What is end-stage kidney disease?
End-Stage Kidney Disease (ESRD) occurs when the kidneys are no longer able to function at a level needed for day-to-day life due to long term chronic diseases. The kidneys filter waste and excess water from your blood as urine. It means your kidneys no longer function well enough to meet the needs of daily life.
End-stage kidney disease is also called end-stage renal disease (ESRD). The kidneys of people with ESRD function below 10 percent of their normal ability, which may mean they’re barely functioning or not functioning at all.
Kidney disease is usually progressive. The length of each stage varies and depends on how your kidney disease is treated, especially in relation to your diet and whether your doctor recommends dialysis. Chronic kidney disease typically doesn’t reach the end stage until 10 to 20 years after you’re diagnosed. ESRD is the fifth stage of the progression of chronic kidney disease, which is measured by your glomerular filtration rate (GFR):
Stage GFR (ml/min/1.73 m2) Health of kidneys
1 ≥90 kidneys function normally, but the first signs of kidney disease appear
2 60-89 kidney function is slightly reduced
3A/3B 45-59 (3A) and 30-44 (3B) kidney function is noticeably reduced
4 15-29 kidney function is extremely reduced
5 <15 ESRD, which is also known as established renal failure.
Prevention of end-stage kidney disease
In some cases, ESRD isn’t preventable. However, you should control your blood glucose levels and your blood pressure. You should always call a doctor if you have any ESRD symptoms. Early detection and treatment can delay or prevent the disease from progressing.
Symptoms of end-stage kidney disease
You may experience a wide range of symptoms, including:
- a decrease in how much you urinate
- inability to urinate
- malaise, or a general ill feeling
- unexplained weight loss
- loss of appetite
- nausea and vomiting
- dry skin and itching
- changes in skin color
- bone pain
- confusion and difficulty concentrating.
Other symptoms may include:
- bruising easily
- frequent nosebleeds
- numbness in your hands and feet
- bad breath
- excessive thirst
- frequent hiccups
- the absence of menstrual cycles
- sleeping problems, such as obstructive sleep apnea and restless leg syndrome (RLS)
- low libido or impotence
- edema, or swelling, especially in your legs and hands.
See your doctor right away if any of these symptoms interfere with your life, especially if you can’t urinate or sleep, are vomiting frequently, or feel weak and unable to do daily tasks.
Diagnosis of end-stage kidney disease
Your doctor diagnoses ESRD using a physical examination and tests to check your kidney function. Kidney function tests include:
Urinalysis: This test helps your doctor check for protein and blood in your urine. These substances indicate that your kidneys aren’t processing waste properly.
Serum creatinine test: This test helps your doctor check whether creatinine is building up in your blood. Creatinine is a waste product that your kidneys should filter out of your body.
Blood urea nitrogen test: This test helps your doctor check how much nitrogen is in your blood.
Estimated glomerular filtration rate (GFR): This test allows your doctor to estimate how well your kidneys filter waste.
Treatment of end-stage kidney disease
The treatments for ESRD are dialysis or a kidney transplant. In some cases, lifestyle changes and medications may help.
You have two options when you undergo dialysis.
One option is hemodialysis, which uses a machine to process your blood. The machine filters out waste using a solution. It then places the clean blood back into your body. This method is usually used three times per week and takes three to four hours each time.
Your doctor may also prescribe peritoneal dialysis. This process involves placing a solution into your abdomen that’s later removed using a catheter. This type of dialysis can be done at home with proper training. It’s often done overnight while you sleep.
Kidney transplant surgery involves removing your affected kidneys (if removal is needed) and placing a functioning donated organ. One healthy kidney is all you need, so donors are often living. They can donate one kidney and continue to function normally with the other. According to the National Kidney Foundation, more than 17,000 kidney transplants were performed in the United States in 2014.
People with diabetes or hypertension should control their conditions to help prevent ESRD. Both conditions benefit from drug therapy using angiotensin converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs).
Some vaccines can help prevent serious complications of ESRD. According to the Centers for Disease Control and Prevention, the hepatitis B and pneumococcal polysaccharide (PPSV23) vaccines can lead to positive outcomes, especially before and during dialysis treatments. Talk to your doctor about which vaccine may be best for you.
Fluid retention can cause rapid weight change, so monitoring your weight is important. You may also need to increase your caloric intake and decrease your protein consumption. A diet low in sodium, potassium, and other electrolytes may be needed, along with fluid restriction.
Limit these foods to avoid consuming too much sodium or potassium:
- nuts and peanut butter
Taking vitamin supplements, such as calcium, vitamin C, vitamin D, and iron, can help your kidney function and the absorption of essential nutrients.
Causes end-stage kidney disease
Many kidney diseases attack the nephrons, the tiny filtering units in the kidneys. This leads to poor blood filtering, which eventually leads to ESRD. ESRD is caused most commonly by diabetes and hypertension (high blood pressure).
If you have diabetes, your body can’t break down glucose (sugar) correctly, so glucose levels in your blood remain high. Having high levels of glucose in your blood damages your nephrons.
If you have hypertension, the increased pressure on the small vessels in your kidneys leads to damage. The damage prevents your blood vessels from performing their blood-filtering duties.
Other causes of ESRD include:
- long-term blockage of the urinary tract by kidney stones, enlarged prostate, or certain types of cancer
- glomerulonephritis, an inflammation of the filters in your kidney (known as glomeruli)
- vesicoureteral reflux, when urine flows into your kidneys
Risk of end-stage kidney disease
Certain people are at higher risk of developing ESRD, such as people who have:
- relatives with ESRD
Your risk of developing ESRD also rises when you have any type of kidney condition, including:
- polycystic kidney disease (PKD)
- Alport syndrome
- interstitial nephritis
- certain autoimmune conditions, such as lupus
According to one study, a fast decline in the normal function of your kidneys can signal the onset of ESRD.
Complications of end-stage kidney disease
Possible complications of ESRD include:
- skin infections from dry skin and itching
- increased risk of infections
- abnormal electrolyte levels
- joint, bone, and muscle pain
- weak bones
- nerve damage
- changes in blood glucose level.
Less common but more serious complications include:
- liver failure
- heart and blood vessel problems
- fluid buildup around your lungs
- stomach and intestinal bleeding
- brain dysfunction and dementia
- joint disorders
Advancements allow people with ESRD to live longer than ever before. ESRD can be life-threatening. With treatment, you’ll likely live for many years afterward. Without treatment, you may only be able to survive without your kidneys for a few months. If you have other accompanying conditions, such as heart issues, you may face additional complications that can affect your life expectancy.
It can be easy to withdraw as you experience the effects of ESRD or the lifestyle changes that come with dialysis. If this happens, seek professional counseling or positive support from your family and friends. They can help you stay actively engaged in your daily life. This can ensure that you maintain a high quality of life.
Your recovery depends on the type of treatment recommended by your doctor.
With dialysis, you can receive treatment at a facility or at home. In many cases, dialysis allows you to prolong your life by regularly filtering waste from your body. Some dialysis options allow you to use a portable machine so that you can continue your daily life without having to use a large machine or go to a dialysis center.
Kidney transplants are also likely to succeed. Failure rates of transplanted kidneys are low, ranging from 3 to 21 percent in the first five years. A transplant allows you to resume normal kidney function. If you follow your doctor’s recommendations for diet and lifestyle changes, a kidney transplant can help you live free from ESRD for many years.
Medically reviewed by Carissa Stephens, RN, CCRN, CPN on July 10, 2017 — Written by Christine DiMaria, Marijane Leonard, and Tim Jewell