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.
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:
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.
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.
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:
Certain factors increase the risk that chronic kidney disease will progress more quickly to end-stage renal disease, including:
Kidney damage, once it occurs, can't be reversed. Potential complications can affect almost any part of your body and can include:
If you have kidney disease, you may be able to slow its progress by making healthy lifestyle choices:
To diagnose end-stage renal disease, your health care provider may ask you about your family's and your medical history. You may also have physical and neurological exams, along with other tests such as:
Certain tests might be repeated over time to help your provider follow the progress of your kidney disease.
There are five stages of kidney disease. To determine what stage you have, your health care provider performs a blood test to check your glomerular filtration rate (GFR). The GFR measures how much blood the kidneys filter each minute, recorded as milliliters per minute (mL/min). As the GFR declines, so does your kidney function.
When your kidneys no longer work at a level that's necessary to keep you alive, you have end-stage renal disease. End-stage renal disease usually occurs when kidney function is less than 15% of typical kidney function.
As a part of kidney disease staging, your provider also might test whether you have protein in your urine.
| Kidney disease stage | GFR, mL/min | Kidney function | |
|---|---|---|---|
| Source: National Kidney Foundation | |||
| Stage 1 | 90 or above | Healthy kidney function | |
| Stage 2 | 60 to 89 | Mild loss of kidney function | |
| Stage 3a | 45 to 59 | Mild to moderate loss of kidney function | |
| Stage 3b | 30 to 44 | Moderate to severe loss of kidney function | |
| Stage 4 | 15 to 29 | Severe loss of kidney function | |
| Stage 5 | Less than 15 | Kidney failure | |
End-stage renal disease treatments include:
A kidney transplant is a surgical procedure to place a healthy kidney from a live or deceased donor into a person whose kidneys no longer function properly. A kidney transplant is often the treatment of choice for end-stage renal disease, compared with a lifetime on dialysis.
The kidney transplant process takes time. It involves finding a donor, living or deceased, whose kidney best matches your own. You then have surgery to place the new kidney in your lower abdomen and attach the blood vessels and ureter — the tube that links the kidney to the bladder — that will allow the new kidney to function.
You may need to spend several days to a week in the hospital. After leaving the hospital, you can expect frequent checkups to monitor your progress as your recovery continues. You may take a number of medications to help keep your immune system from rejecting your new kidney and to reduce the risk of post-surgery complications, such as infection.
After a successful kidney transplant, your new kidney filters your blood, and you no longer need dialysis.
Dialysis does some of the work of your kidneys when your kidneys can't do it themselves. This includes removing extra fluids and waste products from your blood, restoring electrolyte levels, and helping control your blood pressure.
Dialysis options include peritoneal dialysis and hemodialysis.
For dialysis to be successful, you may need to make lifestyle changes, such as following certain dietary recommendations.
If you choose not to have a kidney transplant or dialysis, you can choose palliative or supportive care to help you manage your symptoms and feel better. You also can combine palliative care with kidney transplant or dialysis.
Without either dialysis or a transplant, kidney failure progresses, eventually leading to death. Death can occur quickly or take months or years. Supportive care might include management of symptoms, measures to keep you comfortable and end-of-life planning.
As part of your treatment for kidney disease, your health care provider might recommend that you follow a special diet to help support your kidneys and limit the work they must do. Ask for a referral to a registered dietitian with expertise in kidney disease to learn ways to make your diet easier on your kidneys.
Depending on your situation, kidney function and overall health, your dietitian might recommend that you:
Choose lower potassium foods. Your dietitian might recommend that you choose lower potassium foods at each meal. High-potassium foods include bananas, oranges, potatoes, spinach and tomatoes.
Examples of low-potassium foods include apples, cabbage, carrots, green beans, grapes and strawberries. Be aware that many salt substitutes contain potassium, so you generally should avoid them if you have kidney failure.
Learning you're in kidney failure can come as a shock, even if you've known about your kidney disease for a while. It might be difficult to manage the treatment schedule if you're on dialysis.
To help you cope, consider trying to:
For end-stage renal disease, you'll likely continue to see the same health care provider and care team you've been seeing for treatment of chronic kidney disease. If you're not already being cared for by a doctor who specializes in kidney problems (nephrologist), you might be referred to one as your disease progresses.
To get ready for your appointment, ask if there's anything you need to do ahead of time, such as make changes to your diet. Then take note of:
Take a family member or friend along, if possible, to help you remember the information you're given.
For end-stage renal disease, some basic questions to ask your provider include:
Don't hesitate to ask any other questions you have.
Your provider may ask you questions, such as:
