Home > Diseases and Conditions > End-stage kidney disease
  • We are sorry, but NCBI web applications do not support your browser and may not function properly. More information

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

End-stage kidney disease

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

Last reviewed: October 2, 2013.

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.

Causes

End-stage kidney disease (ESRD) is 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 - 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
  • Problems concentrating or thinking
  • Numbness in the hands, feet, or other areas
  • 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:

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

Treatment

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 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:

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:

Support Groups

Some people get 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. However, both of these treatments can have risks. The outcome is different for each person.

Possible Complications

References

  1. 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.
  2. Himmelfarb J, Ikizler TA. Hemodialysis. N Engl J Med. 2010 Nov 4;363(19):1833-45. Review. PubMed PMID: 21047227. [PubMed: 21047227]
  3. 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. [PubMed: 20375408]
  4. Abboud H, Henrich WL. Clinical practice. Stage IV chronic kidney disease. N Engl J Med. 2010 Jan 7;362(1):56-65. [PubMed: 20054047]
  5. 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. [PubMed: 17720528]
  6. 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. [PubMed: 16678661]
  7. Palmer SC, Navaneethan SD, Craig JC, Johnson DW, Tonelli M, Garg AX, et al. Meta-analysis: erythropoiesis-stimulating agents in patients with chronic kidney disease. Ann Intern Med. 2010;153:23-33. [PubMed: 20439566]

Review Date: 10/2/2013.

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.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Haemodiafiltration, haemofiltration and haemodialysis for end‐stage kidney diseaseHaemodiafiltration, haemofiltration and haemodialysis for end‐stage kidney disease
    Haemodialysis (HD), haemofiltration (HF), haemodiafiltration (HDF) and acetate‐free biofiltration (AFB) are renal replacement therapy (RRT) methods where impurities are removed from the blood extracorporeally, i.e. outside the body using a dialysis machine. It has been suggested that convective methods (either HF, HDF or AFB) may reduce the frequency and severity of adverse symptoms that may occur during and after a dialysis session, and may be more effective than HD in the removal of high molecular weight molecules. We identified 20 studies (657 patients) which compared HF, HDF or AFB with HD (n = 17), HDF with AFB (n = 2) or HF with HDF (n = 1). Our review did not find any evidence for improvement of clinically important outcomes such as mortality, dialysis‐associated hypotension and dialysis‐related amyloidosis with convective modalities when compared to HD.
See all (69) ...

Figures

  • Kidney anatomy.

PubMed Health Blog...

read all...

MedlinePlus.gov links to free, reliable, up-to-date health information from the National Institutes of Health (NIH) and other trusted health organizations.

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...