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End-stage kidney disease

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

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).

Images

Kidney anatomy

Causes

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.

The most common causes of ESRD in the United States are diabetes and high blood pressure. These conditions can affect your kidneys.

ESRD almost always comes after chronic kidney disease. The kidneys may slowly stop working during a period of 10 to 20 years before end-stage disease results.

Symptoms

Common symptoms may include:

Other symptoms may include:

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:

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

Treatment

ESRD may need to be treated with dialysis or kidney transplant. You may need to stay on a special diet or take medicines to help your body work well.

DIALYSIS

Dialysis does some of the job of the kidneys when they stop working well.

Dialysis can:

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.

Two different methods are used to perform dialysis:

KIDNEY TRANSPLANT

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.

SPECIAL DIET

You may need to continue following a special diet for chronic kidney disease. The diet may include:

OTHER TREATMENT

Other treatment depends on your symptoms, but may include:

Talk to your provider about vaccinations that you may need, including:

Support Groups

Some people may benefit from taking part in a kidney disease support group.

Outlook (Prognosis)

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.

Possible Complications

Health problems that can result from ESRD include:

Related Information

Electrolytes
Chronic kidney disease
Diabetes
Pericarditis
Cardiac tamponade
Heart failure - overview
High blood pressure - adults
Peptic ulcer
Anemia
Hepatitis B
Hepatitis C
Peripheral neuropathy
Seizures
Dementia
Metabolism
Miscarriage
Infertility

References

Goldfarb DA, Poggio ED, Demirjian S. Etiology, pathogenesis, and management of renal failure. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 46.

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, Young B, Depner TA, Chin AA. Hemodialysis. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2020:chap 63.

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Review Date: 1/16/2018  

Reviewed By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Internal review and update on 07/10/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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