End-stage renal disease

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 1, 2016
StartDiseasesEnd-stage renal disease

End-state renal disease, or ESRD, is also called chronic kidney failure and occurs when the kidneys are no longer able to support bodily functions. There is, at this time, no cure for ESRD, but medical advances in its treatment can extend the lifespan of those who develop this disease. Treatment can be accomplished through medications, transplants, and/or dialysis, improving the longevity and quality of life for those with ESRD.


Definition & Facts

The kidneys are located on both sides of the upper posterior abdomen; most people have two kidneys. Their function is to remove metabolic waste and other toxins from the body as well as remove excess fluid. If the kidneys develop ESRD, it's permanent, although treatments are available that can extend longevity and ease discomfort. 

ESRD usually occurs after years of chronic kidney disease. It shouldn't be confused with acute renal failure, which can be temporary, and may be due to factors such as a heart attack.

  • ESRD affects almost 700,000 people in the U.S. and more than 2 million people worldwide. 
  • The incidence of ESRD in the U.S. increases by approximately 5 percent annually.
  • More than 100,000 people are on the list for a transplant but only about 20,000 kidneys are donated each year.
  • Dialysis is effective about 75 percent of the time.
  • Transplant patients have about a 97 percent survival rate.
  • African-Americans are at a 3.5 greater risk of developing ESRD.
  • Native Americans and Hispanics are at a 1.5 greater risk of developing ESRD.
  • Kidney donations can be from a living person or one who is recently deceased.
  • The need for kidney donations is rising faster than the supply of donor kidneys available.

Symptoms & Complaints

When the kidneys fail, the body doesn't rid itself of toxins. Therefore, symptoms can include general fatigue or malaise, unexplained weight loss, nausea, headache, and dry skin. Additional symptoms can include changes in skin color, confusion, breathlessness, bone pain, numbness, sleep problems, muscle cramps, loss of appetite, edema, mental fogginess, blood in stool, and/or excessive thirst.

Since the symptoms of ESRD are similar to other conditions, it's best to seek the advice of a medical professional in the event that these symptoms occur. Chronic kidney disease can exist for years and remain unnoticed.


Those who develop ESRD usually do so as a result of other conditions, such as diabetes mellitus and/or high blood pressure, that have continued for years. Autoimmune diseases and genetic disorders also predispose an individual to develop ESRD. Chronic urinary tract issues can contribute to the onset of ESRD.

Damage to the kidneys can trigger ESRD as can sepsis or rapid and decreased blood flow to the kidneys. It can also result from a severe injury that precipitates a profuse blood loss, and from some medications. An enlarged prostate can cause problems that will ultimately present as ESRD because the enlarged prostate puts pressure on the urethra, thereby inhibiting urine flow. Those who routinely have insufficient water intake can find themselves with renal disease due to the kidneys' inability to properly flush themselves.

Diagnosis & Tests

A comprehensive physical examination is the first test to be completed when ESRD is suspected. Since high blood pressure is common with ESRD, medication may be needed in order to reduce it. Tests may also be conducted for electrolyte and blood cell counts, kidney size and function, and kidney stones or kidney cysts. Depending on the findings of these tests, the medical professional may also order a biopsy or a computed tomography (CT) scan in order to eliminate the presence of cancerous or other abnormal cells.

Treatment & Therapy

Treatment for ESRD will depend on several factors; it's not the same treatment for everyone. Factors that help determine the course of treatment include the patient's age and medical history, his or her overall health, the stage and underlying cause of the disease, patient preference, and the patient's tolerance for medications and procedures.

Dialysis is a common treatment for ESRD but can induce feelings of nausea, dizziness, and muscle cramps. These usually subside after treatment but treatments are usually required three times each week and each treatment takes approximately four hours. Although there is no pain except when the needles are injected, dialysis will consume a considerable amount of time each week. A new treatment called high flux dialysis is less time-consuming but may not be appropriate for all patients.

ESRD changes the body chemistry so the health care professional will most likely order frequent tests to maintain the patient's health. This includes testing for blood albumin, calcium, cholesterol, blood count, electrolytes, magnesium, phosphorous, potassium, and sodium. Testing for bone density, and erythropoietin as well as tests that assess the function of the parathyroid will also need to be performed routinely as ESRD changes the results of those tests.

Those who have ESRD may need to adhere to a special diet in order to maintain proper kidney function.

Prevention & Prophylaxis

Preventing the onset of ESRD begins with good dietary habits and attention to good health practices. Since diabetes and high blood pressure are precursors to kidney failure, eating a well healthy diet and eliminating sugary, highly processed foods is an excellent starting point. 

Consuming adequate amounts of water to help flush toxins from the system will also help keep the kidneys functioning properly. When the kidneys function properly, the other body systems, such as lymphatic system, respiratory system, and circulatory systems, are better able to function, which keeps the body in homeostasis.

Weight control, since weight can be directly linked to high blood pressure, can also aid in maintaining good kidney function throughout a lifetime. However, eating a healthy diet is the most important.

ESRD is very treatable and medical advances have made the treatments more user friendly. Those who have this disease can live long and have a good quality of life. However, living a healthy lifestyle and taking measures to avoid the disease is the best prevention and prophylaxis.