End-stage kidney disease
End-stage kidney disease (ESKD) is the last stage of long-term (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).
Renal failure - end stage; Kidney failure - end stage; ESRD; ESKD
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.
ESRD almost always comes after chronic kidney disease. The kidneys may slowly stop working over 10 to 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.
People with ESRD will make much less urine, or their kidneys no longer make urine.
ESRD changes the results of many tests. People 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 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. This method can be done at home or at a dialysis center.
- 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 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 depends on your symptoms, but may include:
- Extra calcium and vitamin D (always talk to your provider 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:
Some people may 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. Both of these treatments have risks. The outcome is different for each person.
Health problems that can result from ESRD include:
- 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 level
- 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, 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. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 52.
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.
Reviewed By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.