Overview End-stage renal disease, also called end-stage kidney disease or kidney failure, occurs when chronic kidney disease — the gradual loss of kidney function — reaches an advanced state. In end-stage renal disease, your kidneys no longer 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 abilities, 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 can also choose to opt for conservative care to manage your symptoms — aiming for the best quality of life during your remaining time.
Show transcript for video How kidneys work
One of the important jobs of the kidneys is to clean the blood. As blood moves through the body, it picks up extra fluid, chemicals and waste. The kidneys separate this material from the blood. It's carried out of the body in urine. If the kidneys are unable to do this and the condition is untreated, serious health problems result, with eventual loss of life.
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Symptoms Early in chronic kidney disease, you might 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
Changes in how much you urinate
Chest pain, if fluid builds up around the lining of the heart
Shortness of breath, if fluid builds up in the lungs
Swelling of feet and ankles
High blood pressure (hypertension) that's difficult to control
Headaches
Difficulty sleeping
Decreased mental sharpness
Muscle twitches and cramps
Persistent itching
Metallic taste
Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. Because your kidneys can make up for lost function, signs and symptoms might not appear until irreversible damage has occurred.
When to seek care Make an appointment with your health care provider if you have signs or symptoms of kidney disease.
If you have a medical condition that increases your risk of kidney disease, your care provider is likely to monitor your kidney function with urine and blood tests and your blood pressure during regular office visits. Ask your provider whether these tests are necessary for you.
Causes
Healthy kidney vs. diseased kidney
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Healthy kidney vs. diseased kidney
Healthy kidney vs. diseased kidney
A typical kidney has about 1 million filtering units. Each unit, called a glomerulus, joins a tubule. The tubule collects urine. Conditions such as high blood pressure and diabetes harm kidney function by damaging these filtering units and tubules. The damage causes scarring.
Polycystic kidney
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Polycystic kidney
Polycystic kidney
A healthy kidney (left) eliminates waste from the blood and maintains the body's chemical balance. With polycystic kidney disease (right), fluid-filled sacs called cysts develop in the kidneys. The kidneys grow larger and gradually lose the ability to function as they should.
Kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years. For some people, kidney damage can continue to progress even after the underlying condition is resolved.
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 or other inherited kidney diseases
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)
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
High blood pressure
Tobacco use
Black, Hispanic, Asian, Pacific Islander or American Indian heritage
Family history of kidney failure
Older age
Frequent use of medications that could be damaging to the kidney
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 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
Malnutrition
Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival
Prevention If you have kidney disease, you may be able to slow its progress by making healthy lifestyle choices:
Achieve and maintain a healthy weight
Be active most days
Limit protein and 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
Oct. 10, 2023