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End-stage renal disease

Overview

End-stage renal disease, also called end-stage kidney disease, occurs when chronic kidney disease — the gradual loss of kidney function — reaches an advanced state. In end-stage renal disease, your kidneys are no longer able to work as they should to meet your body's needs.

Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When your kidneys lose their filtering capabilities, dangerous levels of fluid, electrolytes and wastes can build up in your body.

With end-stage renal disease, you need dialysis or a kidney transplant to stay alive. But you may also choose to forgo dialysis or transplant and opt for conservative care to manage your symptoms — aiming for the best quality of life possible during your remaining time.

Symptoms

Early in chronic kidney disease, you may have no signs or symptoms. As chronic kidney disease progresses to end-stage renal disease, signs and symptoms might include:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Fatigue and weakness
  • Sleep problems
  • Changes in how much you urinate
  • Decreased mental sharpness
  • Muscle twitches and cramps
  • Swelling of feet and ankles
  • Persistent itching
  • Chest pain, if fluid builds up around the lining of the heart
  • Shortness of breath, if fluid builds up in the lungs
  • High blood pressure (hypertension) that's difficult to control

Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. Because your kidneys are highly adaptable and able to compensate for lost function, signs and symptoms may not appear until irreversible damage has occurred.

When to see a doctor

Make an appointment with your doctor if you have any signs or symptoms of kidney disease.

If you have a medical condition that increases your risk of kidney disease, your doctor is likely to monitor your blood pressure and kidney function with urine and blood tests during regular office visits. Ask your doctor whether these tests are necessary for you.

Causes

Kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years.

Diseases and conditions that can lead to kidney disease include:

  • Type 1 or type 2 diabetes
  • High blood pressure
  • Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the kidney's filtering units (glomeruli)
  • Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney's tubules and surrounding structures
  • Polycystic kidney disease
  • Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
  • Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys
  • Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)
Normal kidney vs. diseased kidney

A normal kidney has about 1 million filtering units. Each unit, called a glomerulus, connects to a tubule, which collects urine. Conditions such as high blood pressure and diabetes take a toll on kidney function by damaging these filtering units and collecting tubules and causing scarring.

Normal kidney vs. diseased kidney

A normal kidney has about 1 million filtering units. Each unit, called a glomerulus, connects to a tubule, which collects urine. Conditions such as high blood pressure and diabetes take a toll on kidney function by damaging these filtering units and collecting tubules and causing scarring.

Polycystic kidney

A healthy kidney (left) eliminates waste from the blood and maintains the body's normal chemical balance. Fluid-filled sacs (right), called cysts, characterize polycystic kidney disease.

Risk factors

Certain factors increase the risk that chronic kidney disease will progress more quickly to end-stage renal disease, including:

  • Diabetes with poor blood sugar control
  • Kidney disease that affects the glomeruli, the structures in the kidneys that filter wastes from the blood
  • Polycystic kidney disease
  • Kidney disease after a kidney transplant
  • High blood pressure
  • Tobacco use
  • African-American descent
  • Male sex
  • Older age
  • Lower level of kidney function when your doctor first begins regular measurements of kidney function

Complications

Kidney damage, once it occurs, can't be reversed. Potential complications can affect almost any part of your body and can include:

  • Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
  • A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's ability to function and may be life-threatening
  • Heart and blood vessel (cardiovascular) disease
  • Weak bones and an increased risk of bone fractures
  • Anemia
  • Decreased sex drive, erectile dysfunction or reduced fertility
  • Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures
  • Decreased immune response, which makes you more vulnerable to infection
  • Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium)
  • Pregnancy complications that carry risks for the mother and the developing fetus
  • Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival

Diagnosis

Tests and exams to detect end-stage renal disease may include:

  • A discussion of your health history, including your personal health history and questions about your family's health history.
  • A physical exam, during which your doctor measures your height, weight and blood pressure and also looks for signs of problems with your heart or blood vessels and conducts a neurological exam.
  • Blood tests, to measure the amount of waste products, such as creatinine and urea, in your blood.
  • Urine tests, to check the level of the protein albumin in your urine — a high albumin level may indicate kidney disease.
  • Imaging tests, such as ultrasound, magnetic resonance imaging or a computed tomography (CT) scan, to assess your kidneys' structure and size and look for abnormalities.
  • Removing a sample of kidney tissue (biopsy), to examine under a microscope to learn what type of kidney disease you have and how much damage there is.

Certain tests may be repeated over time to help your doctor follow the progress of your kidney disease.

Stages of kidney disease

There are five stages of kidney disease. To determine what stage kidney disease you have, your doctor performs a blood test to check your glomerular filtration rate (GFR). The GFR measures how much blood the kidneys filter each minute, recorded as milliliters per minute (mL/min). As the GFR declines, so does your kidney function.

When your kidneys are no longer able to work at a level that's necessary for day-to-day life, you have end-stage renal disease. End-stage renal disease usually occurs when kidney function is less than 10 percent of normal.

As a part of kidney disease staging, your doctor also may test whether protein is present in your urine.

Kidney disease stage GFR, mL/min Kidney function
National Kidney Foundation
Stage 1 90 or above Normal or near-normal kidney function
Stage 2 60 to 89 Mild loss of kidney function
Stage 3a 45 to 59 Mild to moderate loss of kidney function
Stage 3b 30 to 44 Moderate to severe loss of kidney function
Stage 4 15 to 29 Severe loss of kidney function
Stage 5 Less than 15 Kidney failure
Kidney biopsy

During a kidney biopsy, your doctor uses a needle to remove a small sample of kidney tissue for lab testing. The biopsy needle is inserted through your skin and is often directed using the guidance of an imaging device, such as ultrasound.

Treatment

End-stage renal disease treatment may include:

  • Kidney transplant
  • Dialysis
  • Supportive care

Kidney transplant

A kidney transplant is a surgical procedure to place a healthy kidney from a live or deceased donor into a person whose kidneys no longer function properly. A kidney transplant is often the treatment of choice for end-stage renal disease, compared with a lifetime on dialysis.

The kidney transplant process takes time. It involves finding a donor, living or deceased, whose kidney best matches your own. You then undergo a surgical procedure to place the new kidney in your lower abdomen and attach the blood vessels and ureter — the tube that links the kidney to the bladder — that will allow the new kidney to function.

You'll spend several days to a week in the hospital. After leaving the hospital, you'll have frequent checkups as your recovery continues. You'll take a number of medications to help keep your immune system from rejecting your new kidney and to reduce the risk of post-surgery complications, such as infection.

After a successful kidney transplant, your new kidney filters your blood, and you no longer need dialysis.

Dialysis

Dialysis does some of the work of your kidneys when your kidneys can't do it themselves. This includes removing extra fluids and waste products from your blood, restoring electrolyte levels, and helping control your blood pressure.

Dialysis options include peritoneal dialysis and hemodialysis.

For dialysis to be successful, you may need to make lifestyle changes, such as following certain dietary recommendations.

Supportive care

With supportive care, your symptoms are managed so that you feel better. You may choose supportive care alone or combine it with other treatment options.

Without either dialysis or a transplant, kidney failure progresses, eventually leading to death. In some people, the disease progresses slowly over months and years, while in others the disease progresses quickly.

Potential future treatments

Regenerative medicine holds the potential to fully heal damaged tissues and organs, offering solutions and hope for people who have conditions that today are beyond repair.

Regenerative medicine approaches include:

  • Boosting the body's natural ability to heal itself
  • Using healthy cells, tissues or organs from a living or deceased donor to replace damaged ones
  • Delivering specific types of cells or cell products to diseased tissues or organs to restore tissue and organ function

For people with kidney disease, regenerative medicine approaches may be developed in the future to help slow progression of the disease.

Kidney transplant

During kidney transplant surgery, the donor kidney is placed in your lower abdomen. Blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs. The new kidney's ureter is connected to your bladder. Unless they are causing complications, your own kidneys are left in place.

Preparing for an appointment

For end-stage renal disease, you'll likely continue to see the same doctor and care team you've been seeing for treatment of chronic kidney disease. If you're not already being cared for by a nephrologist — a doctor who specializes in kidney problems — you may be referred to one as your disease progresses.

What you can do

To get ready for your appointment, ask if there's anything you need to do ahead of time, such as limit your diet. Then make a list of:

  • Your symptoms, including any that seem unrelated to your kidneys or urinary function
  • All your medications and doses, vitamins or other supplements that you take
  • Your key medical history, including any other medical conditions
  • Questions to ask your doctor, listing the most important ones first in case time runs short

Take a family member or friend along, if possible. Sometimes it can be hard to remember everything you talked about with your doctor, and a relative or friend may hear something that you missed or forgot.

For end-stage renal disease, some basic questions to ask your doctor include:

  • What's the level of damage to my kidneys?
  • Is my kidney function worsening?
  • Do I need more tests?
  • What's causing my condition?
  • Can the damage to my kidneys be reversed?
  • What are my treatment options?
  • What are the potential side effects of each treatment?
  • I have these other health conditions. How can I best manage them together?
  • Do I need to eat a special diet?
  • Can you refer me to a dietitian who can help me plan my meals?
  • Should I see a specialist?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there any brochures or other printed material that I can have? What websites do you recommend?
  • How often do I need to have my kidney function tested?

Don't hesitate to ask any other questions during your appointment as they occur to you.

What to expect from your doctor

Your doctor may ask you questions, such as:

  • Are you experiencing any symptoms, such as changes in your urinary habits or unusual fatigue?
  • How long have you had symptoms?
  • Have you been diagnosed or treated for high blood pressure?
  • Have you noticed any changes in your urinary habits?
  • Does anyone in your family have kidney disease?
  • What medications are you currently taking? What doses?

Lifestyle and home remedies

As part of your treatment for kidney disease, your doctor may recommend a special diet to help support your kidneys and limit the work they must do. Ask your doctor for a referral to a dietitian who can analyze your current diet and suggest ways to make your diet easier on your kidneys.

Depending on your situation, kidney function and overall health, your dietitian may recommend that you:

  • Avoid products with added salt. Lower the amount of sodium you eat each day by avoiding products with added salt, including many convenience foods, such as frozen dinners, canned soups and fast foods. Other foods with added salt include salty snack foods, canned vegetables, and processed meats and cheeses.
  • Choose lower potassium foods. Your dietitian may recommend that you choose lower potassium foods at each meal. High-potassium foods include bananas, oranges, potatoes, spinach and tomatoes. Examples of low-potassium foods include apples, cabbage, carrots, green beans, grapes and strawberries. Be aware that many salt substitutes contain potassium, so you generally should avoid them if you have kidney failure.
  • Limit the amount of protein you eat. Your dietitian will estimate the appropriate number of grams of protein you need each day and make recommendations based on that amount. High-protein foods include lean meats, eggs, milk, cheese and beans. Low-protein foods include vegetables, fruits, breads and cereals.

Coping and support

Learning you're in kidney failure may come as a shock, even if you've known about your kidney disease for a while. It may be difficult managing the treatment schedule if you're on dialysis.

To help you cope, consider trying to:

  • Connect with other people who have kidney disease. Other people with end-stage renal disease understand what you're feeling and can offer unique support. If you aren't already a part of one, ask your doctor about support groups in your area. Or contact organizations such as the American Association of Kidney Patients, the National Kidney Foundation or the American Kidney Fund for groups in your area.
  • Maintain your normal routine, when possible. Try to maintain a normal routine, doing the activities you enjoy and continuing to work, if your condition allows. This may help you cope with feelings of sadness or loss after learning that your kidney disease has progressed.
  • Be active most days of the week. With your doctor's advice, aim for at least 30 minutes of physical activity most days of the week. This can help you cope with fatigue and stress.
  • Talk with a person you trust. Living with kidney disease can be stressful, and it may help to talk about your feelings. You may have a friend or family member who is a good listener. Or you may find it helpful to talk with a faith leader or someone else you trust. Ask your doctor for a referral to a social worker or counselor.

Prevention

If you have kidney disease, you may be able to slow its progress by making healthy lifestyle choices:

  • Lose weight if you need to
  • Be active most days
  • Eat a balanced diet of nutritious, low-sodium foods
  • Control your blood pressure
  • Take your medications as prescribed
  • Have your cholesterol levels checked every year
  • Control your blood sugar level
  • Don't smoke or use tobacco products
  • Get regular checkups

Last updated: August 9th, 2017

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