End-Stage Renal Disease


What Is It?

End-stage renal disease is a condition in which the kidneys are no longer able to function normally. Usually this means that they are functioning at less than 10 percent of their normal capacity. When this occurs, dialysis or kidney transplant is needed.

In the United States, more than a third of people with end-stage renal disease have diabetes, and diabetic nephropathy (renal disease due to diabetes) is the leading cause of end-stage renal disease. Up to 40 percent of all people with type 1 (insulin-dependent or juvenile) diabetes eventually develop end-stage renal disease. Kidney disease also can develop in people with type 2 (non-insulin-dependent or adult-onset) diabetes. With either type, poor control of blood sugar increases the risk of end-stage renal disease.

Among other causes of end-stage renal disease, the most common are:

  • High blood pressure (hypertension)
  • Vascular disease (atherosclerosis)
  • Rheumatic diseases (such as lupus)
  • Genetic disorders, such as polycystic kidney disease
  • Exposure to toxic drugs, including certain antibiotics, chemotherapy, contrast dyes and pain relievers


Symptoms of end-stage renal disease include weight loss, nausea or vomiting, general malaise, fatigue, headache, hiccups, itching, decreased urination, easy bruising or bleeding, lethargy, difficulty breathing and seizures. Symptoms may be mild until kidney function has dropped to less than 15 percent of normal.

Usually kidney disease has been recognized for many years before end-stage renal disease occurs. A blood test will show high levels of creatinine and blood urea nitrogen, chemicals ordinarily removed by the kidneys. Dialysis generally is considered when a specific set of problems has developed, such as:

  • Pericarditis (inflammation of the lining of the heart)
  • Fluid overload or congestive heart failure (in which fluid backs up behind the heart into the lungs) that cannot be adequately improved with diuretics (medications that encourage elimination of fluid)
  • Severely elevated blood pressure that is not improved by antihypertensive medications
  • Confusion, decreased alertness or seizures
  • Bleeding related to kidney failure that cannot be improved through other means
  • Severe, unrelenting nausea and vomiting
  • Severe abnormalities in blood tests indicating that dialysis will soon be necessary, even if the problems mentioned above have not yet developed


Kidney disease is diagnosed by analyzing urine and measuring elevated levels of creatinine and urea nitrogen in the blood. Additional tests may be necessary to determine the exact reason that the kidneys have stopped working.

Expected Duration

End-stage renal disease is a lifelong condition unless a kidney transplant is performed.


If you have diabetes, controlling your blood sugar is an important way to reduce your chances of developing end-stage renal disease. Close monitoring and treatment of high blood pressure also can help prevent kidney disease. Many doctors prescribe medications called angiotensin-converting enzyme (ACE) inhibitors at the first signs of elevated blood pressure or protein in the urine (a sign of kidney injury). A low-protein diet (10 percent to 12 percent or less of total calories) also may slow or halt the progression of existing kidney disease, as will quitting smoking and lowering cholesterol levels.


The two treatments for end-stage renal disease are dialysis and kidney transplant. There are two types of dialysis:

  • Hemodialysis usually is performed at a dialysis center in three- to four-hour sessions three times a week. During the treatments blood is removed from a vein, run through filters to remove waste products, and then returned to the body.
  • Peritoneal dialysis may be performed at home, but takes longer and is required more frequently. During peritoneal dialysis, fluid is pumped into the abdomen and waste products accumulate in the fluid, which is later removed.

Kidney transplants have allowed patients with many forms of severe kidney disease to avoid or discontinue dialysis. However, a good genetic match is needed between the donor and the recipient, or the body will reject the new kidney. Most transplant candidates can expect to wait one to three years before they qualify for a donor kidney. New drugs that suppress the immune system help to prevent the body from rejecting the donated organ, but an organ recipient can expect to be on such medication for life.

When To Call A Professional

If you have diabetes, hypertension, or other disease that put you at risk for end-stage renal disease, you should have regular check-ups along with urine and blood tests of your kidney function. Call your doctor if you notice any decrease in urination or other symptoms of end-stage renal disease, especially if you have known kidney disease or its risk factors.


When kidney failure occurs, treatments offer hope for good recovery, and many dialysis and transplant patients lead near-normal lives. Advancing technology continues to brighten the prognosis for those with end-stage renal disease.

Johns Hopkins patient information

Last revised:

Diseases and Conditions Center

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.