What You Need to Know About End-Stage Kidney Disease (ESRD)

End-stage kidney disease is also called end-stage renal disease (ESRD). The kidneys of people with ESRD function below 15% of their normal ability, which may mean they’re barely functioning or not functioning at all.

Kidney disease is usually progressive. The length of each stage varies and depends on how your kidney disease is treated, especially in relation to your diet and whether your doctor recommends dialysis.

Chronic kidney disease typically doesn’t reach the end stage until 10-20 years after you’re diagnosed.

What are the five stages of renal disease?

ESRD is the fifth stage of the progression of chronic kidney disease, which is measured by your glomerular filtration rate (GFR):

You may experience a wide range of symptoms, including:

• decrease in how much you urinate
• inability to urinate
• fatigue
• malaise, or a general ill feeling
• headaches
• unexplained weight loss
• loss of appetite
• nausea and vomiting
• dry skin and itching
• changes in skin color
• bone pain
• confusion and difficulty concentrating

Other symptoms may include:

• bruising easily
• frequent nosebleeds
• numbness in your hands and feet
• bad breath
• excessive thirst
• frequent hiccups
• the absence of menstrual cycles
• sleeping problems, such as obstructive sleep apnea and restless leg syndrome (RLS)
• low libido or impotence
• edema or swelling, especially in your legs and hands

See your doctor right away if any of these symptoms interfere with your life, especially if you can’t urinate or sleep, are vomiting frequently, or feel weak and unable to do daily tasks.

Advancements allow people with ESRD to live longer than ever before, but ESRD can be life threatening. Even with dialysis, the rate of death from ESRD ranges between 20-50% in two years, and this rate is higher for Black people than those who are white.

Death usually occurs due to hyperkalemia (high potassium) or other complications. The 5-year survival rate if you’re undergoing dialysis in the U.S. is about 35%. It’s 25% if you’re also living with diabetes.

That said, your recovery depends on the type of treatment recommended by your doctor. With dialysis, you can receive treatment at a facility or at home. In many cases, dialysis still allows you to prolong your life by regularly filtering waste from your body. Some dialysis options allow you to use a portable machine so that you can continue your daily life without having to use a large machine or go to a dialysis center.

Kidney transplants are also likely to succeed. Failure rates of transplanted kidneys are low, and as many as 97% of all kidney transplants are successful after one year.

A transplant allows you to resume healthy kidney function. If you follow your doctor’s recommendations for diet and lifestyle changes, a kidney transplant can help you live free from ESRD for many years.

It can be easy to withdraw as you experience the effects of ESRD or the lifestyle changes that come with dialysis. If this happens, seek professional counseling or positive support from your family and friends. They can help you stay actively engaged in your daily life. This can ensure that you maintain a high quality of life.

Many kidney diseases attack the nephrons, the tiny filtering units in the kidneys. This leads to poor blood filtering, which eventually leads to ESRD. ESRD is caused most commonly by diabetes and hypertension (high blood pressure).

If you have diabetes, your body can’t break down glucose (sugar) correctly, so glucose levels in your blood remain high. Having high levels of glucose in your blood damages your nephrons.

If you have hypertension, the increased pressure on the small vessels in your kidneys leads to damage. The damage prevents your blood vessels from performing their blood-filtering duties.

Other causes of ESRD include:

• long-term blockage of the urinary tract by kidney stones, enlarged prostate, or certain types of cancer
• glomerulonephritis, which is inflammation of the filters in your kidney (known as glomeruli)
• vesicoureteral reflux, when urine flows into your kidneys
• congenital abnormalities

Certain people also have a higher chance of developing ESRD, such as people who have:

• diabetes
• hypertension
• relatives with ESRD

Your chance of developing ESRD also rises when you have any type of kidney condition, including:

• polycystic kidney disease (PKD)
• Alport syndrome
• interstitial nephritis
• pyelonephritis
• certain autoimmune conditions, such as lupus

Your doctor diagnoses ESRD using a physical examination and tests to check your kidney function. Kidney function tests include:

• Urinalysis: This test helps your doctor check for protein and blood in your urine. These substances indicate that your kidneys aren’t processing waste properly.
• Serum creatinine test: This test helps your doctor check whether creatinine is building up in your blood. Creatinine is a waste product that your kidneys should filter out of your body.
• Blood urea nitrogen test: This test helps your doctor check how much nitrogen is in your blood.
• Estimated glomerular filtration rate (GFR): This test allows your doctor to estimate how well your kidneys filter waste.

The treatments for ESRD are dialysis or a kidney transplant. In some cases, lifestyle changes and medications may help.

Dialysis

You have two options when you undergo dialysis.

One option is hemodialysis, which uses a machine to process your blood. The machine filters out waste using a solution. It then places the clean blood back into your body. This method is usually used three times per week and takes three to four hours each time.

Your doctor may also prescribe peritoneal dialysis. This process involves placing a solution into your abdomen that’s later removed using a catheter. This type of dialysis can be done at home with proper training. It’s often done overnight while you sleep.

Kidney transplant

Kidney transplant surgery involves removing your affected kidneys (if removal is needed) and placing a functioning donated organ. One healthy kidney is all you need, so donors are often living. They can donate one kidney and continue to function normally with the other. According to the National Kidney Foundation, more than 25,000 kidney transplants were performed in the United States in 2022.

Drugs

People with diabetes or hypertension should control their conditions to help prevent ESRD. Both conditions benefit from drug therapy using angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs).

Kerendia (finerenone) is a prescription medication that can reduce the risk of sustained GFR decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in adults with CKD associated with type 2 diabetes.

Vaccinations

Some vaccines can help prevent serious complications of ESRD.

In particular, you should be vaccinated against influenza (flu), tetanus, pneumococcal disease, hepatitis B, and human papillomavirus if you’re under age 26.

Lifestyle changes

Fluid retention can cause rapid weight change, so monitoring your weight is important. You may also need to increase your caloric intake and decrease protein consumption. A diet low in sodium, potassium, phosphorus, and other electrolytes may be needed, along with fluid restriction.

Limit these foods to avoid consuming too much sodium or potassium:

• bananas
• tomatoes
• oranges
• chocolate
• nuts and peanut butter
• spinach
• avocadoes
• sauces like soy or teriyaki
• salad dressings
• various canned foods
• many processed foods and instant or frozen meals
• Cold-cut meats or hotdogs
• bagels

Taking vitamin supplements, such as calcium, vitamin C, vitamin D, and iron, can help your kidney function and the absorption of essential nutrients. That said, if you’re living with kidney disease, speak with your doctor or a dietician for specific recommendations for you.

Possible complications of ESRD include:

• skin infections from dry skin and itching
• increased risk of infections
• abnormal electrolyte levels
• joint, bone, and muscle pain
• weak bones
• nerve damage
• changes in blood glucose level

Less common but more serious complications include:

• liver failure
• heart and blood vessel problems
• fluid buildup around your lungs
• hyperparathyroidism
• malnutrition
• anemia
• stomach and intestinal bleeding
• brain dysfunction and dementia
• seizures
• joint disorders
• fractures

Can you recover from end-stage kidney disease?

Treatment can help you live a long time with kidney disease. Maintaining a well-balanced diet, managing blood pressure and blood sugar levels, and maintaining weight are important.

A registered dietitian can create a tailored meal plan, and you may need to take medications for related conditions. Your doctor, usually a nephrologist, will also oversee your medications to ensure there’s no additional damage to your kidneys and watch out for complications.

What can prevent end-stage kidney disease?

In some cases, ESRD isn’t preventable. However, you should control your blood glucose levels and your blood pressure. You should always call a doctor if you have any ESRD symptoms. Early detection and treatment can delay or prevent the disease from progressing.

How long does it take to go from stage 4 to stage 5 kidney disease?

Research from 2018 found that participants spent a median of nearly eight years in stage 3a, five years in stage 3b, 4.2 years in stage 4, and less than a year in stage 5.

The kidneys filter waste and excess water from the blood, converting it into urine. Chronic kidney disease can disrupt this over time, leading to ESRD.

At this stage, the kidneys are functioning at 15% or less of their normal capacity, which may mean they are barely working or not functioning at all.

Kidney disease is a progressive condition, but the duration of each stage varies depending on treatment methods, such as dietary changes and dialysis recommended by a doctor. While ESRD can be life threatening, these treatments can help significantly prolong your life.