End Stage Renal Disease

End-stage kidney disease is the last stage of chronic kidney disease. This is when your kidneys can no longer support your body’s needs. The kidneys remove waste and excess water from the body.

Causes
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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
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Common symptoms may include:

General ill feeling and fatigue
Itching (pruritus) and dry skin
Headaches
Weight loss without trying
Loss of appetite
Nausea
Other symptoms may include:

Abnormally dark or light skin
Nail changes
Bone pain
Drowsiness and confusion
Problems concentrating or thinking
Numbness in the hands, feet, or other areas
Muscle twitching or cramps
Breath odor
Easy bruising, nosebleeds, or blood in the stool
Excessive thirst
Frequent hiccups
Problems with sexual function
Menstrual periods stop (amenorrhea)
Sleep problems
Swelling of the feet and hands (edema)
Vomiting, often in the morning
Exams and Tests
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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:

Potassium
Sodium
Albumin
Phosphorous
Calcium
Cholesterol
Magnesium
Complete blood count (CBC)
Electrolytes
This disease may also change the results of the following tests:

Erythropoietin
PTH
Bone density test
Treatment
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Dialysis does some of the job of the kidneys when they stop working well.

Dialysis can:

Remove extra salt, water, and waste products so they don't build up in your body
Keep safe levels of minerals and vitamins in your body
Help control blood pressure
Help produce red blood cells
Your health care provider will discuss dialysis with you before you need it. Dialysis removes waste from your blood when your kidneys can no longer do their job.

Usually, you will go on dialysis when you have only 10 - 15% of your kidney function left.
Even people who are waiting for a kidney transplant may need dialysis while waiting.
Two different methods are used to perform dialysis:

During hemodialysis, your blood passes through a tube into an artificial kidney, or filter.
During peritoneal dialysis, a special solution passes into your belly though a catheter tube. The solution remains in your abdomen for period of time and then is removed. This method can be done at home, at work, or while traveling.
A kidney transplant is surgery to place a healthy kidney into a person with kidney failure. Your doctor will refer you to a transplant center. There, you will be seen and evaluated by the transplant team. They will want to make sure that you are a good candidate for kidney transplant.

You may need to follow a special diet for chronic kidney disease. These changes may include:

Eat a low-protein diet.
Get enough calories if you are losing weight.
Limit fluids.
Limit salt, potassium, phosphorous, and other electrolytes.
Other treatment depends on your symptoms but may include:

Extra calcium and vitamin D (always talk to your doctor before taking supplements)
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.
Medicines to control your blood pressure
You should be up-to-date on important vaccinations, including:

Hepatitis A vaccine
Hepatitis B vaccine
Flu vaccine
Pneumonia vaccine (PPV)