Stage 5 chronic kidney disease (CKD), also known as end-stage kidney disease (ESKD), signifies a critical loss of kidney function. At this stage, the kidneys are working at less than 15% of their normal capacity, which requires life-sustaining treatments such as dialysis or a kidney transplant. Navigating this stage involves not only medical intervention but also significant lifestyle changes and emotional support. Below, we explore what this stage means, the health impacts it brings, and how you can manage your health and quality of life through proactive steps.

What Happens in Stage 5 CKD

At stage 5, the kidneys can no longer effectively filter waste and excess fluid from the blood. This is typically confirmed by a consistent estimated glomerular filtration rate (eGFR) of less than 15, or the initiation of dialysis. Symptoms typically grow more pronounced, including:

• Severe fatigue 
• Reduced urination 
• Fluid retention 
• Shortness of breath 
• Nausea 
• Changes in taste and mental clarity 

These physical changes can be distressing and require vigilant monitoring by your healthcare team. 

Alongside kidney failure, patients face a significantly elevated risk of cardiovascular disease, even when other lab values—like urine albumin-creatinine ratio (uACR)—appear moderate. As uACR levels rise, so too does the threat of heart complications. Routine bloodwork and close clinical supervision are critical in detecting and managing this risk. Many people also contend with complications such as:

• Anemia, 
• Bone and mineral disorders, and 
• Electrolyte imbalances like hyperkalemia (high potassium levels).

All of these add complexity to daily health management.

Treatment, Nutrition, and Lifestyle Management

Treatment options for stage 5 CKD include dialysis (hemodialysis or peritoneal), kidney transplantation, or conservative (non-dialysis) management. Each comes with considerations, and decisions depend on a person’s health status, preferences, and lifestyle. Managing coexisting conditions like diabetes or hypertension remains essential to avoid additional strain on the body and treatment complications. Regardless of the chosen approach, early planning can improve outcomes and readiness for care transitions.

Dietary changes are often a cornerstone of CKD management. As the kidneys lose function, they struggle to process common nutrients, requiring adjustments to your intake of:

• Sodium,  
• Potassium,  
• Phosphorus,   
• Protein, and 
• Fluids.  

These needs vary based on whether the person is on dialysis and how much urine they produce. A renal dietitian becomes an indispensable partner, helping tailor food choices to support energy needs and manage symptoms, especially when patients have overlapping dietary restrictions due to conditions like diabetes or heart failure.

Medication Safety and Risk Reduction

At this advanced stage, medication regimens may shift dramatically. Because failing kidneys can no longer eliminate drugs efficiently, some medicines must be reduced, timed differently (especially with dialysis), or stopped altogether. Drugs to manage CKD complications—such as iron supplements, phosphate binders, or active forms of vitamin D—may also be introduced. Regular review of all medications, including over-the-counter products and supplements, helps prevent harmful interactions or toxic buildup.

Risk reduction remains a critical goal. Avoiding NSAIDs, managing blood pressure, maintaining a healthy weight, and quitting smoking are just a few actions that reduce complications and support eligibility for treatments like transplantation. Patients are encouraged to prepare questions for their healthcare team about monitoring, dietary choices, medication timing, and emotional or logistical support, empowering them to take an active role in their care. Despite the gravity of stage 5 CKD, informed decisions and consistent support can significantly improve your quality of life.

*National Kidney Foundation. (2023, July 6). Stage 5 Chronic Kidney Disease (CKD). https://www.kidney.org/kidney-topics/stage-5-chronic-kidney-disease-ckd#:~ 

To ensure that we always provide you with high-quality, reliable information, Responsum Health closely vets all sources. We do not, however, endorse or recommend any specific providers, treatments, or products, and the use of a given source does not imply an endorsement of any provider, treatment, medication, procedure, or device discussed within.