Clinical Distinctions Between ESRF and CKD Stage 5

Key Terminology Distinctions

The National Kidney Foundation recommends avoiding the term "end-stage renal disease" (ESRD) or "end-stage renal failure" (ESRF) because it is not well-defined or consistently used except for administrative purposes 1
In the United States, the Centers for Medicare and Medicaid Services uses the term ESRD to refer to entitlement for Medicare coverage when patients receive dialysis or transplantation, rather than describing the actual medical condition itself 3, 1
The American Society of Nephrology notes that ESRD/ESRF only applies to patients receiving treatment (dialysis or transplantation), excluding patients with the same level of kidney dysfunction who do not receive treatment by choice, lack of recognition, or unavailability 1
The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines state that the term misleadingly implies that the end of life is near and carries stigma, even though patients can survive for years with treatment 1

The National Institute of Diabetes and Digestive and Kidney Diseases defines CKD Stage 5 (kidney failure) as a glomerular filtration rate (GFR) <15 mL/min/1.73 m² or treatment by dialysis, representing loss of more than 85% of kidney function 3, 4, 5
The KDIGO 2020 consensus conference unanimously agreed that "kidney failure" should replace "end-stage" terminology for describing this stage of disease 1, 2

The American College of Physicians recommends that CKD Stage 5 requires further specification beyond just the GFR category: duration of disease, presence or absence of uremic symptoms, and treatment status (with or without kidney replacement therapy) 1, 2
Patients should be classified as "CKD G5" with additional descriptors such as "CKD G5D" (treated by dialysis) or "CKD G1T-G5T" (after transplantation) 2, 6
The European Renal Association notes that CKD Stage 5 includes patients who meet the GFR criteria but are not receiving dialysis or transplantation, whether by choice, lack of access, or because comprehensive conservative care is being provided 2, 6
The International Society of Nephrology states that the presence or absence of uremic syndrome (symptoms and signs associated with kidney failure) should be specified when classifying CKD Stage 5 2

The KDIGO guidelines recommend avoiding ESRD, ESRF, ESKD, or ESKF terminology in clinical documentation—these terms are explicitly listed as "terms to avoid" by KDIGO 2, 6
The Renal Physicians Association advises against assuming all patients with GFR <15 mL/min/1.73 m² are receiving dialysis—specify treatment status explicitly 1, 2
The American Society of Nephrology recommends not relying solely on GFR for classification—include cause of kidney disease and albuminuria category (CGA classification) for complete risk stratification 5