End-Stage Renal (Kidney) Disease

What is end-stage renal disease?

End-stage kidney disease (ESKD), or kidney failure, is the fifth and final stage of chronic kidney disease (CKD) progression. With chronic kidney disease, your kidneys can’t do their day-to-day job. When they fail, you need treatment either dialysis or a kidney transplant to survive.

What do the kidneys do?

The kidneys are bean-shaped organs, located deep inside the body toward the back, down near the hips. Most people have two kidneys. But some people are born with only one kidney, or only one that works. Other people have a single kidney because they donated one or had one removed for another health reason. In most cases, one kidney can still do everything your body needs.

The kidneys:

• Filter blood (about a half-cup per minute) to remove waste, extra water and acid.
• Help the body maintain a healthy balance of water, salt and minerals such as potassium, calcium and magnesium.
• Make urine, or pee, so the body can remove waste.
• Make hormones to help control blood pressure, keep bones strong and create red blood cells to prevent anemia.

What causes kidney failure?

Kidney disease is caused by many different health problems that can damage the kidneys. The damage can take place all at once or a little bit at a time over many years. Eventually, kidney disease can lead to kidney failure.

Common causes of kidney disease include:

• Autoimmune diseases (lupus, for example).
• Birth defects that interfere with kidney development.
• Cysts (pockets of fluid) in the kidneys, from an inherited condition called polycystic kidney disease.
• Diabetes (this is the most common cause in the US).
• High blood pressure (hypertension) (this is the second most common cause in the US) and heart disease.
• Kidney stones.
• Severe or repeat infections, including urinary tract infections.

What are the symptoms of end-stage renal disease?

Early kidney disease often has no symptoms. Some people may not even know they have kidney disease until their kidneys fail.

If your kidneys begin to fail, you may experience:

• Confusion.
• Itchiness all over.
• Lack of appetite.
• Metallic taste in your mouth.
• Muscle cramps or muscle jerking.
• Nausea and vomiting.
• Shortness of breath.
• Swelling in your feet or ankles.
• Too much or too little urine production.
• Trouble sleeping, or sleeping too much.

If you develop any of these symptoms, you should contact a healthcare provider immediately.

What are the complications of renal failure?

End-stage renal failure can cause complications and emergencies that require treatment, including:

• Anemia (not enough red blood cells to carry oxygen throughout the body.)
• Bone disease.
• Brain damage.
• Edema (swelling)
• Fluid in and around the lungs.
• High levels of certain minerals (potassium or phosphorus).
• Infections.
• Nerve damage.
• Seizures.
• Stroke.

What tests should I have for kidney disease?

People with chronic kidney disease usually see a kidney specialist called a nephrologist. This healthcare provider takes blood tests at a set schedule to measure levels of:

• Albumin (protein).
• Calcium (mineral), phosphorus, parathyroid hormone (bone markers++)++
• Cholesterol (fat).
• Creatinine (muscle waste product).
• Magnesium (mineral).
• Potassium and sodium (electrolytes).
• Red blood cells and complete blood count (CBC).

Can doctors cure kidney failure?

Healthcare providers can treat, slow or stop kidney disease but can’t cure kidney failure. A person with end-stage kidney disease needs dialysis or a kidney transplant to survive.

When do you know you need dialysis or a kidney transplant?

Your healthcare provider will calculate a special score called the estimated glomerular filtration rate, or eGFR. This score helps the provider track the severity of kidney disease over time. It starts at 100 (highest kidney function) and goes down to 0 (no kidney function). A score below 15 marks kidney failure and the need for dialysis or kidney transplant.

Healthcare providers determine the filtration rate based on your:

• Age.
• Creatinine blood levels.
• Body size.
• Gender.

What is dialysis?

Dialysis takes over the work of the kidneys to keep your body in balance. It has no effect on kidney function. There are two common types:

• Hemodialysis: A machine called a hemodialyzer removes blood from your body, filters it and returns the cleaned blood to your body. Healthcare providers need to use blood vessels in your arm to transfer the blood.
• Peritoneal dialysis: This treatment cleans the blood while it’s still in your body. To start, healthcare providers place a plastic tube in your belly. They then pump in a solution that collects extra fluid and waste. They remove the solution at the end of the cleaning.

Where do I get dialysis?

You can receive dialysis in a hospital, in a dialysis clinic or at home. Your healthcare provider will help you decide which option is best for you.

How long does dialysis take?

Usually, each hemodialysis treatment lasts about four hours. Most people receiving hemodialysis need it three times a week. A peritoneal dialysis treatment takes 30 to 40 minutes and should get done several times a day.

Your nephrologist will determine what type of dialysis you need based on:

• Amount of waste in your body.
• How much fluid you have.
• Your kidney function.
• Your size.

A person waiting for a kidney transplant needs dialysis treatments right up to the time of surgery.

What is a kidney transplant?

A kidney transplant is an operation where surgeons replace the diseased kidney with a new one placed in the groin area. The kidney can come from someone who has died or from a living donor. Remember, most people have two kidneys and can live just fine with one healthy kidney.

Your healthcare team will perform tests to determine if the donor kidney is a good match. To prevent your body from rejecting a new kidney, you will need to take special drugs. These drugs are called anti-rejection medications or immunosuppressants.

After a successful transplant, the donated kidney will start filtering blood and removing waste.

Can I prevent kidney failure?

The best way to prevent end-stage renal disease is to manage the disease harming your kidneys, especially high blood pressure or diabetes. Doing so will limit the amount of damage done to your kidneys.

What is the outlook for a person with kidney failure?

Healthcare providers can’t cure kidney failure, and the disease is life-threatening. But dialysis or a kidney transplant can help you live longer and manage any symptoms or complications. You can also do the things you enjoy.

Should I change my lifestyle to manage kidney failure?

People with severe kidney disease (even those on dialysis) should:

• Exercise.
• Limit fluids.
• Limit foods that contain phosphorus, potassium or sodium (salt).

A dietician can help you plan proper nutrition for kidney disease.

Can I still work if my kidneys are failing?

Many people with kidney failure keep working. It may make you feel more normal and productive. And it can provide insurance to cover your health costs.

Your healthcare providers can help you plan a treatment schedule that fits your work needs. You can even ask your healthcare provider for a social worker to help you talk with your employer. For example, if you’re on peritoneal dialysis and do it yourself, you’ll need access to a clean place at work. If you’re on hemodialysis, your employer should know that you can’t lift heavy things.

If you can’t work, government and private programs can help. They can provide money, health insurance and transportation to doctors’ appointments and treatments. A social worker can help you find such programs and apply.

A note from Cleveland Clinic

End-stage renal disease is the last stage of chronic kidney disease. It marks the point when kidney function drops to very low levels. Kidney failure failure is life threatening, but dialysis or transplantation can relieve weakened kidneys. If you have kidney disease, a healthcare provider can help you manage the cause and watch your kidney function.