Clinical Manifestations and Diagnosis of Stage 5 Chronic Kidney Disease

Definition and Diagnosis

Stage 5 CKD is defined by a GFR <15 mL/min/1.73 m² and represents kidney failure requiring replacement therapy, indicating loss of more than 85% of kidney function and necessitating dialysis or transplantation, according to the American Journal of Kidney Diseases and International journal of oral science 1, 2, 3
The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines state that GFR ≤ 15 mL/min/1.73 m² is the defining criterion for stage 5 CKD 1, 2

Increased Blood Urea Nitrogen (BUN) levels occur due to accumulation of uremic toxins as kidney function declines, contributing to uremic symptoms including ammonia taste and breath, according to the International journal of oral science 5, 6
Serum creatinine rises progressively as GFR declines, and creatinine levels are used in validated equations (MDRD, CKD-EPI) to estimate GFR, as stated by the Journal of the American College of Radiology and American Journal of Kidney Diseases 2, 3
Electrolyte and acid-base disturbances, including hyperkalemia, are characteristic clinical manifestations of renal failure, according to the International journal of oral science 1, 5, 6

Uremic syndrome occurs as kidney function decreases, toxins accumulate in the blood affecting multiple organ systems, collectively termed uremia, including uremic frost, renal osteodystrophy, and asterixis, as described by the International journal of oral science 1, 5, 6
CKD stage 5 patients have extremely high cardiovascular mortality risk, with 3-year and 5-year survival rates of only 55% and 40% respectively on dialysis, according to Praxis Medical Insights 4

A common error is relying solely on serum creatinine rather than estimated GFR for staging CKD, and GFR should be estimated using validated equations (MDRD or CKD-EPI) that account for age, sex, race, and body size, as recommended by the Journal of the American College of Radiology and American Journal of Kidney Diseases 2, 3