Stage 5 Kidney Disease (CKD G5): Kidney Failure

Recognizing the Critical Window

Emergency signs requiring URGENT care: potassium >6.0 (muscle weakness, palpitations — sudden death risk), severe breathlessness (fluid overload → pulmonary edema), altered mental status, chest pain, and vomiting/dehydration. These are medical emergencies — go to the emergency department.

The 'planned vs unplanned' start matters: patients who start dialysis with an AVF and an informed modality choice have ~20-30% lower first-year mortality than those who start emergently with catheters (European/Indian registry data). If you're reading this at stage 5 without a plan — create one THIS WEEK.

Pre-emptive transplant is the best option for eligible patients: transplant BEFORE dialysis initiation (living donor) has superior survival and quality of life. Evaluation takes 3-6 months — start immediately.

Choosing Your Modality

In-center hemodialysis (India): 3x/week, 4 hours, travel + waiting time. Costs ₹12,000-25,000/month. Pro: medically managed. Con: schedule dependence, travel, catheter risk if no AVF.

Peritoneal dialysis (PD): home-based, 4-5 exchanges/day (CAPD) or overnight cycler (APD). Comparable outcomes, preserves residual function longer, more flexible for work. Cost ₹15,000-22,000/month. Requires training, home space, and discipline.

Home hemodialysis: 5-6x/week at home, best outcomes (FHN trial), but requires training (4-8 weeks), a care partner, and machine cost ₹8-15L. Transplant: best long-term survival; living donor evaluation is the priority.

Conservative management (no dialysis): a legitimate choice for frail elderly patients with high comorbidity — symptom-focused care. Discuss honestly with your doctor; studies show comparable quality of life vs dialysis in selected patients over 75 with heavy comorbidity.

Nutrition & Lifestyle at Stage 5

Protein: 1.2 g/kg/day ONCE ON DIALYSIS (dialysis removes amino acids — the restriction reverses!). This is the most misunderstood transition in renal diets. Until dialysis starts (pre-dialysis stage 5), 0.6-0.8 g/kg/day remains the recommendation.

Potassium: <2,000 mg/day — every food counts. Use the /foods database daily. Coconut water, bananas, and dried fruits are off-limits. Potassium binders may help maintain food freedom.

Fluid: typically 500-1,000 mL/day + urine output once on dialysis. Measure daily weight — weight gain between sessions >3% of dry weight is the fluid alarm.

Phosphorus: <800 mg/day with binders at every meal. Salt: <2g/day. Both control the complications that actually shorten life (calcification, hypertension, heart failure).