End-stage kidney disease is the complete, or almost complete failure of the kidneys to function. The kidneys can no longer remove wastes, concentrate urine, and regulate many other important body functions.
Alternative NamesRenal failure - end stage; Kidney failure - end stage; ESRD
Causes, incidence, and risk factorsEnd-stage kidney disease occurs when the kidneys are no longer able to function at a level needed for day-to-day life. It usually occurs when chronic kidney disease has worsened to the point at which kidney function is less than 10% of normal.
ESRD almost always follows chronic kidney disease. A person may have gradual worsening of kidney function for 10 - 20 years or more before progressing to ESRD.
Patients who have reached this stage need dialysis or a kidney transplant.
The most common causes of ESRD in the U.S. are diabetes and high blood pressure. See Chronic kidney disease for a complete list of causes.
SymptomsSymptoms may include:
Other symptoms may develop, including:
The urine volume may decrease or urine production may stop. The patient will usually have signs of the many complications of chronic kidney disease.
End-stage kidney disease changes the results of many tests. Patients receiving dialysis will need these and other tests done often:
This disease may also change the results of the following tests:
TreatmentDialysis or kidney transplantation is the only treatment for ESRD. Your physical condition and other factors determine which treatment is used.
When you start dialysis depends on different factors, including your lab test results, severity of symptoms, and readiness. You should begin to prepare for dialysis before it is absolutely necessary. The preparation includes learning about dialysis and the types of dialysis therapies, and placement of a dialysis access.
See also: Dialysis
Treatment usually includes an ACE inhibitor, angiotensin receptor blocker, or other medications for high blood pressure.
You may need to make changes in your diet.
See Diet and chronic kidney disease for more detail.
Other treatments may include:
Different treatments are available for problems with sleep or restless leg syndrome.
Patients with chronic kidney disease should be up-to-date on important vaccinations, including:
For additional resources, see kidney disease support group.
Expectations (prognosis)Without dialysis or a kidney transplant, death will occur from the buildup of fluids and waste products in the body. Both of these treatments can have serious risks and consequences. The outcome is different for each person.
ComplicationsTreatment of chronic kidney disease may delay or prevent progression to ESRD. Some cases may not be preventable.
ReferencesTolkoff-Rubin N. Treatment of irreversible renal failure. In: Goldman L, Ausiello D, eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 133.
Mitch WE. Chronic kidney disease. In: Goldman L, Ausiello D, eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 131.
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.
Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43(5 Suppl 1):S1-S290.
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.
Alternative NamesRenal failure - end stage; Kidney failure - end stage; ESRD
Causes, incidence, and risk factorsEnd-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.
SymptomsSymptoms may include:
Other symptoms may include:
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:
This disease may also change the results of the following tests:
TreatmentDialysis 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.
For more information, see: Diet and chronic kidney disease
Other treatment depends on your symptoms but may include:
You should be up-to-date on important vaccinations, including:
See: Kidney disease support group
Expectations (prognosis)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.
ComplicationsTreatment of chronic kidney disease may delay or prevent progression to ESRD. Some cases may not be preventable.
ReferencesHimmelfarb 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 ByReview Date: 09/21/2011
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.
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anyone can
You can get Kidney Disease at any age. I was diagnosed at age 9 with Kidney Disease but had it earlier than that just undiagnosed. Usually it does not get diagnosed until stage 3 of Kidney Disease because that is when post people start to show symptoms. Chronic Kidney Disease means you will end up on either a dialysis machine or need a kidney transplant where as Acute Kidney Disease they might be able to save your kidneys. More can be found out at your local Kidney Foundation depending on what country you are in.
Sometimes it is hard for one to tell what causes a kidney disease, but anything that can damage the kidneys or blood vessels may cause it to develop a disease. Some examples of kidney disease causes are Diabetes, high blood pressure, blocked renal arteries, overuse of medicines, and disease you are born with can all cause kidney disease or failure.