ESRD

Alternative names

Renal failure - end stage; Kidney failure - end stage; End-stage kidney disease

Definition

End-stage kidney disease is a complete or near complete failure of the kidneys to function to excrete wastes, concentrate urine, and regulate electrolytes. Also called End-stage renal disease (ESRD).

Causes, incidence, and risk factors

End-stage kidney disease occurs when the kidneys are no longer able to function at a level that is necessary for day to day life. It usually occurs as chronic renal failure progresses to the point where kidney function is less than 10% of baseline. At this point, the kidney function is so low that without dialysis or kidney transplantation, complications are multiple and severe, and death will occur from accumulation of fluids and waste products in the body.

In the United States, nearly 300,000 people are on long-term dialysis and more than 20,000 have a functioning transplanted kidney. The most common cause of ESRD in the US is diabetes. ESRD almost always follows chronic kidney failure, which may exist for 10 to 20 years or more before progression to ESRD.

Symptoms

• Unintentional weight loss
  
• Nausea or vomiting
  
• General ill feeling
  
• Fatigue
  
• Headache
  
• Frequent hiccups
  
• Generalized itching
  
• Greatly decreased urine output
  
• No urine output
  
• Easy bruising or bleeding
  
• May have blood in the vomit or stools
  
• Decreased alertness
  o drowsiness, somnolence, lethargy
  o confusion, delirium
  o coma
  
• Muscle twitching or cramps
  
• Seizures
  
• Increased skin pigmentation
  
• Skin may appear yellow or brown
  
• Nail abnormalities
  
• Decreased sensation in the hands, feet, or other areas
  

Signs and tests
The patient usually has a long history of chronic kidney failure, which has progressed. The person may have required dialysis to control chronic renal failure. The urine volume may decrease or urine production may stop totally. Signs of complications commonly are present.