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End-stage renal disease (ESRD) is the condition in which there is a permanent and essentially total loss of kidney function.

In ESRD, the kidney functions at 5% or less of its normal capacity. It is also called CKD (for chronic kidney disease), which is the progression from numbers 1 to 5 with 5 being the most severe form of chronic kidney disease.

ESRD or CKD 5 presumes that the patient requires either dialysis or transplant for survival.

What is going on in the body?

Diabetes and high blood pressure are two diseases that cause many of the cases of end-stage renal disease in the US.

Other conditions that can lead to end-stage renal disease include:

• glomerulonephritis, which is swelling and scarring of the filtering part of the kidneys
• polycystic kidneys, an inherited disorder in which cysts enlarge the kidney and cause eventual failure eof their function.
• interstitial kidney disease
• obstructive uropathy, or a blockage in the urinary system
• systemic lupus erythematosus or other similar autoimmune disesaes, in which there is long-term inflammation of joints, skin, and other organs including kidneys.
• multiple myeloma, a cancer of the bone marrow

In end-stage renal disease, toxins slowly build up in the body. Normal kidneys remove these toxins from the body through the passage of urine. The toxins most commonly measured are urea (BUN) and creatinine. By measuring these waste products in the blood, healthcare professionals can tell if the kidneys are functioning normally.

What are the signs and symptoms of the disease?

The symptoms that may result from the the toxic buildup of waste products include:

• a decrease in the amount of urine
• overall swelling of the body called edema
• feeling out of breath or short of breath
• nausea and vomiting
• poor appetite
• metallic taste in the mouth
• hiccups
• weight loss or weight gain with fluid
• fatigue usually from anemia or low blood count
• mental slowness or confusion
• seizures or convulsions (unusual)
• leg cramps
• itching
• pale skin color

What are the causes and risks of the disease?

The risk of end-stage renal disease is increased for

• older persons
• African-Americans
• those with a family history of CKD especially polycystic disease
• Latinos especially from type 2 diabetes
• Native Americans, especially from type 2 diabetes.

What can be done to prevent the disease?

End-stage renal disease can sometimes be prevented by controlling high blood pressure and managing diabetes very tightly. However, once ESRD occurs it is not reversible.

ACE inhibitor medications, such as lisinopril (i.e., Prinivil, Zestril) or enalapril (i.e., Vasotec), can be used to lower high blood pressure and slow the disease's progression before ESRD occurs.. These drugs are also used to lower the amount of protein in the urine. These drugs and other blood pressure medications can slow the rate of kidney failure decline.

How is the disease diagnosed?

The disease is diagnosed by a careful review of a person's medical history and physical examination and through blood tests. Blood samples will be taken to check the levels of creatinine and urea. Urine clearance studies and protein levels will also be done. The blood tests may also show high levels of potassium, phosphorus, parathyroid hormone, and magnesium as well as low levels of calcium.

An ultrasound of the kidneys may show small, scarred kidneys. A kidney biopsy, in which a small sample of kidney tissue is taken, may show how much damage has been done to the kidneys.

What are the long-term effects of the disease?

The long-term effects of end-stage renal disease include:

• high blood pressure
• a significantly high risk of heart disease and heart attacks.
• swelling called edema, because the body is unable to get rid of extra fluid
• electrolyte or mineral abnormalities, especially a high potassium, low calcium, and elevated phosphorus
• anemia, a low level of red blood cells that carry oxygen
• malnutrition (especially of proteins and calories)
• increased risk of infections
• menstrual problems
• decreased sexual drive
• fatigue

What are the treatments for the disease?

The treatments for end-stage renal disease necessitate dialysis and/or kidney transplant and also include:

• a diet that restricts protein, potassium, and phosphorus
• limited fluid intake
• control of blood pressure by antihypertensive drugs
• erythropoietin to improve anemia

Once end-stage renal disease is diagnosed, a person needs to have either dialysis or a kidney transplant. In dialysis, a machine acts as a healthy kidney would, filtering out waste products from the blood or other fluids.

Hemodialysis is the process of filtering out toxins from the blood and returning the blood to the body.

Peritoneal dialysis removes wastes from the peritoneal cavity, which includes the belly and pelvic areas.

What are the side effects of the treatments?

Side effects vary with the treatment used. Any surgery may result in bleeding, infection, and even death. There can be many complications with dialysis, including infections, low blood pressure, and lung and heart problems.

What happens after treatment for the disease?

A person who receives a kidney transplant needs lifelong treatment with immunosuppressants. These are drugs that keep the body's immune system from rejecting the new kidney. Dialysis must be done on a regular schedule. Diet is important for those with kidney failure. A person should be referred to a registered dietician for advice.

How is the disease monitored?

A kidney specialist will monitor dialysis treatment or any effects after a kidney transplant. Long-term follow-up is critical. A person should see his or her healthcare professional regularly even if there are no symptoms of kidney disease.