End-stage kidney diseaseDefinition:
End-stage kidney disease is the complete or almost complete failure of the kidneys to work. The kidneys remove waste and excess water from the body.
Renal failure - end stage; Kidney failure - end stage; ESRD
Causes, incidence, and risk factors:
End-stage kidney disease (ESRD) is 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 U.S. 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 over 10 - 20 years before end-stage disease results.
Symptoms may include:
Other symptoms may include:
Signs and tests:
Your health care provider will perform a physical exam and order blood tests. Most people with this condition have high blood pressure.
Patients with end-stage kidney disease will make much less urine, or urine production may stop.
End-stage kidney disease changes the results of many tests. Patients receiving dialysis will need these and other tests done often:
This disease may also change the results of the following tests:
Dialysis or kidney transplantation is the only treatment for this condition.
For more information on these treatments, see:
Your doctor may also put you on medicine to control your blood pressure.
You may need to make changes in your diet.
- Eat a low-protein diet
- Get enough calories if you are losing weight
- Limit fluids
- Limit salt, potassium, phosphorous, and other electrolytes
For more information, see: Diet and chronic kidney disease
Other treatment depends on your symptoms but may include:
- Extra calcium and vitamin D (always talk to your doctor before taking)
- Medicines called phosphate binders, to help prevent phosphorous levels from becoming too high
- Treatment for anemia, such as extra iron in the diet, iron pills or shots, shots of a medicine called erythropoietin, and blood transfusions.
You should be up-to-date on important vaccinations, including:
End-stage kidney disease leads to death if you do not have dialysis or a kidney transplant. However, both of these treatments can have risks. The outcome is different for each person.
- Bleeding from the stomach or intestines
- Bone, joint, and muscle pain
- Brain dysfunction, confusion, and dementia
- Changes in electrolyte levels
- Changes in blood sugar (glucose)
Damage to nerves of the legs and arms
Fluid buildup around the lungs
- Heart and blood vessel complications
Hepatitis B , hepatitis C , liver failure
- Increased risk of infections
- Phosphorous levels become too high
Potassium levels become too high
- Skin dryness, itching/scratching, leading to skin infection
- Weakening of the bones, fractures, joint disorders
Treatment of chronic kidney disease may delay or prevent progression to ESRD. Some cases may not be preventable.
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KDOQI. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007;50:471-530.
KDOQI: National Kidney Foundation. II. Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease in adults. Am J Kidney Dis. 2006;47(5 Suppl 3):S16-S85.
Palmer SC, Navaneethan SD, Craig JC, Johnson DW, Tonelli M, Garg AX, et al. Meta-analysis: erythropoiesis-stimulating agents in patients with chronic kidney disease. Ann Intern Med. 2010;153:23-33.
|Review Date: 9/21/2011|
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., andHerbert Y. Lin, MD, PHD, Nephrologist, Massachusetts General Hospital; Associate Professor of Medicine, Harvard Medical School.
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