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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).

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Kidney anatomy
Glomerulus and nephron

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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 damage 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 than normal, or their kidneys may 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 provider 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
High blood pressure in adults - hypertension
Peptic ulcer
Anemia
Hepatitis B
Hepatitis C
Peripheral neuropathy
Seizures
Dementia
Metabolism

References

Inker LA, Levey AS. Staging and management of chronic kidney disease. In: Gilbert SJ, Weiner DE, Bomback AS, Perazella MA, Rifkin DE, eds. National Kidney Foundation Primer on Kidney Diseases. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 51.

Taal MW. Classification and management of chronic kidney disease. 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 59.

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. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 63.

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Review Date: 1/6/2022  

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 02/10/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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