End-stage Kidney Disease (ESKD) - Diagnosis & Treatment

How is end-stage kidney disease diagnosed?

The diagnosis of ESKD involves a series of tests to evaluate kidney function and damage. These tests are crucial for determining the stage of kidney disease and the appropriate treatment plan:

Blood tests

• Creatinine and blood urea nitrogen (BUN): These tests measure the levels of waste products in the blood that kidneys filter out. High levels indicate impaired kidney function.

• Estimated Glomerular Filtration Rate (eGFR): This is a critical measure derived from the creatinine test, age, body size, and gender. It estimates how well the kidneys are filtering blood, with lower rates indicating more advanced kidney disease.

Urine test

• Microalbuminuria: This test detects small amounts of albumin in urine and is important for patients who are at risk for kidney disease.

Imaging tests

• Ultrasound: This non-invasive test helps visualise the kidneys' structure and size, identifying abnormalities such as cysts, tumours, or obstructions.

• Computed tomography (CT) scan: Provides a more detailed image of the kidneys and can detect smaller structures and abnormalities not visible on an ultrasound.

Kidney biopsy

In some cases, a biopsy may be necessary to determine the type and extent of kidney damage. This procedure involves removing a small sample of kidney tissue for microscopic examination.

These diagnostic tools are important for confirming the aetiology and presence of ESKD, understanding its severity, and guiding treatment decisions. Regular monitoring through some pf these tests help manage the condition effectively and prevent further complications.

How is end-stage kidney disease treated?

The treatment for ESKD is multifaceted and aims to replace kidney functions and manage symptoms. Here's an expanded view of the key treatment methods:

Dialysis

• Haemodialysis: In haemodialysis, blood is taken out from the body through a vascular access or 'blood line' and shunted through the dialysis machine. This process "cleanses" the blood and removes waste products and excess water. The "cleansed" blood is returned back to the body via another blood line. These blood lines can be in the form of a dialysis catheter, an arteriovenous fistula or an arteriovenous graft.

• Peritoneal dialysis: In peritoneal dialysis (also known as 'water dialysis'), a tube is surgically inserted into your abdomen. The dialysis solution will be infused and drained through the tube while the lining of your abdomen (peritoneum) acts as a filter to remove waste and excess water from your blood.

Kidney transplanation

A kidney transplant is a major surgery in which a patient receives a new kidney from a living or deceased donor.

With a kidney transplant, you will have better quality of life. You will be free from the pain and complications of dialysis and have fewer dietary restrictions to contend with. A working kidney helps regulate your body's fluid and electrolytes, and produce the necessary hormones for good bone health and red blood cell production. Female patients of child-bearing age can also plan for pregnancy.

A successful kidney transplant is the leading form of treatment for end-stage kidney failure.

In a living donor kidney transplant (LDKT), a kidney from a healthy living person (the donor) is removed and placed into someone with end-stage kidney disease (the recipient). This is usually done without the removal of the recipient's own kidneys.

Supportive care

This approach is chosen by some patients who decide not to pursue dialysis or transplantation. Supportive care focuses on managing symptoms and enhancing comfort rather than extending life. It includes pain management, fluid balance control, and psychological support to improve the remaining quality of life.

This approach is chosen by some patients who decide not to pursue dialysis or transplantation. Supportive care focuses on managing symptoms and enhancing comfort rather than extending life. It includes pain management, fluid balance control, and psychological support to improve the remaining quality of life.