End-Stage Renal Disease

Overview

End-stage renal disease, also known as end-stage kidney disease or kidney failure, occurs when chronic kidney disease reaches an advanced stage. In this condition, the kidneys no longer function properly to filter waste and excess fluids from the blood, leading to dangerous accumulation of fluids, electrolytes, and waste products in the body. End-stage renal disease requires dialysis or a kidney transplant for survival, but conservative care may also be chosen to manage symptoms and maintain quality of life.

Understanding the disease

Symptoms

Symptoms of end-stage renal disease (ESRD) may include nausea, vomiting, loss of appetite, fatigue and weakness, changes in urination, chest pain, shortness of breath, swelling in the feet and ankles, high blood pressure, headaches, difficulty sleeping, decreased mental sharpness, muscle twitches and cramps, persistent itching, and a metallic taste in the mouth. However, these symptoms can also be caused by other illnesses, and early signs of kidney disease may be non-specific or absent. It's important to consult a healthcare provider if you experience any of these symptoms.

Risk Factors

Risk factors for developing end-stage renal disease include:

1. Diabetes with poor blood sugar control
2. Kidney disease that affects the glomeruli, the structures in the kidneys that filter wastes from the blood
3. Polycystic kidney disease
4. High blood pressure
5. Tobacco use
6. Black, Hispanic, Asian, Pacific Islander or American Indian heritage
7. Family history of kidney failure
8. Older age
9. Frequent use of medications that can damage the kidneys These factors can increase the risk that chronic kidney disease will progress more quickly to end-stage renal disease, requiring dialysis or a kidney transplant to sustain life.

Development

End-stage renal disease (ESRD) develops when chronic kidney disease progresses to an advanced state, and the kidneys lose their filtering abilities. The kidneys are responsible for filtering waste and excess fluids from the blood, and when they can no longer perform this function, dangerous levels of fluid, electrolytes, and wastes can build up in the body. ESRD can result from various underlying diseases and conditions, including:

1. Diabetes with poor blood sugar control
2. Kidney disease that affects the glomeruli, the structures in the kidneys that filter wastes from the blood
3. Polycystic kidney disease
4. High blood pressure
5. Tobacco use
6. Black, Hispanic, Asian, Pacific Islander, or American Indian heritage
7. Family history of kidney failure
8. Older age Chronic kidney disease often has no symptoms in its early stages, but as it progresses, signs and symptoms may include nausea, vomiting, and swelling in the legs, ankles, and feet. If you have signs or symptoms of kidney disease or are at risk due to a medical condition, it's essential to consult your healthcare provider, who can monitor your kidney function through urine and blood tests and manage any underlying conditions to slow the progression of kidney damage.

Assessment and Diagnosis

Triage

You should see a doctor if you have signs or symptoms of kidney disease, including those associated with end-stage renal disease. Early detection might help prevent kidney disease from progressing to kidney failure. If you have a medical condition that increases your risk of kidney disease, your doctor may monitor your blood pressure and kidney function with urine and blood tests during office visits.

Diagnosis

To diagnose end-stage renal disease, a health care provider may ask about

Management and Treatment

Complications

Potential complications of end-stage renal disease include fluid retention, which can lead to swelling in the arms and legs, high blood pressure, or fluid in the lungs (pulmonary edema). A sudden rise in potassium levels in the blood (hyperkalemia) can also occur, potentially impairing the heart's function and being life-threatening. Other complications may involve heart disease, weak bones and an increased risk of bone fractures, anemia, decreased sex drive, erectile dysfunction or reduced fertility, damage to the central nervous system causing difficulty concentrating, personality changes or seizures, and decreased immune response, making the individual more susceptible to infection.

Treatment

End-stage renal disease (ESRD) is a severe condition where kidneys no longer function properly, and patients require either dialysis or a kidney transplant to survive. Dialysis is a process that replaces the kidneys' functions by filtering waste products, excess fluids, and electrolytes from the blood. There are two main types of dialysis:

1. Hemodialysis: This involves circulating blood through a filter outside the body to remove waste and excess fluids. Sessions usually take place three times a week, with each session lasting around four hours.
2. Peritoneal dialysis: This process involves injecting a dialysis solution into the abdominal cavity, where it contacts the lining of the abdominal wall (peritoneum) to remove waste and excess fluids. This type of dialysis can be performed daily, with each session lasting around 30 minutes to an hour. In addition to dialysis, a kidney transplant can be considered as an alternative treatment for ESRD. A successful transplant can provide a better quality of life and potentially improve lifespan. However, transplants carry risks and may not be suitable for everyone. Factors such as age, overall health, and the availability of a compatible donor can impact the success of a transplant. It is essential to consult a healthcare professional for personalized advice and to determine the best treatment options based on individual circumstances.

Preparing for medical consultation

To prepare for an appointment for end-stage renal disease, you should:

1. Take note of your symptoms: Make a list of all your symptoms, including any that seem unrelated to your kidneys or urinary function, and when they began.
2. Gather your medical history: Compile your key medical history, including other medical conditions, family history of kidney disease, and any prior kidney-related tests or treatments.
3. List your medications: Create a list of all medications, vitamins, or other supplements you take, including doses and frequency.
4. Prepare questions: Write down a list of questions to ask your healthcare provider, such as the level of damage to your kidneys, treatment options, potential side effects, and how to manage other health conditions.
5. Bring a support person: Consider bringing a family member or friend along to help you remember the information provided during the appointment. Remember to ask your healthcare provider if there's anything you need to do in advance, such as restricting your diet or fasting before specific tests.