End-Stage Renal Disease

Condition Basics

What is end-stage renal disease?

End-stage renal disease means that your kidneys may no longer be able to keep you alive. When your kidneys get to the point where they can no longer remove waste, you may need dialysis or a new kidney. When you understand your options, you can make the choice that's best for you.

End-stage renal disease affects your whole body. It can cause serious heart, bone, lung, blood, and brain problems.

What causes it?

Diabetes and high blood pressure are the most common causes.

Other things that can lead to end-stage renal disease include kidney diseases and infections. Long-term use of certain medicines can also damage the kidneys.

For some people, a narrowed or blocked renal artery or a kidney problem they were born with can lead to end-stage renal disease.

What are the symptoms?

As end-stage renal disease gets worse, it can cause:

• Nausea, vomiting, loss of appetite, and weight loss.
• Mental changes. These may include sleepiness, trouble thinking clearly, agitation, psychosis, seizures, and coma.
• Bleeding problems, such as sudden or heavy bleeding from a very minor injury.
• Heart problems, such as an irregular heartbeat and increased pressure on the heart.
• Shortness of breath from fluid buildup in the space between the lungs and the chest wall (pleural effusion).

How is it diagnosed?

Your doctor will do regular blood tests to check on how you're doing. The tests help your doctor know if you need any changes in your treatment. Blood tests measure:

• Levels of waste products and electrolytes in your blood that should be removed by your kidneys. These include creatinine, blood urea nitrogen (BUN), potassium, and calcium.
• Your parathyroid hormone (PTH) level.
• Your red blood cells, to see if you have anemia of chronic kidney disease. Your doctor can use repeat complete blood cell count (CBC) tests to see if anemia treatment is working.

How is end-stage renal disease treated?

In end-stage renal disease, your two treatment choices are dialysis and a kidney transplant.

• Dialysis is a process that filters wastes from your blood. It is not a cure. But it can help you live longer and feel better.
• Kidney transplant may be a good choice if you are in otherwise good health. If this is an option for you, you'll probably need to have dialysis while you wait for a kidney.

Many people with end-stage renal disease have successful kidney transplants. Others live for years using dialysis. Some people choose not to treat their kidney failure and instead make end-of-life plans.

Making these treatment decisions when you are very ill is hard. And it's common to be worried and afraid. It may help to visit a dialysis center or transplant center and talk to others who have made these choices.

How can you care for yourself?

When you're living with end-stage renal disease, making healthy choices can help you feel better.

These steps may also help with high blood pressure, diabetes, or other problems that make kidney disease worse.

• Follow a diet that is easy on your kidneys. A dietitian can help you make an eating plan with the right amounts of salt (sodium), potassium, and protein. You may also need to limit how much fluid you drink each day.
• Be active every day that you can, in any way that you can. Work with your doctor to decide what level of activity is right for you.
• Do not smoke or use tobacco.
• Limit alcohol.

Some medicines can hurt your kidneys. Always talk to your doctor before you take any new medicine, including over-the-counter remedies, prescription drugs, vitamins, and herbs.