End-stage kidney disease is when a person's kidneys fail. It occurs in people with chronic kidney disease.

This article discusses the causes and symptoms of end-stage kidney disease (ESKD), which is also called end-stage renal disease (ESRD) or kidney failure.

We also cover treatment, prevention, and ways to reduce the risk of developing ESKD.

End-stage kidney disease represented by models of kidneys with stethoscope.Share on Pinterest
ESKD is when a person's kidneys fail.

End-stage kidney disease or ESKD is the most advanced stage of chronic or long-term kidney disease, which is when a person gradually loses kidney function over time.

There are five stages of kidney disease. ESKD is stage 5.

When a person has ESKD, their kidneys fail to function, either wholly or partially. Even if the kidneys work partially, it is not enough to meet the body's needs.

The kidneys have an essential role in the body. They filter out waste and excess water from the blood. These waste products come out in a person's urine.

If a person has ESKD, waste products can build up in their blood and may become life-threatening.

A person with ESKD will need kidney dialysis or a kidney transplant to save their life.

A buildup of waste products in the blood causes the symptoms of ESKD. The buildup occurs because the kidneys are no longer able to filter those waste products out of the blood sufficiently.

A person with ESKD may experience:

  • reduced appetite
  • feeling or being sick
  • headaches
  • tiredness
  • itchy, dry skin
  • unexplained weight loss
  • chest pain
  • shortness of breath
  • trouble concentrating
  • little or no urination
  • swelling
  • muscle cramps
  • skin discoloration
  • tingling in the hands or feet

Chronic kidney disease can slowly lead to kidney failure and ESKD, but the kidneys may also stop working suddenly.

If a person suddenly has kidney failure, it is called acute renal failure or acute kidney injury.

We explore the causes of ESKD as well as acute renal failure below:

Chronic causes of ESKD

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High blood pressure may cause ESKD.

According to the American Kidney Fund, diabetes and high blood pressure are the first and second most common chronic conditions that cause ESKD.

Other chronic conditions that can cause ESKD include:

  • lupus and other autoimmune conditions
  • genetic conditions originating at birth
  • problems with the urinary tract
  • nephrotic syndrome, which is a type of kidney disease

Acute renal failure

Acute renal failure is when the kidneys stop working suddenly. This may occur due to:

  • a heart attack
  • poisoning
  • limited blood supply to the kidneys
  • severe dehydration
  • urinary tract obstruction
  • substance misuse
  • severe blood infection, known as sepsis

ESKD is the most advanced stage of chronic or long-term kidney disease. Chronic kidney disease affects between 10 and 16 percent of adults worldwide.

Several factors increase the risk of chronic kidney disease, including:

  • smoking
  • high blood pressure
  • diabetes
  • being overweight
  • older age
  • being of African-American descent
  • low birth weight
  • family history of chronic kidney disease

If a person has chronic kidney disease, the following factors increase the risk it will progress to ESKD:

  • not managing diabetes
  • not controlling high blood pressure
  • drinking too much alcohol
  • smoking

Reduced kidney function may affect many other parts of the body.

Complications of ESKD include:

  • liver damage
  • internal bleeding
  • buildup of fluid on the lungs
  • nerve damage to arms or legs
  • weakened immune system
  • anemia
  • sexual dysfunction
  • trouble concentrating
  • problems during pregnancy
  • fluid retention
  • heart problems
  • bone fractures
  • increased risk of stroke

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Testing a urine sample may help to diagnose ESKD.

If a person has symptoms of ESKD, a doctor may test their blood and urine for waste products. These tests may include:

  • Glomerular filtration rate (GFR): Measures how well the kidneys filter the blood.
  • Urinalysis: Looks for protein and blood in the urine.
  • Serum creatinine test: Tests the blood for a buildup of the waste product creatine.
  • Blood urea nitrogen test: Measures nitrogen in the blood.

According to research from 2016, a doctor may diagnose ESKD if a person has uremia, which is when the blood retains large amounts of substances that the kidneys usually remove in the urine. Uremia means they will need ongoing kidney dialysis.

Doctors will also look for a low GFR, which tells them if the kidneys are not filtering a person's blood well.

A doctor will usually suggest renal replacement therapy for ESKD. Renal replacement therapy includes kidney dialysis or a kidney transplant.

In 2013, more than 1.4 million people were receiving renal replacement therapy worldwide.

There are two main types of kidney dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis is when a machine filters waste from a person's blood. This process takes 3 or 4 hours, and people have it done at a dialysis center. A person with ESKD will usually use hemodialysis 2 or 3 times each week.

During peritoneal dialysis, a person pumps dialysis fluid into their abdomen. The fluid draws out waste fluids through the lining of the abdomen, which is known as the peritoneum. The fluid comes out through a catheter. Peritoneal dialysis can be done at home.

A kidney transplant is when a surgeon replaces the damaged kidney with a healthy one from a donor.

Alongside renal replacement therapy, a person may need to follow a specific diet to support their treatment. The diet may involve:

  • avoiding foods high in protein
  • eating sufficient calories
  • limiting fluid intake
  • controlling electrolytes, such as salt, potassium, and phosphorous

The following lifestyle changes may slow the progress of chronic kidney disease:

  • stopping smoking
  • drinking less alcohol
  • taking prescribed medications correctly
  • managing blood pressure
  • managing blood sugar levels
  • losing weight if overweight
  • exercising regularly
  • eating a healthful, balanced diet

If a person has the symptoms of chronic kidney disease or ESKD, they should see their doctor. Getting the right treatment, as soon as possible, may improve the outlook for this conditions.

Without kidney dialysis or a kidney transplant, ESKD is life-threatening. A person with ESKD that requires kidney dialysis will continue to use it long-term. A kidney transplant may help them regain normal kidney function.