Established renal failure is loss of kidney function to a point where this becomes life threatening. Less than 1 in 10 people with kidney disease get kidney failure. Established renal failure is also called end stage kidney failure (or, in the USA, end stage renal disease).
Established renal failure usually develops slowly, as chronic kidney disease (CKD) progresses over a period of months or years. However, very few people with CKD ever develop established renal failure. In some people kidney failure can develop suddenly, which is called acute kidney failure . Also, someone with CKD may get acute kidney failure if they develop a severe infection or other unexpected illness.
After being told they have kidney failure, most people will feel shocked, even if they already know they have kidney disease. It is totally normal to be upset and confused, and at first to try and deny what is happening.
Personal accounts from people with established renal failure, Maureen and Isambard, can be found here, explaining how they felt when they were diagnosed.
Few people with established renal failure can manage on their own; support from family, friends or hospital staff is absolutely essential. No-one wants to be a burden on anyone else, but hiding feelings from family and friends will make it more difficult in the long term.
If you think you may need help from social services, or be entitled to financial allowances, talk to the social worker attached to your kidney unit.
People cope with kidney failure and have enormously successful lives, but it is not easy and everyone has to overcome problems from time to time. Every person copes in a different way; there is no ‘formula’ to make it easy. Some coping strategies include having an activity (eg a hobby) to turn to; setting goals (eg I will go to that wedding!); keeping up as many normal routines a possible; learning to control disease, not be controlled by it. Understanding your disease and taking an active part in your treatment helps.
Every person with established renal failure needs to make some choices about the type of treatment that is best for them. It is best to plan in advance. Putting off decisions until the last minute may mean more complications or a longer stay in hospital than is necessary.
Planning in advance does mean having to commit to a particular line of treatment, which can be very daunting. Information, support and having time to make the best choices will be enormously helpful. As well as seeing a doctor in clinic, people should talk to nurses on the kidney unit (many units have a nurse who specialises in ‘pre-dialysis care’), and to someone who has had dialysis, who can be contacted through the kdieny unit at the hospital, or through the local kidney patients' association. There are also written accounts of what it is like having dialysis on this website.
To keep as well as possible, everyone with kidney failure should stop smoking, lose weight if they are overweight, keep active and eat a healthy balanced diet, with advice as appropriate from their renal dietitian. The blood pressure and cholesterol should be well controlled, and the levels of phosphate in the blood should be regulated by diet and drugs as necessary. If someone is anaemic, this should be treated.
There are 4 main types of treatment available for life threatening kidney failure, and people need to decide which is best for them. These are:-
This may suit people with other medical problems and slowly progressive kidney failure.
The best treatment for kidney failure in those fit enough for the operation. The best type of transplant, if possible, is from a living donor, given just before dialysis would be needed.
Blood is washed through a machine, normally in three sessions a week. Can be given in hospital as an outpatient, in a local 'satellite' unit, or at home.
Uses a tube in the tummy. Fluid is passed in and out of the tummy four times a day at home, or overnight at home using a machine.
NKF Controlled Document No. 3, How to cope with Established Renal Failure and making treatment choices, written 15 October 2006. Last reviewed 15 October 2006.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.
Page created: 16 May 2007
Last updated: 23 May 2007
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