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|•||Chronic kidney disease|
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End-stage kidney disease
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
End-stage kidney disease (ESRD) is when the kidneys are no longer able to work at a level needed for day-to-day life.
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:
- General ill feeling and fatigue
- Itching (pruritus) and dry skin
- Weight loss without trying
- Loss of appetite
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
- Low level of sexual interest and impotence
- Menstrual periods stop (amenorrhea)
- Sleep problems, such as insomnia, restless leg syndrome, or obstructive sleep apnea
- Swelling of the feet and hands (edema)
- Vomiting, especially in the morning
Exams 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:
- Complete blood count (CBC)
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.
Himmelfarb J, Ikizler TA. Hemodialysis. N Engl J Med. 2010 Nov 4;363(19):1833-45. Review. PubMed PMID: 21047227.
Tonelli M, Pannu N, Manns B. Oral phosphate binders in patients with kidney failure. N Engl J Med. 2010 Apr 8;362(14):1312-24.
Abboud H, Henrich WL. Clinical practice. Stage IV chronic kidney disease. NEngl J Med. 2010 Jan 7;362(1):56-65.
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.
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.