End-stage kidney disease

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Kidney anatomy

Renal failure - end stage; Kidney failure - end stage; ESRD

Dialysis or kidney transplantation is the only treatment for ESRD.

You should begin to prepare for dialysis before it is absolutely necessary. The preparation includes learning about dialysis and the types of dialysis therapies, and placement of a dialysis access.

See also:

• Dialysis
• Kidney transplant

Treatment usually includes an ACE inhibitor, angiotensin receptor blocker, or other medications for high blood pressure.

You may need to make changes in your diet.

• Eat a low-protein diet
• Get enough calories if you are losing weight
• Limit fluids
• Limit salt, potassium, phosphorous, and other electrolytes

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See Diet and chronic kidney disease for more detail.

Other treatments may include:

• Extra calcium and vitamin D (always talk to your doctor before taking)
• Special medicines called phosphate binders, to help prevent phosphorous levels from becoming too high
• Treatment for anemia, such as extra iron in the diet, iron pills, special shots of a medicine called erythropoietin, and blood transfusions.

Different treatments are available for problems with sleep or restless leg syndrome.

Patients with chronic kidney disease should be up-to-date on important vaccinations, including:

• H1N1 (swine flu) vaccine
• Hepatitis A vaccine
• Hepatitis B vaccine
• Influenza vaccine
• Pneumococcal polysaccharide vaccine (PPV)

For additional resources, see kidney disease support group.

Without dialysis or a kidney transplant, death will occur from the buildup of fluids and waste products in the body. Both of these treatments can have serious risks and consequences. The outcome is different for each person.

• Anemia
• Bleeding from the stomach or intestines
• Bone, joint, and muscle pain
• Brain dysfunction, confusion, and dementia
• Changes in electrolyte levels
• Changes in blood sugar (glucose)
• Damage to nerves of the legs and arms
• Fluid buildup around the lungs
• Heart and blood vessel complications
  • Congestive heart failure
  • Coronary artery disease
  • High blood pressure
  • Pericarditis
  • Stroke
• Hepatitis B, hepatitis C, liver failure
• Hyperparathyroidism
• Increased risk of infections
• Malnutrition
• Phosphorous levels become too high
• Potassium levels become too high
• Seizures
• Skin dryness, itching/scratching, leading to skin infection
• Weakening of the bones, fractures, joint disorders

Review Date: 08/31/2010
Reviewed By: Charles Silberberg, DO, Private Practice specializing in Nephrology, Affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).