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The kidneys filter waste and excess water from your blood as urine. Chronic kidney disease causes your kidneys to lose this function over time. End-stage kidney disease is the final stage of chronic kidney disease. It means your kidneys no longer function well enough to meet the needs of daily life.
End-stage kidney disease is also called end-stage renal disease (ESRD). The kidneys of people with ESRD function below 10 percent of their normal ability, which may mean they’re barely functioning or not functioning at all.
Kidney disease is usually progressive. The length of each stage varies and depends on how your kidney disease is treated, especially in relation to your diet and whether your doctor recommends dialysis. Chronic kidney disease typically doesn’t reach the end stage until 10 to 20 years after you’re diagnosed. ESRD is the fifth stage of the progression of chronic kidney disease, which is measured by your glomerular filtration rate (GFR):
|Stage||GFR (ml/min/1.73 m2)||Health of kidneys|
|1||≥90||kidneys function normally, but the first signs of kidney disease appear|
|2||60-89||kidney function is slightly reduced|
|3A/3B||45-59 (3A) and 30-44 (3B)||kidney function is noticeably reduced|
|4||15-29||kidney function is extremely reduced|
|5||<15||ESRD, which is also known as established renal failure|
Many kidney diseases attack the nephrons, the tiny filtering units in the kidneys. This leads to poor blood filtering, which eventually leads to ESRD. ESRD is caused most commonly by diabetes and hypertension (high blood pressure).
If you have diabetes, your body can’t break down glucose (sugar) correctly, so glucose levels in your blood remain high. Having high levels of glucose in your blood damages your nephrons.
If you have hypertension, the increased pressure on the small vessels in your kidneys leads to damage. The damage prevents your blood vessels from performing their blood-filtering duties.
Other causes of ESRD include:
Certain people are at higher risk of developing ESRD, such as people who have:
Your risk of developing ESRD also rises when you have any type of kidney condition, including:
According to one study, a fast decline in the normal function of your kidneys can signal the onset of ESRD.
You may experience a wide range of symptoms, including:
Other symptoms may include:
See your doctor right away if any of these symptoms interfere with your life, especially if you can’t urinate or sleep, are vomiting frequently, or feel weak and unable to do daily tasks.
Your doctor diagnoses ESRD using a physical examination and tests to check your kidney function. Kidney function tests include:
The treatments for ESRD are dialysis or a kidney transplant. In some cases, lifestyle changes and medications may help.
You have two options when you undergo dialysis.
One option is hemodialysis, which uses a machine to process your blood. The machine filters out waste using a solution. It then places the clean blood back into your body. This method is usually used three times per week and takes three to four hours each time.
Your doctor may also prescribe peritoneal dialysis. This process involves placing a solution into your abdomen that’s later removed using a catheter. This type of dialysis can be done at home with proper training. It’s often done overnight while you sleep.
Kidney transplant surgery involves removing your affected kidneys (if removal is needed) and placing a functioning donated organ. One healthy kidney is all you need, so donors are often living. They can donate one kidney and continue to function normally with the other. According to the National Kidney Foundation, more than 17,000 kidney transplants were performed in the United States in 2014.
People with diabetes or hypertension should control their conditions to help prevent ESRD. Both conditions benefit from drug therapy using angiotensin converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs).
Some vaccines can help prevent serious complications of ESRD. According to the Centers for Disease Control and Prevention, the hepatitis B and pneumococcal polysaccharide (PPSV23) vaccines can lead to positive outcomes, especially before and during dialysis treatments. Talk to your doctor about which vaccine may be best for you.
Fluid retention can cause rapid weight change, so monitoring your weight is important. You may also need to increase your caloric intake and decrease your protein consumption. A diet low in sodium, potassium, and other electrolytes may be needed, along with fluid restriction.
Limit these foods to avoid consuming too much sodium or potassium:
Taking vitamin supplements, such as calcium, vitamin C, vitamin D, and iron, can help your kidney function and the absorption of essential nutrients.
Possible complications of ESRD include:
Less common but more serious complications include:
Your recovery depends on the type of treatment recommended by your doctor.
With dialysis, you can receive treatment at a facility or at home. In many cases, dialysis allows you to prolong your life by regularly filtering waste from your body. Some dialysis options allow you to use a portable machine so that you can continue your daily life without having to use a large machine or go to a dialysis center.
Kidney transplants are also likely to succeed. Failure rates of transplanted kidneys are low, ranging from 3 to 21 percent in the first five years. A transplant allows you to resume normal kidney function. If you follow your doctor’s recommendations for diet and lifestyle changes, a kidney transplant can help you live free from ESRD for many years.
Advancements allow people with ESRD to live longer than ever before. ESRD can be life-threatening. With treatment, you’ll likely live for many years afterward. Without treatment, you may only be able to survive without your kidneys for a few months. If you have other accompanying conditions, such as heart issues, you may face additional complications that can affect your life expectancy.
It can be easy to withdraw as you experience the effects of ESRD or the lifestyle changes that come with dialysis. If this happens, seek professional counseling or positive support from your family and friends. They can help you stay actively engaged in your daily life. This can ensure that you maintain a high quality of life.
In some cases, ESRD isn’t preventable. However, you should control your blood glucose levels and your blood pressure. You should always call a doctor if you have any ESRD symptoms. Early detection and treatment can delay or prevent the disease from progressing.
Written by: Christine DiMaria, Marijane Leonard, and Tim Jewellon: Jul 10, 2017
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