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Overview

What Is End Stage Renal Disease?

End Stage Renal Disease (ESRD) is the most advanced stage of chronic kidney disease, when the kidneys have lost most of their ability to filter waste and extra fluid from the blood. Severely reduced kidney function can cause waste, fluid and minerals to build up in the body. Dialysis or a kidney transplant is generally needed to replace lost kidney function. People with diabetes, high blood pressure, inherited conditions or other long-term renal disease may be affected.

Symptoms

Symptoms of End Stage Renal Disease

Symptoms of kidney disease can build gradually and vary from person to person. They may be influenced by fluid retention, anemia, electrolyte changes and the buildup of waste products, so some people may have few noticeable symptoms until kidney function is severely reduced.

  • Fatigue
  • Nausea
  • Loss of appetite
  • Itching
  • Swelling
  • Shortness of breath
  • Changes in urination
  • Muscle cramps
  • Trouble concentrating
  • Sleep problems

Seek urgent care

Do not wait for severe symptoms

Seek prompt medical attention for severe breathing difficulty, chest pain, confusion, fainting or rapidly worsening swelling. These signs may indicate a serious complication of renal failure.

Causes

What Causes End Stage Renal Disease?

Repeated or persistent injury damages the kidneys’ filtering units, called nephrons. As filtration declines over time, waste and extra fluid become harder to remove, and permanent kidney failure can eventually develop. Understanding what causes kidney disease can help guide treatment and slow further damage.

  • Diabetes can damage kidney blood vessels and filtering units over many years.
  • High blood pressure can strain and scar the kidneys, gradually reducing their filtering ability.
  • Inherited kidney disorders can cause structural or functional problems that worsen over time.
  • Glomerular diseases can injure the kidney’s filtering units and lead to progressive renal deficiencies.
  • Autoimmune conditions can cause the immune system to attack kidney tissue.
  • Prolonged urinary obstruction can cause pressure and damage that impair kidney function.
  • Repeated kidney injury can leave lasting damage and contribute to chronic renal failure.

Risk Factors

Risk Factors for End Stage Renal Disease

NON-MODIFIABLE FACTORS

Older age, a family history of renal disease, inherited kidney disorders, previous kidney disease and some racial or ethnic health disparities can increase risk. These factors cannot be changed, but they can help guide earlier medical follow-up.

MODIFIABLE OR MANAGEABLE FACTORS

Diabetes, high blood pressure, smoking, obesity and exposure to certain medicines or toxins may increase risk. Managing these factors can help protect kidney function.

Having a risk factor does not guarantee that kidney failure will develop. Controlling blood pressure and blood glucose, avoiding tobacco and treating existing kidney disease can reduce the risk of progression through the chronic kidney disease stages.

Complications

Complications of End Stage Renal Disease

  • Fluid overload can cause swelling, high blood pressure and breathing problems.
  • High potassium can interfere with the heart’s electrical activity.
  • Metabolic acidosis occurs when the body cannot adequately balance acids in the blood.
  • Anemia can develop when the kidneys make too little of a hormone needed for red blood cell production.
  • Mineral and bone disorder can weaken bones and disturb calcium and phosphorus balance.
  • Cardiovascular disease risk increases with advanced renal failure.
  • Nerve problems may cause numbness, tingling or other changes in sensation.
  • Weakened immunity can make it harder to fight some infections.
  • Malnutrition may occur because of poor appetite, dietary limits or illness-related changes.
  • Uremia is the buildup of waste products that can affect the brain, nerves and other organs.

Emergency symptoms

Recognize a medical emergency

Severe breathing difficulty, chest pain, profound weakness, confusion, seizures or loss of consciousness may signal a medical emergency. Call emergency services or seek immediate care.

Diagnosis

How End Stage Renal Disease Is Diagnosed

Diagnosis is based on kidney function over time, not on a single symptom or test. End stage renal disease generally corresponds to stage 5 chronic kidney disease, but clinicians also assess the cause, complications and readiness for treatment.

  • Estimated glomerular filtration rate helps estimate how well the kidneys filter blood.
  • Urine testing looks for blood, protein and other signs of kidney damage.
  • Blood tests measure waste products and help assess overall kidney function.
  • Electrolyte and blood count testing can identify mineral imbalances and anemia.
  • Kidney imaging can show changes in kidney size, structure or urinary drainage.
  • Selected tests may help identify an inherited, autoimmune or other underlying cause.
StageGeneral meaning
Stages 1–2Kidney damage or mildly reduced function
Stage 3Moderately reduced kidney function; earlier than end stage renal disease
Stage 4Severely reduced kidney function
Stage 5Kidney failure or end stage renal disease

Treatment & Management

Treatment and Management

HEMODIALYSIS

Hemodialysis filters the blood through a dialysis machine on a scheduled basis, usually in a dialysis center or sometimes at home. Access to the bloodstream and the treatment schedule are important considerations.

PERITONEAL DIALYSIS

Peritoneal dialysis uses the lining of the abdomen to filter the blood through exchange fluid. It is performed at home after training, with careful attention to catheter care and infection prevention.

KIDNEY TRANSPLANT

A kidney transplant uses a donated kidney to provide functioning kidney replacement for an appropriate candidate. Evaluation, donor availability, surgery and long-term anti-rejection medicines are major considerations.

  • Take prescribed medicines and have them reviewed regularly.
  • Follow an individualized fluid and dietary plan from the kidney care team.
  • Control blood pressure and diabetes as recommended.
  • Treat anemia and other complications when advised.
  • Care for vascular or catheter access as instructed.
  • Keep recommended vaccinations up to date.
  • Attend regular monitoring visits and laboratory testing.

Prevention

Can End Stage Renal Disease Be Prevented?

End stage renal disease is not always preventable, especially when it results from inherited or other unavoidable conditions. However, early treatment of diseases that damage the kidneys can delay or sometimes avoid progression to kidney failure.

  • Control blood pressure with lifestyle measures and prescribed treatment.
  • Manage diabetes and follow the recommended blood glucose plan.
  • Avoid tobacco and seek support to stop smoking.
  • Choose a heart-healthy eating pattern suited to your health needs.
  • Use medicines safely and tell clinicians about all medicines and supplements.
  • Limit unnecessary use of nonsteroidal anti-inflammatory drugs, or NSAIDs.
  • Stay physically active at a level that is safe for you.
  • Complete recommended kidney testing if you have risk factors or signs of kidney disease.

Outlook and Prognosis

Outlook and Prognosis

End Stage Renal Disease represents permanent, severe loss of kidney function. Dialysis or a kidney transplant can provide ongoing kidney replacement and may support quality of life, although both require continuing medical care.

The outlook varies with age, overall health, the cause of kidney failure, cardiovascular health, treatment adherence, dialysis access, transplant eligibility, nutrition and the response to complications. These factors can affect daily life and long-term health across the stages of kidney disease.

When Should You See a Doctor

When Should You See a Doctor?

  • Arrange medical evaluation for persistent swelling.
  • Ask for medical advice about major changes in urination.
  • Contact a clinician about ongoing nausea.
  • Discuss unexplained fatigue with a healthcare professional.
  • Seek evaluation for new or persistent itching.
  • Arrange prompt medical review for shortness of breath.
  • Talk with a clinician if you have known risk factors for kidney disease.

Get urgent help

Know when symptoms are an emergency

Seek emergency care for severe breathing difficulty, chest pain, fainting, new confusion, seizures or severe weakness. Get immediate help if a healthcare professional suspects dangerously high potassium.

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