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End Stage Kidney Disease

Medically reviewed by Last updated on Aug 31, 2022.

What is end-stage kidney disease (ESRD)?

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.

What are the signs and symptoms of ESRD?

  • Swelling in your hands, ankles, or feet
  • Fatigue, drowsiness, or weakness
  • Nausea, vomiting, or loss of appetite
  • Constipation
  • Itchy skin
  • Muscle cramps or leg movements you cannot control
  • Bone pain
  • Shortness of breath or chest pain

How is ESRD diagnosed and treated?

Blood tests will show how well your kidneys are working and if you have other health conditions caused by ESRD. You may need the following treatments:

  • Dialysis is a treatment to remove chemicals and waste from your blood when kidneys can no longer do this.
  • 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).
  • A kidney transplant may be done to replace your kidney with a healthy, donor kidney.

How can I 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.

How can I care for myself?

  • 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.

When should I seek immediate care?

  • 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.

When should I contact my healthcare provider?

  • 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.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. 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.

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Further information

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