End-Stage Renal Disease

End-stage renal disease is a condition in which the kidneys no longer function normally. "Renal" describes anything having to do with the kidneys. Nearly everyone is born with two kidneys. They both need to fail for end-stage renal disease to develop.

Kidneys eliminate poisons from the body, and keep a normal balance of fluid and certain minerals in the body. When the kidneys can no longer perform this function, a person becomes very ill and ultimately dies.

In end-stage renal disease, the kidneys function at a fraction of their normal capacity. When this occurs, there are only two options: 1) replace the job the kidneys are supposed to do by using a machine, instead (kidney dialysis) or 2) transplant a new, healthy kidney. A single new healthy kidney can do the work of the two sick kidneys.

Diabetes is the leading cause of end-stage renal disease. Kidney disease can result from type 1 or type 2 diabetes. With either type, poor control of blood sugar increases the risk of end-stage renal disease.

Other common causes of end-stage renal disease are:

• High blood pressure
• Atherosclerosis

• Autoimmune diseases like systemic lupus erythematosus (lupus)
• Genetic disorders, such as polycystic kidney disease
• Exposure to toxic drugs, including:
  • certain antibiotics
  • chemotherapy
  • contrast dyes
  • pain relievers

Symptoms

Symptoms of end-stage renal disease include:

• Weight loss
• Nausea or vomiting
• General malaise
• Fatigue
• Headache
• Hiccups
• Itching
• Decreased urination
• Easy bruising or bleeding
• Lethargy
• Difficulty breathing
• Seizures

Symptoms may remain mild or absent until kidney function drops to less than 20% of normal.

Dialysis is urgent when one or more of the following occurs:

• Fluid overload or congestive heart failure (CHF) that cannot be managed with medications. In CHF, fluid backs up into the lungs, legs and other parts of the body.
• Dangerous elevations of potassium, sodium or acids in the blood. These substances can affect how other organs function.
• Confusion, decreased alertness or seizures
• Bleeding related to kidney failure that cannot be improved through other means
• Severe, unrelenting nausea and vomiting
• Inflammation of the covering of the heart

Dialysis may also be necessary if symptoms affect quality of life or nutritional status. This is especially true if they are accompanied by severely abnormal blood tests.

Diagnosis

Kidney disease is diagnosed through urine and blood tests. These tests measure levels of creatinine and urea nitrogen in the urine and blood.

Additional tests may be necessary to determine why the kidneys have stopped working.

Expected Duration

End-stage renal disease is a lifelong condition unless a kidney transplant is done. Even with a successful transplant, a person must take medicine for the rest of his or her life.

Prevention

You can take steps to reduce your risk of developing end-stage renal disease:

• If you have diabetes, control your blood sugar.
• Closely monitor and aggressively treat high blood pressure. High blood pressure further damages the kidneys in people with kidney disease.
• If you have kidney disease, avoid over the counter arthritis medicines. Non-steroidal anti-inflammatory drugs (NSAIDs) can cause kidney damage.
• Talk with your doctor about medication to slow the progression of chronic kidney disease. Your doctor may recommend an SGLT2 inhibitor, such as canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance).
• Quitting smoking and lowering cholesterol levels may also help.

Treatment

The two treatments for end-stage renal disease are dialysis and kidney transplant.

Dialysis

There are two types of dialysis:

• Hemodialysis. During hemodialysis, blood is removed from a vein. It is run through filters in a hemodialysis machine to remove waste products. The blood is then returned from the machine to the body. Hemodialysis usually is done at a dialysis center. The treatments are done three times a week, in three- to four-hour sessions.

• Peritoneal dialysis. During peritoneal dialysis, sterile fluid is infused into the abdomen. Waste products gradually accumulate in the fluid, which is drained several hours later. Peritoneal dialysis is done at home. It takes longer than hemodialysis and must be done four to five times a day. It can be automated to occur during sleep.

Kidney transplants

Kidney transplants allow people with severe kidney disease to avoid or discontinue dialysis.

Anyone who receives a kidney transplant must take immunosuppressive drugs for life, unless they received a kidney donated by their identical twin. These are drugs that prevent the body from rejecting the donated organ. In addition, a good genetic match is needed for a successful transplant. Most transplant candidates wait one to three years before a good genetic match can be found from an unrelated donor.

When To Call a Professional

You should have regular checkups if you have:

• Diabetes
• High blood pressure
• Other diseases that put you at risk of end-stage renal disease

These checkups should include urine and blood tests to measure your kidney function.

When blood tests indicate kidney disease, your doctor should refer you to a kidney specialist. This specialist is called a nephrologist.

Call your doctor if you notice any decrease in urination or other symptoms of end-stage renal disease. Be particularly vigilant if you have kidney disease or its risk factors.

Prognosis

When kidney failure occurs, treatments offer hope for good recovery. Many people on dialysis or who have received transplants lead near normal lives.

Additional Info

National Institute of Diabetes & Digestive & Kidney Disorders
https://www.niddk.nih.gov/

National Kidney Foundation
https://www.kidney.org/