of this exciting research? Please visit the following links:
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Last Reviewed: Oct 20, 2011
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University