End-Stage Renal (Kidney) Disease: Symptoms, Causes, Treatment

What are the symptoms of end-stage renal (kidney) disease?

End-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD) where the kidneys have lost nearly all their ability to function effectively. Symptoms of ESRD can include:

Fatigue: Feeling extremely tired and lacking energy.
Fluid retention: Swelling in the legs, ankles, feet, or face due to fluid buildup (edema).
Shortness of breath: Difficulty breathing, especially when lying down.
Itching: Persistent itching, often generalized but sometimes localized to a specific area.
Nausea and vomiting: Feeling sick to your stomach and vomiting.
Loss of appetite: Not feeling hungry or having a reduced desire to eat.
Changes in urination: Urinating more or less frequently, or experiencing foamy urine.
Muscle cramps: Painful muscle cramps, particularly in the legs.
Confusion: Feeling confused, having difficulty concentrating, or experiencing memory problems.
Skin changes: Changes in skin color or texture, or developing dry, flaky skin.

It’s important to note that these symptoms can also be caused by other conditions, so it’s crucial to consult with a healthcare provider for a proper diagnosis and treatment.

What are the causes of end-stage renal disease?

End-stage renal disease (ESRD) can be caused by various factors that lead to permanent damage or failure of the kidneys. Some common causes include:

Diabetes: Uncontrolled or poorly managed diabetes is one of the leading causes of ESRD. High blood sugar levels can damage the small blood vessels in the kidneys over time, affecting their ability to filter waste from the blood.
Hypertension (high blood pressure): Chronic high blood pressure can damage the blood vessels in the kidneys, reducing their ability to filter waste and fluids from the blood effectively.
Glomerulonephritis: This is a group of diseases that cause inflammation and damage to the kidney’s filtering units (glomeruli). Over time, this damage can lead to kidney failure.
Polycystic kidney disease (PKD): A genetic disorder characterized by the growth of numerous cysts in the kidneys. These cysts can eventually replace much of the normal kidney tissue, leading to kidney failure.
Autoimmune diseases: Conditions like lupus and other autoimmune disorders can cause inflammation and damage to the kidneys, leading to ESRD.
Infections: Severe or recurrent kidney infections (pyelonephritis) can cause scarring of the kidneys, reducing their ability to function properly.
Obstructive nephropathy: Conditions that cause obstruction of the urinary tract, such as kidney stones or enlarged prostate, can lead to kidney damage and ESRD if left untreated.
Congenital abnormalities: Some people are born with structural abnormalities in their kidneys or urinary tract that can lead to kidney damage and ESRD over time.
Other factors: Other factors that can contribute to ESRD include kidney artery stenosis (narrowing of the arteries supplying the kidneys), long-term use of certain medications, and chronic kidney infections.

It’s important to manage any underlying conditions that can contribute to kidney damage and to seek early treatment to prevent or delay the progression to ESRD.

How is the diagnosis of end-stage renal disease made?

The diagnosis of end-stage renal disease (ESRD) is typically made through a combination of medical history, physical examination, and laboratory tests. Here’s an overview of the diagnostic process:

Medical history and physical examination: Your healthcare provider will ask about your symptoms, medical history, family history, and any risk factors you may have for kidney disease. They will also perform a physical examination to look for signs of kidney disease, such as swelling in the legs or abdomen.
Blood tests: Blood tests are used to measure the level of waste products, such as creatinine and urea, in your blood. These levels can indicate how well your kidneys are functioning. Blood tests can also measure other parameters like electrolyte levels and hemoglobin.
Urinalysis: A urine sample is analyzed to check for the presence of protein, blood, or other abnormalities that may indicate kidney damage.
Imaging tests: Imaging tests such as ultrasound, CT scan, or MRI may be used to assess the size, shape, and structure of your kidneys. These tests can help identify any structural abnormalities or blockages in the urinary tract.
Kidney biopsy: In some cases, a kidney biopsy may be performed to remove a small sample of kidney tissue for examination under a microscope. This can help determine the cause of kidney damage and the extent of the disease.
Glomerular filtration rate (GFR): GFR is a measure of how well your kidneys are filtering waste from your blood. A GFR below 15 mL/min/1.73 m² is one of the criteria for diagnosing ESRD.

Once ESRD is diagnosed, treatment options such as dialysis or kidney transplant will be discussed with you. Early detection and treatment of kidney disease can help slow down its progression to ESRD and improve quality of life.

What is the treatment for end-stage renal disease?

End-stage renal disease (ESRD) is a stage of kidney failure where the kidneys are no longer able to filter waste and excess fluids from the blood, and the patient requires dialysis or a kidney transplant to survive. The treatment options for ESRD depend on the individual’s overall health, age, and other medical conditions. Here are some common treatment options:

Dialysis: Dialysis is a process that filters waste products from the blood when the kidneys are no longer able to do so. There are two main types of dialysis:
- Hemodialysis: A machine filters the blood outside the body, usually three times a week, for 3-4 hours per session.
- Peritoneal dialysis: A fluid called dialysate is inserted into the abdominal cavity to filter waste products, done at home or in a healthcare setting.
Kidney Transplant: A kidney transplant involves replacing the diseased kidneys with a healthy kidney from a donor. The transplanted kidney can come from a deceased or living donor.
Home Hemodialysis: This involves performing dialysis at home, using a machine that filters the blood, usually 5-7 times a week.
Continuous Ambulatory Peritoneal Dialysis (CAPD): This is a type of peritoneal dialysis that involves exchanging dialysate bags multiple times a day.
Automated Peritoneal Dialysis (APD): This is a type of peritoneal dialysis that uses a machine to automatically exchange dialysate bags while you sleep.
Vascular Access Management: For patients undergoing hemodialysis, maintaining proper vascular access (the connection between the artery and vein) is crucial. This includes regular monitoring and maintenance of the access site.
Medications: Medications may be prescribed to manage symptoms such as anemia, high blood pressure, and bone disease associated with ESRD.
Nutritional Counseling: A renal dietitian can help patients with ESRD manage their nutrition and fluids to reduce waste buildup in the body.
Palliative Care: Palliative care focuses on relieving symptoms and improving quality of life for patients with ESRD who are not candidates for dialysis or transplantation.

It’s essential for patients with ESRD to work closely with their healthcare team to develop a personalized treatment plan that meets their individual needs and goals.

How long can you live with end-stage renal disease?

The survival rate for patients with end-stage renal disease (ESRD) varies depending on several factors, including the patient’s overall health, age, and the treatment they receive. Here are some general guidelines:

Without treatment:

If left untreated, ESRD typically leads to death within a few months due to buildup of waste products and electrolyte imbalances in the body.

With dialysis:

Hemodialysis: The average survival rate for patients on hemodialysis is around 5-7 years, but some patients can live for 10-15 years or more with regular dialysis treatments.
Peritoneal dialysis: The average survival rate for patients on peritoneal dialysis is around 7-10 years.

With a kidney transplant:

The average survival rate for patients who receive a kidney transplant is around 10-15 years, with some patients living for 20-30 years or more with a functioning transplant.
However, the success of a kidney transplant also depends on the patient’s overall health, age, and other medical conditions.

Factors that affect survival rate:

Age: Older patients tend to have a lower survival rate than younger patients.
Underlying medical conditions: Patients with comorbidities such as diabetes, heart disease, or lung disease may have a lower survival rate.
Nutritional status: Patients with malnutrition or wasting may have a lower survival rate.
Compliance with treatment: Patients who adhere to their treatment plan and follow their healthcare provider’s instructions tend to have a better outcome.

Overall:

With proper treatment and management, patients with ESRD can live for many years, even decades. However, the quality of life and survival rate can vary depending on individual factors. It’s essential for patients to work closely with their healthcare team to develop a personalized treatment plan and manage their condition effectively.