Patient education: End-stage kidney disease (kidney failure) (The Basics)

What is end-stage kidney disease? — End-stage kidney disease is the point in kidney disease when the kidneys mostly or completely stop working. It is also called "kidney failure."

When they are working normally, the kidneys filter blood and remove waste and excess salt and water. When a person has chronic kidney disease ("CKD"), the kidneys slowly lose the ability to filter blood. End-stage kidney disease is when they can no longer filter blood properly.

Some people with CKD reach end-stage kidney disease after many years. For others, the kidneys stop working sooner. Some people are able to prevent end-stage kidney disease with medicines and lifestyle changes.

What are the symptoms of end-stage kidney disease? — Symptoms can include:

●Nausea, vomiting, or loss of appetite

●Swelling of the feet, ankles, or legs

●Chest pain due to fluid buildup around the heart

●Feeling very tired or having trouble concentrating

●Nerve problems, like weakness, numbness, or tingling

●Problems with sex

Without treatment, end-stage kidney disease can cause seizures, coma, heart problems, and eventually death.

Is there a test for end-stage kidney disease? — Yes. If you have CKD, see your nephrologist (kidney doctor) regularly. At these appointments, you will get regular tests to check your kidneys. These include blood and urine tests. They can show if you have, or are getting close to, end-stage kidney disease.

How is end-stage kidney disease treated? — Once kidney damage has happened, it can't be reversed. Treatment for end-stage kidney disease involves finding another way to filter blood and remove waste. This can help you live longer.

In general, the treatment choices are:

●Kidney transplant – This is surgery in which a doctor puts a healthy kidney into your body (figure 1). The new, healthy kidney then does the job of the diseased kidneys. (People need only 1 kidney to live.)

A new kidney can come from a living donor (usually a family member or friend) or a dead donor. If you have a kidney transplant, you will need to take medicines for the rest of your life. This is to keep your body from reacting badly to the new kidney.

A kidney transplant is usually the best way to treat end-stage kidney disease. But it is not always an option. Some people are not candidates for a transplant. And for those who are, a new kidney is not always available.

●Dialysis – This is a treatment that takes over the job of the kidneys. Some people get dialysis while they wait for a kidney transplant. Otherwise, dialysis must be continued for the rest of your life. There are 2 types of dialysis:

•Peritoneal dialysis – This is a procedure that you do at home every day. It involves piping a special fluid into your belly. This fluid collects waste and excess salt and water from your blood. Then, the used fluid drains out of your belly (figure 2).

•Hemodialysis – This is a procedure in which a dialysis machine takes over the job of the kidneys. The machine pumps blood out of your body, filters it, and returns it to your body (figure 3).

If you choose hemodialysis, you will need to have it at least 3 times a week. You might have the option of having hemodialysis at a dialysis center (in a hospital or clinic) or at home.

You, your doctor, and your family will need to work together to find the treatment that's right for you. It will depend partly on your condition, overall health, and home situation.

Some people choose not to have a kidney transplant or dialysis. Without either of these treatments, end-stage kidney disease eventually leads to death. This usually happens quickly, within days to weeks. But in some cases, it can take longer. If you choose not to have a kidney transplant or dialysis, you can still get care to help make you more comfortable.

Is there anything else I can do? — The only way to treat end-stage kidney disease is with a kidney transplant or dialysis. If you are waiting to get a transplant or start dialysis, there are other things that you can do to help protect your kidneys. These things can also help if you have kidney disease that is not yet end-stage.

You should:

●See your nephrologist regularly.

●Follow all of your doctor's instructions about medicines. This includes taking all of your prescribed medicines every day, and avoiding medicines that can harm your kidneys.

●Get treatment for any health problems that affect your kidneys. For example, if you have diabetes, it's important to keep your blood sugar in a healthy range. If you have high blood pressure, medicines and lifestyle changes can help with this.

●Work with your doctor, nurse, or dietitian to make changes to your diet. The best diet for you will depend on your situation and whether you are getting dialysis.

●Get the vaccines that your doctor recommends. People with kidney disease are at a higher risk for certain infections, which can be dangerous. Vaccines can help prevent some infections.

●Avoid smoking.

●Try to get regular physical activity. Even gentle forms of exercise, like walking, are good for your health.

When should I call the doctor? — Call your doctor or nurse for advice if you have end-stage kidney disease and you:

●Have signs of infection, such as a fever of 100.4°F (38°C) or higher, chills, or pain when urinating

●Have very bad belly pain

●Have trouble breathing

●Are urinating less than normal or cannot urinate

●Have new or worsening symptoms, like:

•Feeling very tired and have no energy

•Not being hungry or losing weight without trying

•Nausea or vomiting

•Being unable to sleep

●Cannot get to your medical appointments

More on this topic

Patient education: Choosing between dialysis and kidney transplant (The Basics)
Patient education: Kidney transplant (The Basics)
Patient education: Planning for a kidney transplant (The Basics)
Patient education: Peritoneal dialysis (The Basics)
Patient education: Hemodialysis (The Basics)
Patient education: Preparing for hemodialysis (The Basics)
Patient education: Dialysis and diet (The Basics)
Patient education: Chronic kidney disease (The Basics)
Patient education: Acute kidney injury (The Basics)

Patient education: Dialysis or kidney transplantation — which is right for me? (Beyond the Basics)
Patient education: Peritoneal dialysis (Beyond the Basics)
Patient education: Hemodialysis (Beyond the Basics)
Patient education: Chronic kidney disease (Beyond the Basics)