Stage 5 kidney failure means your kidneys are functioning at less than 15% of their normal capacity. At this stage, also called end-stage kidney disease (ESKD), the kidneys can no longer filter enough waste and fluid from your blood to keep you alive without treatment. An estimated glomerular filtration rate (eGFR) below 15, confirmed with repeat testing over three months, is the threshold that defines stage 5.
This is the most advanced stage of chronic kidney disease. It doesn’t mean your kidneys have stopped working entirely, but they’ve lost so much function that waste products build up in your bloodstream and cause symptoms throughout your body. At this point, you’ll need to make decisions about treatment: dialysis, a kidney transplant, or a path called conservative care.
What Happens Inside Your Body
Healthy kidneys filter waste products and excess fluid from your blood, sending them out through urine. When kidney function drops below 15%, those toxins accumulate in your bloodstream, a condition called uremia. This buildup affects nearly every organ system.
Nausea, vomiting, and loss of appetite are usually the first symptoms people notice. As waste levels rise, other problems follow: persistent fatigue, shortness of breath, muscle cramps, itchy skin, trouble thinking clearly, unexplained weight loss, and a metallic taste in your mouth. If uremia goes untreated and becomes severe, your breath can take on a urine-like odor, and yellowish-white crystals may appear on your skin after sweating. The most dangerous complications of untreated uremia include inflammation around the heart, seizures, and coma.
Failing kidneys also struggle to produce a hormone that tells your bone marrow to make red blood cells. This leads to anemia, which compounds the fatigue and breathlessness. At the same time, your body loses the ability to regulate minerals like phosphorus and calcium properly, which weakens bones over time. These mineral imbalances begin developing earlier in kidney disease but become most pronounced by stage 5.
Dialysis: What It Looks Like Day to Day
Dialysis takes over the filtering job your kidneys can no longer do. There are two main types, and the choice between them depends on your health, lifestyle, and preferences.
Hemodialysis cycles your blood through a machine that removes waste and returns the clean blood to your body. It requires a minor surgical procedure, usually in the arm, to create a permanent access point where your blood flows out to the machine and back in. Most people go to a dialysis clinic three to five times a week for sessions that typically last several hours each.
Peritoneal dialysis works differently. A surgeon places a small catheter into the lining of your abdominal wall, and a special fluid is introduced into the abdominal cavity to absorb waste products. This type runs daily but can be done at home or even during your normal activities, giving more flexibility than clinic-based hemodialysis.
Five-year survival on dialysis is roughly 40 to 42%, based on data from the U.S. Renal Data System. That number has remained relatively stable over the past decade. Dialysis keeps you alive, but it replaces only some of what healthy kidneys do, so managing diet, fluid intake, and medications remains important.
Kidney Transplant
A kidney transplant offers significantly better long-term outcomes than staying on dialysis. Five-year survival after receiving a kidney from a living donor is about 91%. With a deceased donor kidney, it’s around 80%. For perspective, a 55- to 59-year-old woman who receives a transplant gains roughly 10 extra years of life compared to remaining on dialysis. For a man the same age, the advantage is close to 9 years.
Getting a transplant isn’t automatic. You need to be evaluated and accepted by a transplant program. You can contact a transplant center yourself or get a referral from your doctor. The evaluation involves extensive medical testing of your kidney function, other organs, blood type, and immune markers that determine which donor kidneys would be compatible. The team also assesses whether you’re healthy enough for surgery and long-term medication, whether you have stable housing so they can reach you when an organ becomes available, and whether you have a support system to help with appointments and medications.
Conditions that might prevent listing include serious heart or lung disease, a current cancer diagnosis, or severe obesity. A history of substance use doesn’t automatically disqualify you if you’ve shown progress in recovery. Financial resources or insurance coverage also matter, since transplant recipients take anti-rejection medications for the rest of their lives.
Conservative Care Without Dialysis
Some people with stage 5 kidney failure choose not to pursue dialysis or transplant. This path, called conservative care (sometimes supportive or palliative care), focuses on managing symptoms and maintaining quality of life for as long as possible. A care team helps control pain, swelling, fatigue, and other symptoms using diet and medications, while also supporting the patient’s family.
Conservative care is not the same as giving up treatment. It involves active management of kidney disease to slow progression and reduce discomfort. Many people who choose this route live more than 14 months, and some transition to hospice care when they have fewer than six months to live. Because choosing to forgo dialysis is a life-limiting decision, healthcare providers screen for depression before finalizing the plan to make sure the decision isn’t driven by untreated mental health issues.
Diet Changes at Stage 5
What you eat matters more at this stage than at any earlier point in kidney disease. When your kidneys can’t filter properly, minerals like potassium, phosphorus, and sodium accumulate in your blood and can cause dangerous complications, from irregular heart rhythms (too much potassium) to further bone damage (too much phosphorus). Protein intake also needs careful adjustment because protein metabolism produces waste your kidneys can’t clear efficiently.
There’s no single diet that works for everyone with stage 5 kidney failure. Your specific limits for potassium, phosphorus, sodium, protein, and fluids depend on your remaining kidney function, whether you’re on dialysis, your body size, and other health conditions. A kidney dietitian can tailor these recommendations and adjust them over time as your situation changes. If you’re on dialysis, your protein needs actually go up because the treatment itself removes some protein from your blood.
How Quickly Stage 5 Progresses
Stage 5 doesn’t follow a single timeline. Some people remain stable at an eGFR just under 15 for months or even years with careful management, while others decline more rapidly. The speed depends on what caused the kidney disease in the first place, how well blood pressure and blood sugar are controlled, and whether complications like infections or heart problems develop along the way.
Most people at stage 5 will eventually need to start dialysis or pursue a transplant, but “eventually” can mean different things for different people. Regular monitoring of your eGFR, symptoms, and lab work helps your care team identify when that point is approaching so you can prepare rather than face an emergency start.