11 Things Doctors Want You to Know About Kidney Failure

Medically Reviewed By William C. Lloyd III, MD, FACS
Written By Diana Rodriguez on November 9, 2020
  • Kidney Failure
    Kidney failure is the last stage of kidney disease, but it can still be treated.
    More than half a million Americans have been diagnosed with kidney failure. It’s a serious condition, but there are treatment options that can help you maintain good quality of life. Here’s what some top doctors who treat kidney failure want their patients to know.
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    1. “It’s important to understand what kidney failure is.”
    Kidney failure is the most severe form of kidney disease. “Kidney failure is when your kidneys no longer function and you need treatment with dialysis or kidney transplant to sustain life,” says Joseph Vassalotti, MD, chief medical officer at the National Kidney Foundation. “One of the things that happens with kidney failure,” he adds, “is that natural waste products build up and cause symptoms: nausea, decreased appetite, or sleep disturbances, for example.” Kidney failure can also cause serious complications that can lead to a heart attack or stroke
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    2. “Chronic kidney failure can be treated but not cured.”
    Chronic kidney failure develops over a period of time in people who have kidney disease. “Most kinds of chronic kidney failure are not reversible,” says Dr. Vassalotti. Once the kidneys become too damaged, treatment options become more invasive. “If [kidney failure progresses] to the point where the kidneys can’t maintain the patient’s life, that’s when a patient would need a transplant or to go on dialysis,” says Allen Nissenson, MD, chief medical officer at DaVita Kidney Care. However, with treatment, people can live for years with chronic kidney failure. And, says Dr. Nissenson, “The real end game is to enhance the patient’s quality of life.”
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    3. “Acute kidney failure, on the other hand, is usually temporary.”
    Acute kidney failure happens abruptly, often when your blood pressure drops significantly as a result of injury or infection. “The hallmark of acute kidney failure is that it comes on suddenly and it generally goes away, either totally or almost totally,” Says Jeffrey Berns, MD, professor of medicine at the Hospital of the University of Pennsylvania. Dr. Vassalotti adds, “An example is a sick person in intensive care, who has an overwhelming infection and multiple organ failure, including kidney failure. [He or she] might require dialysis but might ultimately recover from that infection and then come off dialysis.”
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    4. “You can reduce your risk for chronic kidney failure.”
    You can help keep your kidneys working better if you address underlying conditions. “The most common causes of kidney failure are diabetes and high blood pressure,” Dr. Nissenson says. Managing these issues can help prevent kidney disease and kidney failure. “If you have early kidney disease,” he explains, “the most important thing to do, if you have high blood pressure too, is to get it really well controlled. If you have diabetes, have your blood sugar really well controlled.” 
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    5. “Be aware of your risk for kidney failure.”
    “People need to know if they are at risk for kidney disease,” “Both African Americans and Hispanics have an increased prevalence of kidney failure,” says Dr. Nissenson. “Anyone with a family member who’s been diagnosed with kidney disease has a somewhat higher chance of having it,” he adds, “and people who are older—usually over the age of 70—have a slightly increased risk.” It’s important, says Dr. Berns, “that [patients] and their physicians know what their level of kidney function is.” Simple tests can track how the kidneys are working, such as ones that detect the presence of albumin or protein in the urine, which can be a sign of kidney damage.
  • Woman in chair getting dialysis
    6. “If you need dialysis, you have options.”
    “Dialysis comes in a number of different flavors,” says Dr. Vassalotti. “There is hemodialysis, where people are hooked up to an artificial kidney machine that blood is filtered through, and then tubes return the blood to the patient.” In peritoneal dialysis, a special solution is pumped to the abdomen to clean your blood. Dr. Berns feels peritoneal dialysis allows for a more normal daily routine, noting, “People can do it at home, oftentimes overnight, on their own schedule to some extent.” The better you understand the different techniques, the more you can participate in choosing a treatment that’s right for you. 
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    7. “You can have high quality of life when you are being treated for kidney failure.”
    Kidney failure patients may believe, Dr. Nissenson says, that “dialysis really just keeps you alive but not feeling very well.” However, he notes, “The reality is, with close attention to medications and good adherence with the dialysis and listening to dietitians’ recommendations, patients can live for long, long periods of time. They can remain working, travel, and can have very full, happy, productive and satisfying lives. So it’s not the sort of doom and gloom that many people think it is.”
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    8. “Dialysis has a higher success rate than in the past.”
    Though the basics of dialysis have not changed, the techniques and equipment have gotten better. These changes have had an impact, says Dr. Nissenson. “The likelihood of survival has improved about 30% over the past decade,” he says, “so there have been improvements in the ability to deliver the treatment safely.” He adds, “There is also a better understanding of the overall health needs and overall medical care of the patient, which has helped drive down the high death rate that was seen when dialysis was first started.”
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    9. “A kidney transplant is a better option than dialysis, though.”
    Dialysis is not always the first line treatment for many kidney failure patients. According to Dr. Berns, “The best option for many patients is transplantation without ever going on dialysis. I personally recommend transplants for the vast majority of my patients.” Dr. Nissenson adds, “For patients who are medically suitable, a transplant is the best form of treatment because–assuming it works well, and most of them do nowadays—it comes the closest to reproducing what two normal kidneys did before.” 
  • Male doctor talking to female patient lying in hospital bed
    10. “You will probably have to wait for a kidney transplant.”
    A donated kidney can come from a deceased or living donor, but either way, there is a lack of available kidneys. “The best option for transplants is from a living donor,” notes Dr. Vassalotti, “though there is a challenge in the United States in that there [are] 100,000 people waiting for kidneys. People who are not able to get a living donor can often have a quite substantial wait–three to five or more years–for a deceased donor kidney.” Dr. Berns adds, “There is a tremendous shortage of organs in this country.” 
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    11. “You can play a role in managing your kidney failure.”
    “I think the more the patient participates in the treatment, the better,” says Dr. Vassalotti. “I think the patients who are engaged will do better, generally understand treatment better, know more about the treatment, and can tell other doctors about the treatment if they are in the hospital, for instance.”. For patients, Dr. Vassalotti says, that adds up to more successful outcomes. “The more they know, the more empowered they feel—and the better they do.”
11 Things Doctors Want You to Know About Kidney Failure

About The Author

  1. Kidney Failure/ESRD. American Kidney Fund. http://www.kidneyfund.org/kidney-disease/kidney-failure/#what_causes_kidney_failure
  2. Frequently Asked Questions. American Association of Kidney Patients. https://www.aakp.org/education/faqs.html
  3. Kidney Failure. Medline Plus, National Institutes of Health. https://medlineplus.gov/kidneyfailure.html
  4. What is Kidney Failure? National Kidney Foundation. https://www.kidney.org/atoz/content/KidneyFailure

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 9
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