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End-stage kidney disease

  • Definition
    • 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.

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

  • Alternative Names
    • Renal failure - end stage; Kidney failure - end stage; ESRD

  • Causes
    • The kidneys remove waste and excess water from the body. 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 United States 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.

  • Symptoms
    • 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
  • Treatment
    • ESRD may need to be treated with dialysis or kidney transplant. You may need to stay on a special diet or take medicines to help your body work well.

      DIALYSIS

      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 the body make 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.

      KIDNEY TRANSPLANT

      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.

      SPECIAL DIET

      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

      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
  • 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
  • References
    • Fogarty DG, Taal MW. A stepped care approach to the management of chronic kidney disease. In: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 62.

      Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713-735. PMID: 24647050 www.ncbi.nlm.nih.gov/pubmed/24647050.

      Inker LA, Levey AS. Staging and management of chronic kidney disease. In: Gilbert SJ, Weiner DE, eds. National Kidney Foundation Primer on Kidney Diseases. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 53.

      Yeun JY, Ornt DB, Depner TA. Hemodialysis. In: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 65.