A patient with stage 4 kidney disease means that his glomerular filtration rate is lower than 15 ml/min/1.73m2. This is also known as end stage renal disease. The patient develops this stage when more than 80% of the renal function is lost. There are lot of problems associated with stage 4 kidney disease because the kidneys can no longer function to excrete the toxic waste and excess water from the body. Kidneys also maintain the electrolyte balance and produce erythropoietin hormone which is essential in forming red blood cells from the bone marrow. There can be metabolic abnormalities such as uremia, hypercalcemia and many others which result in cardiovascular disease, skin disease, gastrointestinal complications, endocrine abnormalities, muscle dysfunction and nervous system abnormalities. All these result in the death of the patient. In order to prolong life, they will need kidney transplantation. Until a suitable donor is found, dialysis is the only way to prolong the life of these patients.
Is every patient undergoing dialysis?
Because dialysis is an invasive procedure which requires long and frequent hospital visits, the need for dialysis must be balanced against the drawbacks. Especially in older people, hemodialysis may be too invasive because it required arterio venous fistula formation which can take several weeks to mature. Although dialysis can prolong the life, in elderly, frail patients the outcome may be poor. Some small studies have suggested that the outcome in quality of life and outcome in mortality has no significant difference between the elderly people who elect to undergo dialysis and those who decided against it. According to one study, within the first year of initiating dialysis, over 50 % died while approximately 30 % had a decrease in functional status. (Kumar & Clark, 2017)
Life expectancy with chronic kidney disease
From the start of renal replacement therapy, the data regarding life expectancy are available from the U.S. Renal Data System and the UK Renal Registry. Since the cause for renal failure can be different in different individuals, the natural history of the disease and the prognosis of the disease should also need to be taken into consideration. While in children and young adolescents the kidney failure may be due to an autoimmune disease or a congenital disease, the older adults will get chronic kidney disease due to long standing hypertension or diabetes mellitus. These co morbid diseases will also have an impact on the disease and will lead to early mortality. (Kumar & Clark, 2017)
It has been shown that the reduced life expectancy in kidney failure is not solely due to accumulation of urea and other toxic by products. The disease process itself which progresses rapidly when the glomerular filtration rate falls below 60 ml/min, has a significant contribution. (Neild, 2016)
The impact of dialysis on stage 4 kidney disease
Dialysis can generally increase a patient’s life expectancy by 2 – 5 years in stage 4 renal failure. Life threatening conditions seen in these patients such as heart failure, hyperkalemia, metabolic acidosis can be prevented by the help of dialysis. Some patients, with the help of other drugs to control the disease progress, can maintain their left over renal function and produce an adequate amount of urine to sustain life.
Therefore, in order to predict the life expectancy, several things need to be considered. These include the age of the patient, gender, race, the underlying disease process, treatment, compliance, life style, socio economic status, dialysis frequency and adequacy. The biochemical test results such as blood urea, serum creatinine, serum electrolytes and glomerular filtration rate will give some idea how he is progressing but there is no scientific way of predicting the life expectancy entirely based on those results. In fact, it is widely individualized and it should be predicted after considering all these factors. (“Life Span For Stage 4 Renal Failure With And Without Dialysis-Kidney Failure”, 2017)
What are the actual figures currently available as life expectancy for stage 4 kidney failure?
According to several renal registries, the actual figure for the life expectancy varies. The UK renal registry shows that the median life expectancy for a patient in the 35 – 39 age groups is a further 13.5 years at the 90th day of dialysis if he or she were to undergo renal transplant in the future. According to the US renal data system, a person aged 35 – 39 years will live a further 12.5 years on dialysis and he could add 30.8 more years if successful renal transplantation was undertaken. However patients tend to live in between these two values. The Canadian kidney failure results show that a person in the same age group can live 13.8 more years if he is on dialysis. (Neild, 2016)
The final results will depend on the patient and not the values in statistics. Therefore getting the best out of the treatment with a positive attitude while attending to other complications of the kidney disease can prolong the life span and the overall quality of life.
- Kumar, P., & Clark, M. (2017). Kumar & Clark clinical medicine (9th ed., pp. 786-787). Edinburgh: Elsevier Saunders.
- Life Span For Stage 4 Renal Failure With And Without Dialysis-Kidney Failure. (2017). Kidneyfailureweb.com. Retrieved 16 October 2017, from http://www.kidneyfailureweb.com/prognosis/221.html
- Neild, G. (2016). Life expectancy with chronic kidney disease: an educational review. Pediatric Nephrology, 32(2), 243-248. http://dx.doi.org/10.1007/s00467-016-3383-8