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End-stage kidney disease


End-stage kidney disease is the last stage of chronic kidney disease. This is when your kidneys can no longer support your body's needs. The kidneys remove waste and excess water from the body.

End-stage kidney disease is also called end-stage renal disease (ESRD).

Alternative Names

Renal failure - end stage; Kidney failure - end stage; ESRD


ESRD occurs when the kidneys are no longer able to work at a level needed for day-to-day life.

The most common causes of ESRD in the U.S. are diabetes and high blood pressure. These conditions can affect your kidneys.

ESRD almost always comes after chronic kidney disease. The kidneys may slowly stop working over 10 to 20 years before end-stage disease results.


Common symptoms may include:

Other symptoms may include:

  • Abnormally dark or light skin
  • Nail changes
  • Bone pain
  • Drowsiness and confusion
  • Problems concentrating or thinking
  • Numbness in the hands, feet, or other areas
  • Muscle twitching or cramps
  • Breath odor
  • Easy bruising, nosebleeds, or blood in the stool
  • Excessive thirst
  • Frequent hiccups
  • Problems with sexual function
  • Menstrual periods stop (amenorrhea)
  • Sleep problems
  • Swelling of the feet and hands (edema)
  • Vomiting, often in the morning

Exams and Tests

Your health care provider will perform a physical exam and order blood tests. Most people with this condition have high blood pressure.

People with ESRD will make much less urine, or their kidneys no longer make urine.

ESRD changes the results of many tests. People receiving dialysis will need these and other tests done often:

This disease may also change the results of the following tests:


Treatment for ESRD may involve dialysis or kidney transplant. You may need to stay on a special diet or take medicines to help your body work well.


Dialysis does some of the job of the kidneys when they stop working well.

Dialysis can:

  • Remove extra salt, water, and waste products so they do not build up in your body
  • Keep safe levels of minerals and vitamins in your body
  • Help control blood pressure
  • Help produce red blood cells

Your provider will discuss dialysis with you before you need it. Dialysis removes waste from your blood when your kidneys can no longer do their job.

  • Usually, you will go on dialysis when you have only 10 to 15% of your kidney function left.
  • Even people who are waiting for a kidney transplant may need dialysis while waiting.

Two different methods are used to perform dialysis:

  • During hemodialysis, your blood passes through a tube into an artificial kidney, or filter.
  • During peritoneal dialysis, a special solution passes into your belly though a catheter tube. The solution remains in your abdomen for period of time and then is removed. This method can be done at home, at work, or while traveling.


A kidney transplant is surgery to place a healthy kidney into a person with kidney failure. Your doctor will refer you to a transplant center. There, you will be seen and evaluated by the transplant team. They will want to make sure that you are a good candidate for kidney transplant.


You may need to continue following a special diet for chronic kidney disease. The diet may include:

  • Eating foods low in protein
  • Getting enough calories if you are losing weight.
  • Limiting fluids.
  • Limiting salt, potassium, phosphorous, and other electrolytes.


Other treatment depends on your symptoms but may include:

  • Extra calcium and vitamin D (always talk to your doctor before taking supplements)
  • Medicines called phosphate binders, to help prevent phosphorous levels from becoming too high
  • Treatment for anemia, such as extra iron in the diet, iron pills or shots, shots of a medicine called erythropoietin, and blood transfusions.
  • Medicines to control your blood pressure

Talk to your provider about vaccinations that you may need, including:

Support Groups

Some people may benefit from taking part in a kidney disease support group.

Outlook (Prognosis)

End-stage kidney disease leads to death if you do not have dialysis or a kidney transplant. Both of these treatments have risks. The outcome is different for each person.

Possible Complications

Complications may include:


Abboud H, Henrich WL. Clinical practice. Stage IV chronic kidney disease. N Engl J Med. 2010;362:56-65.

Fogarty DG, Tall MW. A stepped care approach to the management of chronic kidney disease. In: Taal MW, Chertow GM, Marsden PA, et al., eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 61.

Hsu CY. Epidemiology of kidney disease. In: Taal MW, Chertow GM, Marsden PA, et al., eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 19.

Stevens PE, Levin A, Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158:825-830. PMID 23732715

Yeun JY, Ornt DB, Depner TA. Hemodialysis. In: Taal MW, Chertow GM, Marsden PA, et al., eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 64.

Review Date: 11/26/2014
Reviewed By: Charles Silberberg, DO, private practice specializing in nephrology; affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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