End-Stage Renal Disease (ESRD)

End-stage renal disease—ESRD—is also known as kidney failure. It is often caused by chronic kidney disease (CKD) and is stage 5—or the final stage—of CKD, which is when the kidneys stop functioning. ESRD is when 85% to 90% of kidney function is gone.

The kidneys help remove waste and extra water from the body, help make red blood cells, and aid in controlling blood pressure. Without healthy, functioning kidneys, various parts of the body cannot function properly, leading to health problems.

This article discusses the causes, symptoms, diagnosis, and treatment of ESRD.

Person is hospital bed with healthcare provider

Juan Silva / Getty Images

What Causes Kidney Failure?

Kidney failure is caused when the kidneys cannot do the work they need to do to keep the body healthy. The most common causes of kidney failure in the United States are high blood pressure and diabetes.

Risk Factors

Risk factors for chronic kidney disease that can eventually lead to ESRD include:

Signs and Symptoms

ESRD does not happen abruptly; it is the end process of progressive renal failure from kidney disease. It can take more than 10 to 20 years of chronic kidney disease to reach end-stage.

Sometimes people may not even realize they have kidney disease until they start to have symptoms due to kidney failure.

Symptoms can include:

  • Sleep difficulties
  • Decreased appetite
  • Weakness
  • Fatigue
  • Itching
  • Unintentional weight loss
  • Muscle cramps, particularly in the legs
  • Swelling in the feet/ankles
  • Anemia

Other symptoms may also include:

  • Trouble concentrating
  • Abnormally light or dark skin
  • Excessive thirst
  • Easy bruising or nosebleeds
  • Peripheral neuropathy
  • Vomiting

Diagnosis and Tests

Chronic kidney disease is usually diagnosed through a variety of things:

  • Physical exam
  • Family and medical history
  • Tests and imaging studies

As the disease progresses, kidney function is monitored through:

  • Blood tests: The eGFR (estimated glomerular filtration rate) measures how well your kidneys filter waste from the blood; the stage of kidney disease is based on the eGFR; the blood urea nitrogen (BUN) checks the level of urea nitrogen, a waste product.
  • Urine tests: This checks for protein in your urine to see how much damage there is to the kidneys.
  • Kidney ultrasound: This is an imaging test that uses sound waves to get a picture of your kidneys.
  • Kidney biopsy: A very small piece of the kidneys is removed to be microscopically examined for damage.
  • CT scan: Another imaging test to get a detailed picture of the kidneys.

Complications of Kidney Failure

When the kidneys don’t work, this can cause an array of problems, health-wise. Although dialysis can help, the kidneys still don’t work as well as healthy kidneys. This means a person is at risk for other complications and conditions, including:

  • Anemia
  • Bone disease and high phosphorus
  • Heart disease
  • High potassium
  • Fluid buildup
  • Mental health issues

Management and Treatment

There is no cure for ESRD, but people can live long lives with treatment and management. The main treatments for ESRD include:

Dialysis helps the body excrete waste and extra fluids in the blood. While it can help with what the kidneys usually do, it cannot do everything, so some medical and health problems from kidney failure may remain.

A kidney transplant gives you a healthy kidney by implanting it via surgery. The kidney comes from either a live donor or a dead donor, and the new kidney can do everything a healthy kidney can do.

If you don’t want to do dialysis or get a kidney transplant, medical management is available. This involves treating the symptoms of kidney failure to manage them and providing supportive care. It will not treat kidney failure and won’t keep you alive. It helps you live as comfortably as possible until your body can’t function anymore.

Living With End-Stage Renal Disease

Many factors go into staying as healthy as possible, with or without ESRD. If you have ESRD, it’s even more important to try to stay healthy to maintain your quality of life.

If you choose not to have dialysis or a kidney transplant, medical management can help you stay comfortable during the days or weeks you have. This can often be done with little changes to diet, lifestyle habits, and regular communication and visits with your healthcare provider.

Things that can be done include:

  • Dietary changes: less sodium, grilling or baking instead of frying, low-fat dairy, minimizing consumption of processed foods
  • Staying active (always check with your healthcare provider before starting a new exercise routine)
  • Limiting alcohol and tobacco
  • Seeing your healthcare provider regularly
  • Support groups: This can help with the emotional aspects of living with ESRD

Summary

The last stage of chronic kidney disease is kidney failure or end-stage kidney disease. This is when only 10% to 15% of kidney function remains.

Because the kidneys help the body excrete waste and aid in the functioning of so many other organs, if the kidneys do not work correctly, this can cause various issues in the body, leading to other diseases and conditions.

Kidney failure cannot be cured, but there are treatments and ways to manage it. There are also changes in lifestyle behaviors that can keep you as healthy as possible for as long as possible.

A Word From Verywell

When CKD transitions to ESRD, it can be overwhelming. Talk with your treatment team about how you’re feeling and what your needs are right now. They can help connect you with services and supports that can help with your emotional and practical needs. For example, some treatments can help you live longer, and some medicines can help make you comfortable.

Frequently Asked Questions

  • Can kidney failure be cured?

    No, it cannot. However, it can be treated and managed to help you live longer. Talk with your healthcare team about your treatment options. These can change based on your age, your overall health, health problems you might have, the level of support you have, and your lifestyle.

  • Is kidney failure painful?

    Kidney failure by itself is not painful. What causes the pain and discomfort are the various issues in the body it causes due to organ system dysfunction or fluid buildup.

  • How do you know if you need dialysis or a kidney transplant?

    If you are diagnosed with ESRD, your healthcare provider will talk with you about dialysis, kidney transplant, or medical management. You will not know by yourself if you need dialysis or a kidney transplant. You may have symptoms of kidney failure, but your healthcare provider will run tests for an official clinical diagnosis and then talk with you about treatment options.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Kidney Foundation. What is kidney failure?

  2. Penn Medicine. End-stage kidney disease.

  3. Johns Hopkins Medicine. End stage renal disease.

  4. American Kidney Fund. Tests for kidney disease.

  5. American Kidney Fund. Complications of kidney failure.

  6. American Kidney Fund. Treatment of kidney failure.

  7. American Kidney Fund. Live healthy - steps to keep your kidney damage from getting worse.