• Advanced renal disease

    The progression of renal disease (also called kidney disease or ESRD) often begins slowly and progresses over time, sometimes taking 10 to 20 years or more to reach end-stage classification. End stage simply means that kidney function as decreased so much that patients cannot live without dialysis or a kidney transplant. Most patients who develop end stage renal disease have been managing chronic kidney disease (CKD) for a significant period of time but have been able to function without dialysis or a transplant. End stage is simply a progression of chronic kidney disease. There is no cure for ESRD.


    Most cases of ESRD are caused by the same factors that trigger CKD. Among the various causes of chronic kidney disease (CKD), diabetes is one of the most insidious followed by high blood pressure. Other kidney conditions that may lead to kidney failure are inherited familial diseases (e.g., polycystic kidney disease and chronic glomerulonephritis) as well as a variety of other kidney conditions that impair kidney function. Research shows that more than 20 million people (age 20 or older) in the United States have CKD.

    The best prevention for ESRD is to prevent chronic failure first. Other triggers for ESRD include trauma or sudden injury to the kidneys, and major blood loss.


    Symptoms of ESRD may be similar to those experienced with chronic kidney disease, but more severe in nature and patients will notice symptoms throughout their bodies as the condition worsens. These can include:

    • Weight loss without trying
    • Nausea
    • Itching skin
    • Generally feeling ill; fatigue
    • Skin and nail changes
    • Excessively dark or light skin
    • Thirst
    • Swelling of the hands and feet
    • Vomiting, especially in the morning
    • Less or no urination

    Patients should seek prompt medical attention for evaluation of ESRD symptoms.

    Testing and diagnosis

    To diagnose ESRD, providers will complete a thorough physical assessment and blood work. Kidney disease will affect a variety of the body’s blood components and providers will evaluate:

    • Albumin
    • Potassium
    • Sodium
    • Phosphorus
    • Calcium
    • Magnesium
    • CBC
    • Electrolytes

    End stage renal disease may also influence bone health and patients may need a bone mineral density scan or other diagnostic imaging.


    Renal dialysis or a kidney transplant are the only options for ESRD treatment. In addition to one of these two choices, patients may need to make changes in lifestyle choices and take steps to control blood pressure if it is elevated. Patients may expect to follow a low-protein diet, limit fluids, and reduce the amount of salt, potassium, phosphorous and electrolytes they take in.


    In ESRD patients, dialysis is often initiated when the kidneys are unable to function to remove waste from the blood. Dialysis is a mechanical intervention that cleans the blood. It usually involves a four-hour period (three-to-four days per week) of attachment to an IV in a clinic setting or at home (or being surgically fitted with a peritoneal catheter). For this reason, patients often view dialysis as disruptive to the normal activities of daily life. However, dialysis may be essential for patients who have progressed to ESRD. One health risk is infection via the IV or peritoneal catheter; another risk is electrolyte imbalance. Yet, many ESRD patients function quite well on dialysis and are able to maintain their quality of life.

    Kidney Transplant

    If the kidneys fail, patients may be a candidate for a kidney transplant. A living related donor is the best option, due to the higher success rate in terms of long-term outcome and lessened need for anti-rejection drugs. Blood typing and tissue typing are performed on potential donors to ensure there is a “match” so that the recipient’s body will not immediately reject the new kidney as foreign matter.

    If a living related donor is not available, the second-best option is a living non-related donor. If no living donor is found, a cadaver transplant may be a viable option. These donors have usually died due to a traumatic brain injury but without damage to their heart or kidneys–and have previously expressed that they wanted to donate their organ(s) in case of their death.