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End-Stage Renal Disease (ESRD)

End-stage renal disease, also called end-stage kidney disease or kidney failure, occurs when chronic kidney disease — the gradual loss of kidney function — reaches an advanced state. In end-stage renal disease,  the kidneys no longer work as they should to meet the body's needs.



Kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years. For some people, kidney damage can continue to progress even after resolving the underlying condition.

Diseases and conditions that can lead to kidney disease include:​

  • Type 1 or type 2 diabetes 

  • High blood pressure 

  • Polycystic kidney disease or other inherited kidney disease 

  • Inflammation of the kidney's filtering units, tubules, and surrounding structures

  • Prolonged obstruction of the urinary tract

  • Recurrent kidney infection 

  • Vesicoureteral reflux, a condition that  causes urine to back up into the kidneys


There may be no signs or symptoms early in chronic kidney disease. As chronic kidney disease progresses to end-stage renal disease, symptoms might include:

  • Nausea or vomiting

  • Loss of appetite

  • Fatigue and weakness

  • Changes in urination

  • Chest pain, if fluid builds up around the lining of the heart

  • Shortness of breath, if fluid builds up in the lungs

  • Swelling of feet and ankles

  • High blood pressure (hypertension) that is difficult to control

  • Headaches

  • Difficulty sleeping


Kidney damage, once it occurs, cannot be reversed. If someone has kidney disease, they may be able to slow its progress by making healthy lifestyle choices:

  • Be active most days

  • Limit protein and eat a balanced diet of nutritious, low-sodium foods.

  • Control your blood pressure.

  • Have your cholesterol levels checked every year.

  • Control your blood sugar level.

  • Don't smoke or use tobacco products

  • Get regular checkups


Stages of Kidney Disease

There are five stages of kidney disease. Stage 1 is healthy kidney function, and Stage 5 is complete kidney failure. A healthcare provider performs a blood test to determine the stage to check the glomerular filtration rate (GFR). The GFR measures how much blood the kidneys filter each minute, recorded as milliliters per minute (mL/min). As the GFR declines, so does kidney function. End-stage renal disease is when the kidneys no longer work at the level necessary to keep a person alive. 


Click here to see a diagram of the stages. 


End-stage renal disease treatments include Kidney Transplants, Dialysis, and Palliative (Supportive) care.

  • Kidney Transplants: A kidney transplant is a surgical procedure to place a healthy kidney from a live or deceased donor into a person whose kidneys no longer function properly. A kidney transplant is often the treatment of choice for end-stage renal disease, compared with a lifetime on dialysis.

  • Dialysis: Dialysis does the work of your kidneys when they can't, including removing extra fluids and waste products from your blood, restoring electrolyte levels, and helping control your blood pressure.  

         Types of Dialysis include:

Peritoneal dialysis (PD): During peritoneal dialysis, blood vessels in your abdominal lining (peritoneum) fill in for your kidneys with the help of a fluid that washes in and out of the peritoneal space. Peritoneal dialysis is completed in your home. For more information about Peritoneal dialysis, click here.

Hemodialysis (HHD): During hemodialysis, a machine does some of the work of the kidneys by filtering harmful wastes, salts, and fluid from your blood. Hemodialysis may be done at a center or in your home. For more information about Hemodialysis, click here.

Types of In-Center Hemodialysis

  1. ​Traditional in-center hemodialysis is performed in a dialysis center by trained healthcare professionals three days a week, usually for about four hours per treatment. 

  2. In-center self-care hemodialysis, you—and your care partner if you choose to have one—will be trained by the dialysis care professionals to perform part or all of your dialysis treatment. Like traditional in-center hemodialysis, self-care hemodialysis is performed in a dialysis clinic three times each week for about four hours per treatment. 

  3. In-center nocturnal hemodialysis is performed by dialysis professionals in a dialysis facility overnight for six to eight hours while you sleep.

  • Palliative care:   Palliative care can be combined with a kidney transplant or dialysis or used when someone chooses not to have a kidney transplant or dialysis in order to help manage symptoms and feel better. Kidney failure progresses without either dialysis or a transplant, eventually leading to death. Death can occur quickly or take months or years. Supportive care might include the management of symptoms, measures to keep you comfortable, and end-of-life planning.


Paying for Dialysis

Medicare, Medicaid, and private insurance plans cover most of the healthcare costs of dialysis. Most people who are starting dialysis can get Medicare insurance, usually after a waiting period of three months. Health insurance helps pay for dialysis, there may still be some costs, such as premiums, deductibles, co-insurance, and copayments.  For more information, visit the Centers for Medicare and Medicaid.

Beneficiaries may become entitled to Medicare based on ESRD. Benefits based on ESRD are for all covered services, not only those related to the kidney failure condition. Medicare Part B pays 80% of the costs of dialysis. The beneficiary is responsible for paying for the other 20% of the costs or finding a supplemental plan (like a Medigap policy) to cover this amount.


Tips on What to Look for in a Dialysis Center

Even if HHD or PD is performed at home, a visit to a dialysis center once a month to check in with the dialysis care team will be necessary.

Check Medicare’s Dialysis Facility Website. You can also compare dialysis facilities using Medicare’s Dialysis Facility Compare website . This tool can help provide a “snapshot” of a facility and make useful comparisons. However, this website only uses health statistics to make comparisons between clinics. It does not consider things like patient satisfaction, cleanliness, staff competence, and other factors that may be important to you. Click here to learn more about the new Dialysis Facility Compare (DFC) Star Program. 


Schedule a visit. Call and make an appointment to visit the clinic. Send a friend or family member or call the clinic to learn more. Visiting beforehand will familiarize you with how to get there, the staff and facility, and how comfortable you feel inside. Is the facility adequately staffed with experienced, trained professionals? Did they make you feel welcome? Were they helpful? Were they able to answer questions?


Consider cleanliness. How would you rate the overall cleanliness of the facility?


Consider the location and distance from your home. Is the facility convenient for you to get to? How far will you travel each week to get to your treatments? Is it necessary to live close to the facility?


Think about your mode of transportation. Do you have reliable transportation to get to your treatments?  If not, ask the center about their preferred providers.


Is the nephrologist part of the team? Do you want to continue being treated by your current nephrologist? Be aware that some nephrologists may only work with a specific dialysis clinic. How important is this to you?


Ask about available schedules. Does the clinic offer a dialysis schedule that fits your needs? Are there openings for new patients on those shifts?


Ask about home dialysis. Does the facility offer these options if you are interested in a home or nocturnal dialysis? You may not be interested in home dialysis now but may want the chance later.

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