What Is End-Stage Kidney Disease?
Chronic kidney disease is a condition in which your kidneys lose
function over time. A diagnosis of end-stage kidney disease means that you’re
in the final stage of chronic kidney disease and your kidneys are not
functioning well enough to meet the needs of daily life. Your kidneys are
responsible for filtering waste and excess water from your blood in the form of
End-stage kidney disease is also referred to as end-stage renal
disease (ESRD). If you have ESRD, your kidneys are functioning below 10 percent
of their normal function. This may mean that your kidneys are barely
functioning or not functioning at all. Kidney disease is usually progressive.
Chronic kidney disease typically doesn’t reach the end stage until 10 to 20
years after you’re diagnosed. ESRD may also develop slowly.
What Causes End-Stage Kidney Disease?
Many types of kidney diseases attack the nephrons, which are the
tiny units in the kidneys that do the filtering. This results in your blood not
being filtered properly and eventually leads to ESRD.
Diabetes and high blood pressure, or hypertension, are the two
most common causes of ESRD. If you have diabetes, your body can’t break down
glucose, or sugar, correctly and glucose levels remain high in your blood. High
levels of glucose in your blood damage your nephrons.
If you have hypertension, the increased pressure that’s forced
upon the small vessels in your kidneys leads to damage. This damage prevents
your blood vessels from performing their blood-filtering duties.
Who Is at Risk for End-Stage Kidney Disease?
The two main groups at risk for ESRD are people with diabetes and
those with hypertension. You are also more likely to develop the condition if
you have relatives with the disease.
Your risk of developing ESRD also rises when you have any type of
kidney disease or condition, including:
- polycystic kidney disease
- Alport syndrome
- interstitial nephritis
- certain autoimmune conditions, such as lupus
What Are the Symptoms of End-Stage Kidney Disease?
You may experience a wide range of symptoms. Common symptoms
- a decrease in how much you urinate
- an inability to urinate
- a general ill feeling
- unexplained weight loss
- a 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
- absence of menstrual cycles
- sleeping problems such as obstructive sleep
apnea and restless leg syndrome (RLS)
- low libido or impotence
- swelling, or edema, especially in your legs and
How Is End-Stage Kidney Disease Diagnosed?
Your doctor will diagnose ESRD through a physical examination and
tests to check your kidney function. Kidney function tests your doctor may use include
- A urinalysis is used to check for protein and
blood in your urine. These are signs that your kidney isn’t processing waste
- A serum creatinine test is used to check whether
creatinine, a waste product your kidney filters out of your body, is building
up in your blood.
- Blood urea nitrogen is used to check how much
nitrogen is in your blood.
- The estimated glomerular filtration rate (GFR) estimates
how well your kidneys are filtering waste.
How Is End-Stage Kidney Disease Treated?
The two treatments for ESRD are dialysis or a kidney transplant.
You have two options when you undergo dialysis.
One option is hemodialysis, which is a process that uses a
machine to process your blood. It then filters out the waste using a solution
and places the clean blood back into your body. This treatment method is
usually used three times per week. It takes three to four hours each time.
Your doctor may also prescribe peritoneal dialysis, which
involves placing a solution into your abdomen that’s later removed using a
Kidney transplant surgery involves removing your diseased kidneys
and replacing them with a donated organ. One healthy kidney is all you need.
This means that donors are often living because they can donate one and
continue to function normally. According to the National
Kidney Foundation, more than 17,000 kidney transplants were done in the
United States in 2014.
Other Management Techniques
People with diabetes and those with hypertension should control
their conditions in order to prevent ESRD. Both conditions benefit from drug
therapy using angiotensin converting enzyme (ACE) inhibitors or angiotensin
receptor blockers (ARBs).
A diet low in sodium, potassium, and other electrolytes may be
needed, along with fluid restrictions. Caloric intake may need to be increased,
and protein consumption may need to decrease.
Complications of End-Stage Kidney Disease
Possible complications of ESRD include the following:
- skin infections from itching and dry skin
- hepatitis B
- hepatitis C
- liver failure
- heart and blood vessel problems
- a fluid buildup around your lungs
- an increased risk of infections
- nerve damage
- joint, bone, and muscle pain
- stomach and intestinal bleeding
- brain dysfunction and dementia
- abnormal electrolyte levels
- blood glucose level changes
- a weakening of your bones
- joint disorders
Advancements in treatments allow people with ESRD to live much
longer than ever before. Treatment is crucial because without dialysis or a kidney transplant, ESRD can be
life-threatening. The outcome of your treatment depends on you and your
Preventing End-Stage Kidney Disease
In some cases, ESRD isn’t preventable. However, you should keep
your blood glucose levels and your blood pressure under control. You should
always call a doctor if you have any ESRD symptoms. Early detection and
treatment can delay or prevent the disease from progressing.