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Key Questions - Renal care

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Helen Noble, BSc, DMS, Cert Couns, RGN, is senior clinical nurse specialist in renal supportive care, Barts and The London NHS Trust and doctoral student, City University.

What is the difference between acute renal failure and end-stage renal disease (ESRD)?

In acute renal failure the kidneys fail very quickly. It may be caused by injury, major blood loss, reaction to a medication or a post-surgical procedure. Often acute renal failure will recover, although if the kidneys are very badly damaged, it could be permanent.
In ESRD kidney failure is permanent and this kind of failure cannot recover. ESRD is often caused by diabetes or hypertension. Some patients may be born with kidney problems, have reactions to some medications and some injuries can also cause ESRD.

How is ESRD different from chronic kidney disease (CKD)?

CKD involves permanent damage to the kidneys but they may still work well enough for patients to live, even if they have some damage. Recent research suggests that one in 10 of the population may have CKD, but it is less common in young adults, occurring in one in 50. In those aged over 75, CKD is present in half the population. However, many elderly people with CKD may have normal ageing of their kidneys.

If the kidneys continue to deteriorate, CKD can lead to ESRD. This is when the kidneys have failed and dialysis or a kidney transplant is required.

What are the signs and symptoms of renal failure?

Damage to the kidneys is often ‘silent’. It may be discovered incidentally following a blood test or urinalysis. Symptoms are uncommon unless kidney failure is advanced and may include:

  • Lethargy;
  • Pruritus;
  • Decreased appetite;
  • Nausea and vomiting;
  • Breathlessness;
  • Fluid retention or oedema;
  • General weakness and malaise.

How is ESRD treated?

There are two main types of dialysis offered: peritoneal dialysis and haemodialysis.

Peritoneal dialysis: a plastic tube is placed within the abdomen and leads out to the skin surface on the abdomen. Fluid is run into the abdomen, left for several hours and then run out again to wash out toxic substances from the body. Many people can learn to carry out this treatment at home with support from the renal team.

Haemodialysis: This is carried out via an ‘artificial kidney’ machine that cleans the blood and returns it by tubing to a vein. It is usually carried out over four hours and needs to be repeated, on average, every couple of days. It is done in a specialised dialysis unit attached to a hospital.

How long is the wait for a kidney transplant and what needs to be considered before an organ is offered?

The wait for a transplant can range from a number of weeks to several years. Many issues are considered when an organ becomes available, including:

  • Tissue match (how close a match the kidney is to the patient);
  • Blood type;
  • How long the patient has been waiting;
  • Immune status/antibody level;
  • Distance (how close the organ is to the patient);
  • Medical urgency;
  • Age (children tend to have shorter wait times);
  • Current health.
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