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End Stage Kidney Disease


End-stage kidney disease (ESRD) is when your kidney function is so poor that you need dialysis treatments or a kidney transplant to survive. ESRD usually occurs after long-term kidney disease.


Return to the emergency department if:

  • You have shortness of breath or chest pain.
  • You have a rash, or a new wound that is very painful.
  • You have severe muscle cramps or pain.
  • Your heart is beating faster than normal for you.

Contact your healthcare provider if:

  • You urinate less than is normal for you.
  • You gain or lose more weight than your healthcare provider told you is okay.
  • You are more tired or drowsy.
  • You have increased nausea or vomiting.
  • You have pain that does not decrease, even after you take medicine.
  • You have questions or concerns about your condition or care.


  • Medicines are given to decrease blood pressure, pain, or itching. You may also need medicine to decrease nausea, or to treat or prevent anemia (low number of red blood cells).
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Follow up with your healthcare provider as directed:

You will need to return for more tests. You may also need to return for routine dialysis treatments. Write down your questions so you remember to ask them during your visits.

Manage ESRD:

  • Protect your dialysis access site. Do not let anyone take blood or blood pressure readings on the arm where you have your arteriovenous fistula or graft. Cover your peritoneal catheter with a bandage. Do not touch the catheter.
  • Limit fluids to 1 liter a day (about 34 ounces) , or as directed by your healthcare provider. This can help you manage swelling between dialysis appointments.
  • Weigh yourself at the same time every day. Use the same scale, and wear the same amount of clothing. Record your weight and bring it with you to follow-up appointments.
  • Do not use NSAIDs or aspirin. They can increase the risk of bleeding in your stomach.


  • Manage other health conditions, such as high blood pressure, diabetes, and heart disease. These conditions can make your ESRD worse.
  • Eat foods low in sodium, phosphorus, and potassium as directed. You may also need to eat foods high in protein. You may need to see a dietitian if you need help planning meals.
  • Maintain a healthy weight. Ask your healthcare provider how much you should weigh. Ask him to help you create a weight loss plan if you are overweight.
  • Exercise as directed. Regular exercise can help you manage conditions that occur with ESRD, such as high blood pressure and diabetes. Exercise may give you more energy and decrease constipation. Ask about the best exercise plan for you.
  • Limit alcohol. Ask how much alcohol is safe for you to drink. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.
  • Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung and kidney damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
  • Ask your healthcare provider if you need vaccines. Pneumonia, influenza, and hepatitis can be more harmful or more likely to occur when you have ESRD. Vaccines reduce your risk of infection with these viruses.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about End Stage Kidney Disease (Aftercare Instructions)

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