End-stage kidney disease is the complete, or almost complete failure of the kidneys to

function. The kidneys can no longer remove wastes, concentrate urine, and regulate many
other important body functions.

Causes

End-stage kidney disease occurs when the kidneys are no longer able to function at a
level needed for day-to-day life. It usually occurs when chronic kidney disease has
worsened to the point at which kidney function is less than 10% of normal.

ESRD almost always follows chronic kidney disease. A person may have gradual
worsening of kidney function for 10 - 20 years or more before progressing to ESRD.

Patients who have reached this stage need dialysis or a kidney transplant.

The most common causes of ESRD in the U.S. are diabetes and high blood pressure. See
Chronic kidney disease for a complete list of causes.

Symptoms

Symptoms may include:

• General ill feeling and fatigue

• Generalized itching (pruritus) and dry skin
• Headaches
• Weight loss without trying
• Loss of appetite
• Nausea

Other symptoms may develop, including:

• Abnormally dark or light skin and changes in nails

• Bone pain
• Brain and nervous system symptoms
o Drowsiness and confusion
o Problems concentrating or thinking
o Numbness in the hands, feet, or other areas
o Muscle twitching or cramps
• Breath odor
• Easy bruising, nosebleeds, or blood in the stool
• Excessive thirst
• Frequent hiccups
• Low level of sexual interest and impotence
• Menstrual periods stop (amenorrhea)
• Sleep problems, such as insomnia, restless leg syndrome, or obstructive sleep
apnea
 • Swelling of the feet and hands (edema)
• Vomiting, especially in the morning

Exams and Tests

The urine volume may decrease or urine production may stop. The patient will usually
have signs of the many complications of chronic kidney disease.

End-stage kidney disease changes the results of many tests. Patients receiving dialysis
will need these and other tests done often:

• Potassium
• Sodium
• Albumin
• Phosphorous
• Calcium
• Cholesterol
• Magnesium
• Complete blood count (CBC)
• Electrolytes

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

• Erythropoietin
• PTH
• Bone density test

Treatment

Dialysis or kidney transplantation is the only treatment for ESRD. Your physical
condition and other factors determine which treatment is used.

When you start dialysis depends on different factors, including your lab test results,
severity of symptoms, and readiness. You should begin to prepare for dialysis before it is
absolutely necessary. The preparation includes learning about dialysis and the types of
dialysis therapies, and placement of a dialysis access.

See also: Dialysis

Treatment usually includes an ACE inhibitor, angiotensin receptor blocker, or other

medications for high blood pressure.

You may need to make changes in your diet.

• Eat a low-protein diet

• Limit fluids
 • Limit salt, potassium, phosphorous, and other electrolytes
• Get enough calories if you are losing weight

See Diet and chronic kidney disease for more detail.

Other treatments may include:

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

Different treatments are available for problems with sleep or restless leg syndrome.

Patients with chronic kidney disease should be up-to-date on important vaccinations,

including:

• Pneumococcal polysaccharide vaccine (PPV)

• Influenza vaccine
• H1N1 (swine flu) vaccine
• Hepatitis B vaccine
• Hepatitis A vaccine

Support Groups

For additional resources, see kidney disease support group.

Outlook (Prognosis)

Without dialysis or a kidney transplant, death will occur from the buildup of fluids and
waste products in the body. Both of these treatments can have serious risks and
consequences. The outcome is different for each person.

Possible Complications

• Anemia
• Bleeding from the stomach or intestines
• Bone, joint, and muscle pain
• Brain dysfunction, confusion, and dementia
• Changes in electrolyte levels
• Changes in blood sugar (glucose)
• Damage to nerves of the legs and arms
• Fluid buildup around the lungs
• Heart and blood vessel complications
o Congestive heart failure
 o Coronary artery disease
o High blood pressure
o Pericarditis
o Stroke
• Hepatitis B, hepatitis C, liver failure
• Hyperparathyroidism
• Increased risk of infections
• Malnutrition
• Phosphorous levels become too high
• Potassium levels become too high
• Seizures
• Skin dryness, itching/scratching, leading to skin infection
• Weakening of the bones, fractures, joint disorders

Prevention

Treatment of chronic kidney disease may delay or prevent progression to ESRD. Some
cases may not be preventable.

Alternative Names

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

References

Tolkoff-Rubin N. Treatment of irreversible renal failure. In: Goldman L, Ausiello D, eds.

Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 133.

Mitch WE. Chronic kidney disease. In: Goldman L, Ausiello D, eds. Goldman: Cecil
Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 131.

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.

Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice

guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J
Kidney Dis. 2004;43(5 Suppl 1):S1-S290.

Update Date: 8/12/2009

Updated by: Parul Patel, MD, Private practice specializing in Nephrology, Kidney and
Pancreas Transplantation, affiliated with California Pacific Medical Center Department
of Transplantation, San Francisco, CA. Review provided by VeriMed Healthcare
Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.