End stage renal disease (ESRD) is the last stage of chronic, or long-term, kidney disease.
There is currently no cure for ESRD, but some treatments and surgeries may help extend someone’s life expectancy.
This article discusses important information about ESRD, such as the associated signs and symptoms, some causes, and life expectancy details.
ESRD can cause a wide range of signs and symptoms, as wastes, fluids, electrolytes, and minerals accumulate in the body.
Failing kidneys may also become unable to fulfill other important bodily functions, such as helping control blood pressure, strengthen bone, and make new red blood cells.
Someone with kidney failure may experience:
- swelling of the feet and ankles
- reduced appetite or unintended weight loss
- nausea and vomiting
- muscle cramps
- difficulty sleeping
- not urinating enough
- pain, stiffness, and swelling in the joints
- weakness or numbness
- unexplained exhaustion
- a loss of sense of taste
- confusion, memory problems, or difficulty concentrating
- bruising easily
Someone with ESRD may experience most of or all of the above symptoms. Some or all of these symptoms may be severe and occur either all or at least most of the time.
The causes of ESRD are usually conditions that damage or weaken the kidneys over time, eventually causing enough damage to significantly reduce their function.
The kidneys filter wastes, electrolytes, and water from the blood using filtering units comprising tiny blood vessels. If these tiny blood vessels have exposure to high sugar levels in the blood, they can eventually narrow and become clogged. Without proper blood flow, the kidneys become damaged.
Diabetes can also damage nerves that tell the brain when to empty the bladder, resulting in pressure from a full bladder that can damage the kidneys. If urine stays in the bladder too long, it also increases the risk of bacteria causing a urinary tract infection, which can spread to and damage the kidneys.
Another common cause of kidney failure is high blood pressure. The bodies of people with high blood pressure push blood through the blood vessels with a lot of force, which can damage tiny blood vessels in the kidney.
Some less common causes of ESRD include:
- genetic conditions such as polycystic kidney disease
- urinary tract conditions or problems
- nephrotic syndrome
- autoimmune conditions, such as IgA nephropathy and lupus
In some cases, the kidneys may fail suddenly, even within 2 days.
Some common causes of acute, or sudden, kidney failure include:
- severe urinary tract problems
- heart attack
- drug misuse and illegal drug use
- reduced blood flow to the kidneys
To assess whether or not someone has kidney failure, a doctor will run tests to see how well their kidneys are functioning.
They will diagnose ESRD when a person’s kidneys are functioning at less than 15% of the normal rate.
The doctor will also check the levels of albumin and creatine, which are molecules associated with kidney function, in the person’s urine.
To confirm a diagnosis of ESRD, the doctor may also order:
People with ESRD may receive dialysis or a kidney transplant. However, some people choose not to have either. Instead, they may choose to take their medications and monitor their diet and lifestyle choices as a healthcare team advises.
During dialysis, a machine receives a person’s blood from their body and runs it through a filter called a dialyzer that removes wastes and excess fluids. The machine then reintroduces the filtered blood back into the person’s body.
Most people who receive dialysis at a hospital or dialysis center need to have three dialysis sessions per week, with each lasting 2–4 hours. People who use a dialysis machine at home may require more sessions per week, sometimes four to six.
Someone may also receive peritoneal dialysis, wherein the stomach receives and removes fluids several times daily to clean the blood.
People receiving dialysis typically follow a food and fluid plan that may involve monitoring and limiting the intake of:
People with ESRD can often help manage their symptoms by:
- developing a dietary plan, ideally with the help of a dietitian, to make sure that malnutrition does not occur and that people eat kidney-friendly foods
- staying physically active
- keeping in touch with friends and family and asking for support when needed
- taking all medications, supplements, and other remedies as prescribed
- sticking to their dialysis schedule, if appropriate
- going over medications, symptoms, and other factors with doctors frequently
- avoiding caffeine in the afternoon and avoiding alcohol before bed
- avoiding smoking
- establishing a good sleep routine
- treating restless legs syndrome, sleep apnea, and other sleep-disturbing conditions
- managing and treating high blood pressure and diabetes
Someone with ESRD may receive treatment with dialysis long term or until a donor kidney becomes available. Kidney transplants involve removing the failing kidney and replacing it with a healthy donor kidney.
If someone decides not to receive dialysis or wait for a kidney donor, doctors may provide them with medications to help ease the symptoms and provide comfort until they pass.
In some cases, there is no way to prevent kidney failure. This is the case when it is due to a genetic condition or malformation, injury, or infection.
That said, the best way to prevent ESRD is to follow lifestyle and dietary habits that reduce the risk of developing the two leading causes of ESRD, diabetes and high blood pressure.
For example, a person could try:
- maintaining a moderate body weight
- eating a healthy, balanced diet
- reducing their intake of saturated fat
- avoiding or limiting alcohol consumption
- avoiding or limiting their intake of sweetened foods and drinks
- reducing their intake of processed or heavily refined foods
- getting enough exercise and sleep each day
- staying hydrated
- managing or reducing stress
- avoiding sitting for prolonged periods of time
Many people with ESRD who receive dialysis regularly or have a kidney transplant can often live long, healthy, active lives.
The life expectancy for a person receiving dialysis is around 5–10 years, though many live for 20–30 years. People who receive a donor kidney from a living donor tend to go 15–20 years before needing a new kidney. Donor kidneys from deceased donors tend to last 10–15 years before needing to be replaced.
However, it is important to note that someone’s precise outlook or life expectancy depends largely on how well they follow their treatment plan and any additional health conditions they have.
Even with dialysis treatment early in the course of the condition, an estimated
Having ERSD is also associated with frequent hospitalizations, higher healthcare costs, and metabolic changes.
People with ESRD cannot survive long without dialysis or a kidney transplant. That said, many people with ESRD who receive either dialysis or a kidney transplant can live for decades.
A person should seek medical attention if one or more of the symptoms associated with kidney failure or disease occurs.
If they receive a diagnosis of ESRD, they should talk with a doctor about the pros and cons of different treatment options.