Uremia

What is uremia?

Uremia is a dangerous condition that occurs when your kidneys don’t function well enough to filter waste products out of your blood. It’s a result of untreated kidney failure, and it develops when the levels of waste products become so high that you develop symptoms.

When your kidneys work as expected, they filter waste products and excess fluids from your blood. The waste products and fluids leave your body through your urine (pee). They also help maintain normal levels of acids, electrolytes and hormones, such as vitamin D and erythropoietin (EPO). Damaged kidneys can’t filter blood well, which allows toxins to build up in your body.

Uremia most often develops due to kidney failure from chronic kidney disease (CKD), or end-stage renal (kidney) disease (ESKD). For most people, ESKD takes a long time to develop. But it can also develop if a severe case of sudden (acute) kidney injury causes your kidneys to fail.

Untreated uremia can lead to a coma and eventually death.

At which stage of chronic kidney disease does uremia occur?

There are five stages of chronic kidney disease. When uremia relates to CKD, it only occurs in complete kidney failure — CKD stage IV.

How common is uremia?

Uremia should be very uncommon. If you’re under the care of a healthcare provider who specializes in diagnosing and treating kidney conditions (nephrologist), they’ll treat kidney failure with either a kidney transplant or dialysis before or shortly after mild uremic symptoms develop.

When dialysis first became available in the mid-20th century, people had to wait until they had severe uremia symptoms to begin dialysis. That’s no longer the case.

What are the symptoms of uremia?

Nausea and vomiting and loss of appetite are usually the first uremia symptoms you’ll notice. It may start out as mild nausea when you first wake up or when you smell food. Some people lose their appetite after they start eating. If a kidney transplant isn’t available, a healthcare provider will recommend starting dialysis as soon as mild nausea and loss of appetite develop.

Other uremia symptoms include:

• Unexplained weight loss.
• Problems with thinking and remembering (cognitive dysfunction).
• Feeling very tired (fatigue).
• Shortness of breath (dyspnea).
• Metallic taste in your mouth.
• Muscle cramps.
• Itching.

In cases of severe, untreated uremia, symptoms include:

• Your breath may smell like pee (uremic fetor).
• Yellow-white crystals may appear on your skin after sweat dries (uremic frost).
• Chest pain from inflammation of the lining of the heart (pericarditis).
• Seizures.
• Coma.

What is the main cause of uremia?

Kidney failure from chronic kidney disease most often causes uremia. Any condition that causes CKD can lead to kidney failure and uremia. Diabetes and high blood pressure (hypertension) are the two most common causes of CKD, but there are many others.

Who is most likely to get uremia?

You’re more likely to have uremia if you have kidney failure and aren’t able to start dialysis before uremia develops. In such cases, you may not know you have CKD and therefore can’t seek care that might prevent kidney failure.

If you have CKD, especially if your kidney score (estimated glomerular filtration rate) is under 45, it’s important to begin getting care from a nephrologist. Not all CKD progresses to kidney failure. And many cases of CKD can’t be prevented. A nephrologist will help you understand your CKD and get you the care necessary to prevent or delay kidney failure. If kidney failure develops, a nephrologist will work with you to either get a kidney transplant or start dialysis before more severe uremia symptoms develop.

What are the complications of uremia?

Untreated uremia can cause serious complications, including:

Blood complications

• Too few healthy red blood cells (anemia).
• Excessive bleeding.

Skeletal problems

• Problems maintaining healthy bones.

Heart complications

• Fluid around your heart (pericardial effusion).
• Inflammation of the lining of the heart (pericarditis).

Brain complications

• Decreased brain function from toxin buildup (uremic encephalopathy).
• Hiccups.
• Twitching or restlessness.
• Seizures.
• Coma.

Other complications

• Inability to get pregnant (infertility).
• Lack of nutrients in your body (malnutrition).

How is uremia diagnosed?

To diagnose uremia, a healthcare provider will:

• Evaluate your symptoms.
• Review your health history, especially your kidney health and biological family history.
• Perform a physical examination, including blood tests to see how well your kidneys work (kidney function).

The blood tests involve different tests that determine how well your kidneys work (kidney function). These include:

• Estimated glomerular filtration rate (eGFR). A healthcare provider calculates your eGFR from a serum creatinine test that’s part of most chemistry panels. It estimates how well your kidneys filter blood, which helps establish whether your kidneys are failing.
• Blood urea nitrogen (BUN) test. A BUN test is a type of blood test that measures how much of the waste product urea nitrogen is in your blood. The BUN can be very high in uremia (which is where the name uremia comes from). But BUN is just a marker of the buildup of toxins in your blood. BUN itself doesn’t cause uremia symptoms. In some cases, uremia can develop when BUN levels aren’t that high.

There isn’t a cutoff for BUN or eGFR that tells your provider you have uremia. But the eGFR will always be near or below 15.

If a provider suspects uremia, they’ll refer you to a nephrologist, if you’re not already under the care of one. If your symptoms are more severe, they may recommend you be admitted to the hospital for more urgent treatment.

What tests will be done to diagnose uremia?

If you have poor kidney function, a healthcare provider may also order more tests to determine the cause of your kidney failure, such as a kidney ultrasound. A kidney ultrasound is an imaging test that measures the size and shape of your kidneys and looks for scarring. It can also detect kidney blockages, such as kidney stones, or injuries.

Can uremia be cured?

The only way to cure uremia is to replace kidney function. The most common uremia treatment is dialysis. Dialysis is a procedure that cleans your blood. There are two types of dialysis:

• Hemodialysis. Hemodialysis uses a machine to filter your blood outside of your body.
• Peritoneal dialysis. Peritoneal dialysis uses the lining of your stomach and a special fluid to filter your blood.

You may be able to have a kidney transplant if end-stage kidney failure causes uremia. A kidney transplant replaces your damaged kidney with a donor kidney. The donor kidney may come from either a living or deceased donor. Kidney transplant is preferable to dialysis, so it’s important to consider a transplant.

Are there any specific medications to treat uremia?

Medications won’t treat your uremia symptoms. But as part of your treatment plan to help prevent the other effects of uremia on your body, a healthcare provider may recommend:

• Replacement EPO that prevents anemia.
• Iron supplements to treat anemia if your iron stores are low.
• Medications that help prevent bone disease, such as calcium supplements, vitamin D supplements and phosphate binders.

A provider may also recommend treatments that relate to CKD but not uremia, such as:

• Blood pressure medications (antihypertensives).
• Medications to treat heart disease.

Can uremia be prevented?

If you have end-stage kidney disease, you should have regular dialysis to keep toxins under control. If you have chronic kidney disease, you may be able to prevent or delay CKD from progressing by:

• Working closely with a nephrologist.
• Managing your blood pressure, diabetes or other medical problems.
• Taking your medications exactly as a healthcare provider prescribes them.
• Avoiding drugs that may further damage your kidneys, including nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, prescription laxatives and recreational (nonprescription) drugs.
• Eating a heart-healthy diet.
• Getting plenty of physical activity.
• Maintaining a healthy weight for you.
• Quitting smoking.

What is the outlook for people with uremia?

Uremia usually requires dialysis and careful monitoring. Without dialysis, severe uremia may cause a coma and eventually death.

How long can a person live with uremia?

If you have kidney failure severe enough to cause uremia, you may survive only a few days or weeks without dialysis or a kidney transplant. If you choose not to start dialysis (for example, if you have another serious illness that’ll significantly shorten how long you may live), then healthcare providers can help care for you and treat the symptoms of uremia (palliative care).

Should I make any changes to my diet?

If you have CKD, you should follow a heart-healthy, low-sodium eating pattern. You may need to adjust or avoid certain medications. A healthcare provider can help you make the safest choices.

If your CKD is more advanced, you may develop elevated levels of potassium, phosphorus or parathyroid hormone (PTH). In such cases, you should talk to a healthcare provider or dietitian who specializes in kidney health (renal dietitian) before changing your diet or taking supplements.

Renal dietitians may often recommend eating patterns to help prevent these elevated levels. This includes limiting your intake of:

• Potassium.
• Phosphate.
• Protein.

When should I see a healthcare provider?

Schedule regular appointments with a healthcare provider to monitor your kidney health.

Contact a provider if you have kidney disease risk factors, including:

• A biological family history of kidney disease.
• A past kidney injury.
• High blood pressure.
• Changes in your peeing habits.
• Swelling (edema), especially around your ankles, hands or face.
• You take a lot of NSAIDs.

When should I go to the ER?

Go to the nearest emergency room or call 911 or your local emergency number if you or someone else with kidney issues shows signs of:

• Abnormal behavior.
• Chest pain.
• Difficulty concentrating.
• Confusion.
• Difficulty breathing.
• Not knowing where you are (disorientation).
• Drowsiness.
• Fatigue.
• Nausea and vomiting.

What questions should I ask a healthcare provider?

You may want to ask your provider:

• How do you know that I have uremia?
• Should I make changes to what I eat and drink?
• What’s your recommended treatment?
• Can you refer me to a nephrologist?
• Can you refer me to a support group?