Chronic kidney disease happens when your kidneys no longer filter your blood the way they should, so wastes and extra fluids accumulate in your body.

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases.

Other conditions that affect the kidneys are:

• Glomerulonephritis: a disease that causes inflammation and damage to the kidney's filtering units. This disorder is the third most common type of kidney disease.

• Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue.

• Malformations that occur as a baby develops in its mother's womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.

• Autoimmune diseases such as lupus

• Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.

• Repeated urinary infections.

Most people may not have any severe symptoms until their kidney disease is advanced. However, you may notice that you:

• feel more tired and have less energy

• have trouble concentrating

• have a poor appetite

• have trouble sleeping

• have dry, itchy skin

• have swollen feet and ankles

• have puffiness around your eyes, especially in the morning

• have muscle cramping at night

• need to urinate more often, especially at night.

Chronic kidney disease comes in five stages.

Stage 5 also known as kidney failure or end stage renal disease (ESRD) is when kidneys functionbelow 10-15% of their normal capacity.

Kidney failure usually occurs after years of having chronic kidney disease. Less common is acute kidney failure, a sudden stop of kidney function usually seen in critically ill hospitalized patients.

Whichever the case may be, it is vital that a person with kidney failure receives a kidney replacement therapy to stay alive.

When it comes to treating end stage renal disease, the treatment is dialysis unless your doctor thinks you are a good candidate for a kidney transplant.

Still you will need dialysis while waiting for a matching kidney donor. Dialysis keeps your body in balance by removing waste, salt and extra water to prevent them from building up in the body and helping to control blood pressure.

There are two major dialysis choices that can suit your lifestyle and underlying medical conditions: hemodialysis and peritoneal dialysis.

Hemodialysis is the most common way to treat advanced kidney failure. In hemodialysis, a machine filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately.

The procedure can help you carry on an active life despite failing kidneys. For hemodialysis, you are connected to a filter (dialyzer) by tubes attached to your blood vessels.

Your blood is slowly pumped from your body into the dialyzer, it is filtered and then pumped back into your body.

Hemodialysis may improve your quality of life and increase your life expectancy, however it does not reverse chronic kidney failure.

Hemodialysis treatment usually lasts about four hours and is done three times per week. There are different types of hemodialysis that can suit your lifestyle and underlying medical conditions:

• In-center hemodialysis: Get treatments at a dialysis center from caring kidney care professionals and interact with other patients.

• Home hemodialysis: Perform hemodialysis in the privacy of your own home, with a trained care partner to help you with treatments.

• Nocturnal hemodialysis in-center or at home: Turn sleep time into dialysis treatment time. Hemodialysis is done 3 to 7 nights a week. Each session is done overnight (about 6 to 8 hours).

Before dialysis treatment can begin, your vascular surgeon will need to create a site where the blood can flow in and out of your body during the dialysis sessions.

This is called a dialysis access. Your vascular surgeon will perform an extensive physical exam to identify satisfactory vessels to construct the fistula or implant a graft.

He or she will then perform (or request) an ultrasound study for “vein mapping” of your arms or even legs looking to identify the best available (if any) vein for fistula planning.

The typical site to get your first access is the wrist or forearm of your non dominant hand.

If these sites are not suitable or have already been used, then your vascular surgeon may choose to use the wrist or forearm of the dominant hand before eventually using the upper arm or even your groin’s veins.

Peritoneal dialysis (PD) can be an excellent (if not better for some patients) alternative to hemodialysis. Peritoneal dialysisuses a natural membrane inside your abdomen (peritoneal membrane) as a filter to clear wastes and extra fluid from your body and to return electrolyte levels to normal.

You will need to have a peritoneal dialysis catheter placed in your belly (dialysis access) before you begin dialysis.

A PDcatheter is a flexible silicon tube (Tenckhoff ) that allows dialysis fluid to enter the abdominal cavity, dwell inside for a while, and then drain back out again.

There are several different designs and manufacturers, but there is no evidence that one type of catheter works better than another.

Peritoneal dialysis is a good treatment option for people who have kidney failure. Advantages include:

• Few dietary or fluid restrictions.

• No needle sticks.

• Independence and ability to normalize daily routines.

• The ability to do the dialysis at home on your own schedule.

• Reduced dependence on blood pressure medicine.

• Fewer problems with anemia.

The process of doing peritoneal dialysis is called an exchange and it includes the following steps

• Fill: Dialysis fluid enters yourperitoneal cavity

• Dwell: While the fluid is in your peritoneal cavity, extra fluid and waste travel across the peritoneal membrane into the dialysis fluid.

• Drain: After a few hours, the dialysis fluid is drained and replaced with new fluid.

A kidney transplant, though not a cure, can be the ultimate treatment for a patient with end stage renal disease. This involves having a healthy kidney from another person surgically placed into the body.

The new, donated kidney does the work that the two failed kidneys used to do.

There are two types of donors:

Living donors: A living donor may be a family member, a friend, a coworker, or any person who is willing to give a kidney to someone in need. A person only needs one healthy kidney to live.

Cadaver donors: A cadaver donor is someone who has recently died. Most donor kidneys come from this source.

Due to the shortage of kidneys, patients on the waiting list for a deceased donor kidney may wait many years. A kidney transplant though isn't for everyone. You may have a condition that makes the transplant surgery dangerous or not likely to succeed.

A successful transplant takes a coordinated effort from your whole health care team. Your team includes, your nephrologist, transplant surgeon, transplant coordinator, pharmacist, dietitian, and social worker— as well as you and your family. If your nephrologist thinks you are a candidate for a kidney transplant you will undergo several tests to confirm your eligibility (good overall health, no significant heart or lung disease, no cancer) to enter the transplant list. Tests will also be done to make sure the donor kidney matches your tissue type and blood type. This helps reduce the chances that your body will reject the new kidney.