Stage 5 Chronic Kidney Disease (CKD)

What is Stage 5 CKD?

Stage 5 CKD means your kidneys have failed or lost most of their ability to filter waste and fluids from the blood. It is the most severe stage of CKD, also known as kidney failure, end-stage renal disease (ESRD), or end-stage kidney disease (ESRD).

Overview of stage 5 chronic kidney disease

Chronic Kidney Disease (CKD) is divided into five stages based on kidney function and whether there are signs of blood or protein in the urine.

Patients with stage 5 CKD have a glomerular filtration rate (eGFR) of less than 15ml/min for three months or more. This means their kidneys are working less than 15% of their function. The patient’s kidneys are not able to maintain fluid balance resulting in higher build-up of toxins and salts and patients will need dialysis or a kidney transplant to survive.

Many patients living with stage 5 CKD also experiences other health issues related to kidney disease, such as anaemia and metabolic bone disease.

At stage 5 CKD, you should have made decisions and plans regarding kidney replacement therapy, such as dialysis. Some patients gradually progress to stage 5 CKD and are well-informed about the available treatment options. Unfortunately, for some patients, CKD is only discovered at stage 5 and needs quick action from the nephrology team.

Signs & Symptoms of stage 5 chronic kidney disease (CKD)

Here are some common symptoms of stage 5 CKD:

Fatigue
Shortness of breath
Swelling in your hands and feet
Puffy eyes
Change in urine colour or volume
Muscle cramps
Loss of appetite
Nausea and bad taste in the mouth
Trouble sleeping
Itch
Discolouration of nails and skin

Learn more about the different kidney disease symptoms you may experience and why.

Although symptoms may be more prominent at stage 5, symptoms of CKD are mostly non-specific in nature, so it is important to be aware of the symptoms you are experiencing and to inform your doctors and nephrology team of any new or worsening symptoms, especially fatigue and loss of appetite.

Diagnosis at stage 5 chronic kidney disease (CKD)

Illustration of woman consulting with doctor about kidney disease and treatment options

The diagnosis of CKD is done through blood and urine tests. The tests are performed to diagnose the stage of CKD by determining the estimated glomerular filtration rate (eGFR) and protein content in urine, which gives an indication of your kidney function. In Stage 5 CKD, the eGFR is less than 15 ml/min.

Once the diagnosis of stage 5 CKD is confirmed, you will need to urgently see a kidney specialist, also known as a nephrologist, to assess the underlying kidney problem and to develop a treatment plan.

This can be an extremely stressful and anxious time as there are pros and cons to different treatment options, and it is important to gather all the information before developing a treatment plan that is right for you. Find out important questions to ask when meeting your nephrologist to make an informed decision about your kidney disease treatment.

Treatment options for stage 5 chronic kidney disease (CKD)

Female physician reviewing information with a man and woman

There are two treatments for kidney failure: dialysis and kidney transplant. You may also choose not to pursue either treatment option, also known as conservative care. As stage 5 CKD is irreversible, the main goal of treatment is to slow or halt the progression of the disease.

Your nephrology team will work with you to develop a treatment plan suited to you. This plan will include a range of medications to not only help with kidney function but also to manage your symptoms or health issues caused by kidney disease.

Dialysis

Dialysis is a medical process that mimics the functions of healthy kidneys by removing toxins from the body and maintaining fluid balance.

The two main types of dialysis are Haemodialysis (HD) and Peritoneal Dialysis (PD). Typically, in Singapore, PD is performed at home, while HD is performed in a dialysis centre.

Kidney Transplant

A kidney transplant involves a surgical procedure where a healthy kidney is placed inside your body.

Your nephrology team will assess your suitability for a kidney transplant. Typically, in Singapore, eligible patients will be on dialysis while waiting to receive a transplant, however it can also be performed for suitable patients even without embarking on dialysis

Conservative Care

Conservative care improves your quality of life by managing symptoms without dialysis or a kidney transplant. This may include medications.

Every patient is unique, so your conditions and preferences will be considered before deciding on the kidney replacement therapy best suited for you.

What can I expect as a stage 5 CKD patient in Singapore?

You will be evaluated through laboratory tests, radiographic and ultrasound scans and, where appropriate, real-time ultrasound-guided kidney biopsy. You will also be evaluated for the cause of kidney failure and the prognosis to provide holistic management of the disease.¹
You will receive counselling on the available treatment options for stage 5 CKD from your healthcare team as well as medical and dietary therapy to slow the progression of the disease.
Your healthcare team will work with you to develop a treatment plan and guide you on the next steps.

Managing stage 5 chronic kidney disease (CKD)

Proper chronic kidney disease (CKD) management is vital to improving your quality of life with stage 5 CKD. Therefore, you should maintain a regular exercise routine and follow the recommended diet. You should also stop smoking and monitor your other health conditions. At stage 5 CKD, you will need to visit hospitals frequently to monitor your kidney condition. You should also be starting your kidney replacement therapy when needed, either dialysis or kidney transplant, depending on the treatment plan developed by you and your nephrologist.

When is kidney replacement therapy started?

Your nephrologist will assess the best time to start dialysis based on your symptoms and blood test results. There is no hard and fast rule regarding when you should start dialysis. The treatment should be tailored based on your lifestyle and life goals.

People diagnosed with stage 5 chronic kidney disease (CKD) will need quick clinical assessments and may need to start urgently on dialysis.

Diet

With stage 5 CKD, diet is an integral part of managing your CKD condition because your kidneys are not able to get rid of enough waste products and fluids from your body on their own.

You should limit your sodium intake to less than 2,300 mg per day (about one teaspoon of salt). Your nephrologist may also recommend changes to your protein, fluid/water, and potassium intake, based on your health condition, dietary requirements, and CKD treatment plan. It is imperative to follow your dietitian’s recommendations to ensure you stay well-nourished.

Learn more about maintaining a kidney-friendly diet.

Exercising

Regardless of whether you are on dialysis, exercise is key to staying fit and mentally healthy even with stage 5 CKD. Regular exercises can be beneficial for your physical and mental well-being. Maintaining an active lifestyle can be instrumental in improving your other health conditions, such as high blood pressure and diabetes.

Find out more about exercising while on dialysis. There may be some specific limitations depending on the type of dialysis you are on. Do plan your exercise routine with your nephrology team and follow their recommendations accordingly.

Regular monitoring

Regular monitoring of your kidney function is vital when you have stage 5 CKD as you prepare to start kidney replacement therapy. You may also need to see other doctors to have your dialysis access surgically created for you. You should visit your primary care doctor regularly to keep them informed and to have your care team advise and guide you closely as you initiate your kidney replacement therapy.

Illustration of doctor explaining kidney disease condition and treatment options to elderly patient

The prognosis for stage 5 chronic kidney disease

Talking to your nephrologist about your short-term and long-term challenges and goals is important. Your CKD treatment plan should be personalised based on your challenges and goals. This can be a challenging time for you and your loved ones, and it is, therefore, important to get all the help and information you need as you start dialysis.

FREQUENTLY ASKED QUESTIONS

Can stage 5 CKD be reversed?

What is the life expectancy for stage 5 chronic kidney disease (CKD)?

What should I ask my healthcare team when diagnosed with stage 5 CKD?

At stage 5 CKD, you should be under the care of a nephrologist and a healthcare team. You should have considered the different CKD treatment options, such as dialysis, conservative care, or kidney transplant. Some questions you may want to ask at this stage are:

What is my eGFR?
Do I need to start dialysis? And if yes, when?
Is kidney transplant a viable treatment option for me, and what are the next steps required?
Can I receive a kidney transplant without undergoing dialysis?
How do I know which treatment option is the best for me?
Do I need to make any changes to my medications?
Under what circumstances should I seek urgent medical attention?

Find out important questions to ask your kidney doctor or nephrologist to make an informed decision about your chronic kidney disease treatment.

Should I tell my friends and colleagues that I am at stage 5 CKD?

It is important that you share your chronic kidney disease diagnosis with your family or the people you live with so they can support you as you make decisions. But it is up to you whether you want to talk about the stage of your kidney disease with other people. Generally, sharing your condition with people close to you is beneficial as you may need their support and understanding while undergoing treatment for stage 5 CKD.

References

Chronic Kidney Disease

Kidney Disease Treatment

Living with Dialysis