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</div><div><span>End-stage kidney disease</span></div></div>
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</a><h1 class="with-also" itemprop="name">End-stage kidney disease</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>End-stage kidney disease (ESKD) is the last stage of <a test="test" href="./000471.htm">long-term (chronic) kidney disease</a>. This is when your kidneys can no longer support your body's needs.</p><p>End-stage kidney disease is also called end-stage renal disease (ESRD).</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>The kidneys remove waste and excess water from the body. ESRD occurs when the kidneys are no longer able to work at a level needed for day-to-day life.</p><p>The most common causes of ESRD in the United States are <a test="test" href="./001214.htm">diabetes</a> and <a test="test" href="./000468.htm">high blood pressure</a>. These conditions can damage your kidneys.</p><p>ESRD almost always comes after chronic kidney disease. The kidneys may slowly stop working during a period of 10 to 20 years before end-stage disease results.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>Common symptoms may include:</p><ul><li><a test="test" href="./003089.htm">General ill feeling</a> and <a test="test" href="./003088.htm">fatigue</a></li><li>Itching (<a test="test" href="./003217.htm">pruritus</a>) and dry skin</li><li><a test="test" href="./003024.htm">Headache</a></li><li>Weight loss without trying</li><li>Loss of appetite</li><li>Nausea </li></ul><p>Other symptoms may include:</p><ul><li>Abnormally dark or light skin</li><li>Nail changes</li><li>Bone pain</li><li><a test="test" href="./003208.htm">Drowsiness</a> and <a test="test" href="./003205.htm">confusion</a></li><li>Problems concentrating or thinking</li><li>Numbness in the hands, feet, or other areas</li><li><a test="test" href="./003296.htm">Muscle twitching</a> or cramps</li><li>Breath odor</li><li>Easy bruising, nosebleeds, or blood in the stool</li><li>Excessive thirst</li><li>Frequent hiccups</li><li>Problems with sexual function</li><li>Menstrual periods stop (amenorrhea)</li><li>Sleep problems</li><li>Swelling of the feet and hands (<a test="test" href="./003103.htm">edema</a>)</li><li>Vomiting, often in the morning </li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>Your health care provider will perform a physical exam and order blood tests. Most people with this condition have high blood pressure.</p><p>People with ESRD will make much less urine than normal, or their kidneys may no longer make urine.</p><p>ESRD changes the results of many tests. People receiving dialysis will need these and other tests done often:</p><ul><li><a test="test" href="./003484.htm">Potassium</a></li><li><a test="test" href="./003481.htm">Sodium</a></li><li><a test="test" href="./003480.htm">Albumin</a></li><li><a test="test" href="./003478.htm">Phosphorous</a></li><li><a test="test" href="./003477.htm">Calcium</a></li><li><a test="test" href="../patientinstructions/000386.htm">Cholesterol</a></li><li><a test="test" href="./003487.htm">Magnesium</a></li><li><a test="test" href="./003642.htm">Complete blood count</a> (CBC)</li><li><a test="test" href="./002350.htm">Electrolytes</a></li></ul><p>This disease may also change the results of the following tests:</p><ul><li>Vitamin D</li><li><a test="test" href="./003690.htm">Parathyroid hormone</a></li><li><a test="test" href="./007197.htm">Bone density test</a></li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>ESRD may need to be treated with <a test="test" href="./007434.htm">dialysis</a> or <a test="test" href="./003005.htm">kidney transplant</a>. You may need to stay on a special diet or take medicines to help your body work well.</p><p>DIALYSIS</p><p>Dialysis does some of the job of the kidneys when they stop working well.</p><p>Dialysis can:</p><ul><li>Remove extra salt, water, and waste products so they do not build up in your body</li><li>Keep safe levels of minerals and vitamins in your body</li><li>Help control blood pressure</li><li>Help the body make red blood cells </li></ul><p>Your provider will discuss dialysis with you before you need it. Dialysis removes waste from your blood when your kidneys can no longer do their job.</p><ul><li>Usually, you will go on dialysis when you have only 10% to 15% of your kidney function left.</li><li>Even people who are waiting for a kidney transplant may need dialysis while waiting. </li></ul><p>Two different methods are used to perform dialysis:</p><ul><li>During <a test="test" href="../patientinstructions/000707.htm">hemodialysis</a>, your blood passes through a tube into an artificial kidney, or filter. This method can be done at home or at a dialysis center.</li><li>During <a test="test" href="./007434.htm">peritoneal dialysis</a>, a special solution passes into your belly though a catheter tube. The solution remains in your abdomen for period of time and then is removed. This method can be done at home, at work, or while traveling. </li></ul><p>KIDNEY TRANSPLANT</p><p>A kidney transplant is surgery to place a healthy kidney into a person with kidney failure. Your provider will refer you to a transplant center. There, you will be seen and evaluated by the transplant team. They will want to make sure that you are a good candidate for kidney transplant.</p><p>SPECIAL DIET</p><p>You may need to continue following a special <a test="test" href="./002442.htm">diet for chronic kidney disease</a>. The diet may include:</p><ul><li>Eating foods low in protein to limit your total daily protein intake</li><li>Getting enough calories if you are losing weight</li><li>Limiting fluids</li><li>Limiting salt, potassium, phosphorous, and other electrolytes </li></ul><p>OTHER TREATMENT</p><p>Other treatment depends on your symptoms, but may include:</p><ul><li>Extra calcium and vitamin D. (Always talk to your provider before taking supplements.)</li><li>Medicines called phosphate binders, to help prevent blood phosphorous levels from becoming too high.</li><li>Treatment for anemia, such as extra iron in the diet, iron pills or shots, shots of a medicine called erythropoietin, and blood transfusions.</li><li>Medicines to control your blood pressure. </li></ul><p>Talk to your provider about vaccinations that you may need, including:</p><ul><li><a test="test" href="./007595.htm">Hepatitis A vaccine</a></li><li><a test="test" href="./007613.htm">Hepatitis B vaccine</a></li><li><a test="test" href="./007775.htm">COVID-19 vaccine</a></li><li><a test="test" href="./007600.htm">Flu vaccine</a></li><li><a test="test" href="./007607.htm">Pneumonia vaccine</a> (PPV)</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Support Groups</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>Some people may benefit from taking part in a <a test="test" href="./002172.htm">kidney disease support group</a>. </p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-6"><p>End-stage kidney disease leads to death if you do not have dialysis or a kidney transplant. Both of these treatments have risks. The outcome is different for each person.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Possible Complications</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>Health problems that can result from ESRD include:</p><ul><li><a test="test" href="./000560.htm">Anemia</a></li><li>Bleeding from the stomach or intestines</li><li>Bone, joint, and muscle pain</li><li>Changes in blood sugar (glucose)</li><li><a test="test" href="./000593.htm">Damage to nerves of the legs and arms</a></li><li><a test="test" href="./000086.htm">Fluid buildup around the lungs</a></li><li><a test="test" href="./000468.htm">High blood pressure</a>, <a test="test" href="./000195.htm">heart attack</a>, and <a test="test" href="./000158.htm">heart failure</a></li><li><a test="test" href="./001179.htm">High potassium level</a></li><li>Increased risk of infection</li><li>Liver damage or failure</li><li><a test="test" href="./000404.htm">Malnutrition</a></li><li>Miscarriages or infertility</li><li><a test="test" href="./000807.htm">Restless legs syndrome</a></li><li><a test="test" href="./000726.htm">Stroke</a>, <a test="test" href="./003200.htm">seizures</a>, and <a test="test" href="./000739.htm">dementia</a></li><li>Swelling and edema</li><li>Weakening of the bones and fractures related to high phosphorous and low calcium levels </li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Renal failure - end stage; Kidney failure - end stage; ESRD; ESKD</p></div></div></section><section><div class="section sec-mb"><div class="section-header"><div class="section-title"><h2>Images</h2></div><div class="section-button"><button type="submit" aria-controls="section-tnails" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/1101t.jpg" alt="Kidney anatomy" title="Kidney anatomy" class="side-img"/><a href="../imagepages/1101.htm">Kidney anatomy</a></li>
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/24353t.jpg" alt="Glomerulus and nephron" title="Glomerulus and nephron" class="side-img"/><a href="../imagepages/19932.htm">Glomerulus and nephron</a></li>
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</ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Inker LA, Levey AS. Staging and management of chronic kidney disease. In: Gilbert SJ, Weiner DE, Bomback AS, Perazella MA, Rifkin DE, eds. <em>National Kidney Foundation Primer on Kidney Diseases</em>. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 51.</p><p>Taal MW. Classification and management of chronic kidney disease. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. <em>Brenner and Rector's The Kidney. </em>11th ed. Philadelphia, PA: Elsevier; 2020:chap 59.</p><p>Yeun JY, Young B, Depner TA, Chin AA. Hemodialysis. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. <em>Brenner and Rector's The Kidney.</em> 11th ed. Philadelphia, PA: Elsevier; 2020:chap 63.</p></div></div></section>
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<section><div class="section"><div class="section-header"><div class="section-title"><h2>Review Date 3/31/2024</h2></div><div class="section-button"><button type="submit" aria-controls="section-version" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<div id="section-version" class="section-body"><p>Updated by: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. </p>
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