End-stage renal disease (ESRD) is when chronic kidney disease has advanced so far that the kidneys no longer work well enough to filter wastes and fluids from the blood, resulting in dangerous levels of buildup within the body. ESRD is also called end-stage kidney disease, and the loss of kidney function with this condition is irreversible.

The United States Renal Data System (USRDS) reports 746,557 cases of end-stage renal disease in 2017, a 2.6% increase from 2016. Medicare spending in 2017 for ESRD patient treatments totaled $35.9 billion.

The vascular surgeons at Vascular Specialists of Central Florida help patients with end-stage renal disease prepare for dialysis by providing the means (called access) by which dialysis treatment can be administered.

Symptoms of ESRD might not appear until chronic kidney disease is advanced and irreversible damage has already been done. The kidney is a remarkably adaptable organ, and it is able to compensate for lost function. This adaptability can also delay the initial presentation of chronic kidney disease and ESRD symptoms. The kidneys of patients with ESRD are functioning at below ten percent compared to their normal ability.

The two most common causes of ESRD are hypertension (high blood pressure) and diabetes. There is also an increased risk for the condition if your mother, father or sibling has kidney failure. There is a wide range of symptoms for end-stage renal disease, which can often be confused as indications of other medical conditions. Some ESRD symptoms include:

• A decrease in the amount you urinate
• Fatigue
• Headaches
• Unexplained Weight Loss
• Nausea and vomiting
• Your skin color changes

End-stage renal disease is the fifth and final stage of progressive chronic kidney disease. A physician can assess damage to the kidney and progression of disease based on the organ’s functionality. Physicians also consider a patient’s Glomerular Filtration Rate (GFR), which analyzes the rate at which kidneys filter wastes and extra fluid out of the blood. GFR is measured in milliliters per minute.

Treatment for end-stage renal disease usually involves kidney dialysis, frequently done through the bloodstream, called hemodialysis. It is typically administered in an outpatient center several times a week.

In order for the dialysis machine to clean the blood, a means of access to the bloodstream is required to create high blood flow rates. This is accomplished with a surgical procedure performed by vascular surgeons.

A tube can be placed in the jugular vein in the neck to be used for a few weeks or months;  however, surgeons prefer to create the access for dialysis in the arm to achieve durable and prolonged function. This also decreases the risk of infection associated with long-term use of catheters.

Fistulas and grafts are the two types of accesses for the arms. A fistula involves a surgical procedure to connect the patient’s artery and vein, to create a high blood flow system. There are three common types of fistulas used to create an access, named after the types of connections used to place them:

• Radio-cephalic fistula
• Brachio-cephalic fistula
• Brachio-basilic transposition fistula

The Arteriovenous (AV) graft involves using a looped, artificial tube that connects an artery to a vein. It is usually surgically placed at the upper forearm. Our vascular surgeons prefer to place a fistula instead of a graft whenever possible, because the fistula generally offers a lower risk of infection.

After the access is in place, a patient can begin hemodialysis treatment. The dialysis machine processes a patient’s blood and filters out the wastes. The cleaned blood is sent back into the body through the access. Each dialysis treatment usually takes three to four hours.

Some patients with end-stage renal disease will undergo a kidney transplantation operation to receive a donated organ. The new kidney replaces the failing ones. Kidney transplant patients will need to take medications for the rest of their lives to help keep the new kidney healthy.

After a patient has a hemodialysis access placed by a vascular surgeon, he or she will need ongoing care to maintain the access to make sure it functions properly. If there is a complication at the site of a dialysis access, many patients prefer to be treated by the physician who performed the surgery and is familiar with their care.

By returning to the same provider for continual care, patients may experience reduced paperwork and stress, as well as an increased comfort level and deeper relationship with their care team. The team, because they’re familiar with the patient and their health, is also able to quickly understand and treat any changes that may arise.