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.
Renal failure - end stage; Kidney failure - end stage; ESRD
End-stage kidney disease (ESRD) is when the kidneys are no longer able to work at a level needed for day-to-day life.
ESRD almost always comes after chronic kidney disease. The kidneys may slowly stop working over 10 - 20 years before end-stage disease results.
Common symptoms may include:
- General ill feeling and fatigue
- Itching (pruritus) and dry skin
- Weight loss without trying
- Loss of appetite
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.
Patients with end-stage kidney disease will make much less urine, or urine production may stop.
End-stage kidney disease changes the results of many tests. Patients receiving dialysis will need these and other tests done often:
- Complete blood count (CBC)
This disease may also change the results of the following tests:
Dialysis does some of the job of the kidneys when they stop working well.
- Remove extra salt, water, and waste products so they don't 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 health care 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 - 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 follow a special diet for chronic kidney disease. These changes may include:
- Eat a low-protein diet.
- Get enough calories if you are losing weight.
- Limit fluids.
- Limit 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
You should be up-to-date on important vaccinations, including:
Some people get benefit from taking part in a kidney disease support group.
End-stage kidney disease leads to death if you do not have dialysis or a kidney transplant. However, both of these treatments can have risks. The outcome is different for each person.
- Bleeding from the stomach or intestines
- Bone, joint, and muscle pain
- Changes in blood sugar (glucose)
- Damage to nerves of the legs and arms
- Fluid buildup around the lungs
- High blood pressure, heart attack, and heart failure
- High potassium levels
- Increased risk of infection
- Liver damage or failure
- Miscarriages or infertility
- Restless legs syndrome
- Stroke, seizures, and dementia
- Swelling and edema
- Weakening of the bones and fractures related to high phosphorous and low calcium levels
Fogarty DG, Tall MW. A stepped are 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: Saunders Elsevier; 2011:chap 61.
Himmelfarb J, Ikizler TA. Hemodialysis. N Engl J Med. 2010 Nov 4;363(19):1833-45. Review. PubMed PMID: 21047227.
Tonelli M, Pannu N, Manns B. Oral phosphate binders in patients with kidney failure. N Engl J Med. 2010 Apr 8;362(14):1312-24.
Abboud H, Henrich WL. Clinical practice. Stage IV chronic kidney disease. N Engl J Med. 2010 Jan 7;362(1):56-65.
KDOQI. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007;50:471-530.
KDOQI: National Kidney Foundation. II. Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease in adults. Am J Kidney Dis. 2006;47(5 Suppl 3):S16-S85.
Reviewed By: Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.