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.

Causes

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

Symptoms

There may be no signs or symptoms early in chronic kidney disease. As chronic kidney disease progresses, 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

Prevention

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 such as:

Be active most days
Limit protein and eat a balanced diet of nutritious, low-sodium foods
Control blood pressure
Have cholesterol levels checked every year
Control blood sugar levels
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 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.

Treatment

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 the kidneys when they can't, including removing extra fluids and waste products from the 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 the 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 the blood. Hemodialysis may be done at a center (see below) or in the home. For more information about Hemodialysis, click here.

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.
In-center self-care hemodialysis is when the person and caregiver are trained by the dialysis care professionals to perform the 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.
In-center nocturnal hemodialysis is performed by dialysis professionals in a dialysis facility overnight for six to eight hours while the person sleeps.

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 will progress without either dialysis or a transplant, eventually leading to death. Supportive care might include the management of symptoms, comfort measures, 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, regardless of age. For more information, visit the Centers for Medicare and Medicaid.

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.