End-stage renal disease represents the final phase of chronic kidney disease, when the kidneys can no longer support life on their own. More than 500,000 people in the United States live with this condition, facing daily challenges that require dialysis or transplantation to stay alive.

What Is End-Stage Renal Disease?

End-stage renal disease, also called end-stage kidney disease or kidney failure, occurs when chronic kidney disease reaches its most advanced state. At this point, your kidneys have lost nearly all their ability to function properly. The medical definition involves a glomerular filtration rate (GFR) of less than 15 mL per minute per 1.73 square meters, which means the kidneys are filtering blood at less than 15% of their normal capacity.^[2]

Your kidneys are remarkable organs that perform several life-sustaining jobs. They filter waste products and excess fluids from your blood, then remove these substances through urine. When kidneys fail, dangerous levels of fluid, electrolytes (minerals like sodium and potassium that help your body function), and waste products accumulate in your body. Without treatment, this buildup becomes life-threatening.^[1]

The progression from chronic kidney disease to end-stage renal disease typically happens over many years. Kidney disease is classified into five stages based on how well the kidneys are working. End-stage renal disease is stage five, the final and most severe stage. By this point, the kidneys have suffered permanent damage that cannot be reversed, and patients need either dialysis or a kidney transplant to survive.^[2]

How Common Is End-Stage Renal Disease?

End-stage renal disease affects a substantial number of people in the United States. More than 500,000 individuals currently live with this condition, making it a significant public health concern. The disease places enormous strain not just on patients and their families, but also on the healthcare system as a whole.^[2]

The numbers have grown dramatically over recent decades. Between 1980 and 2000, the incidence of end-stage renal disease increased more than threefold. This sharp rise occurred primarily because of increasing rates of diabetes, high blood pressure, and related conditions in the population. Although the rate of new cases has leveled off since 2000, the total number of people living with end-stage renal disease continues to climb steadily. This is largely because patients are surviving longer with modern treatments.^[9]

The financial burden is staggering. End-stage renal disease accounts for approximately 10% of all Medicare fee-for-service spending, despite affecting a much smaller percentage of the population. The condition also carries a high mortality rate. Fewer than half of patients who begin hemodialysis survive for five years, underscoring the serious nature of this disease.^[9]

What Causes End-Stage Renal Disease?

End-stage renal disease results from the progressive loss of kidney function over time. The condition most commonly develops as the final outcome of chronic kidney disease that has gradually worsened. Several underlying conditions can damage the kidneys to this extent, with diabetes and high blood pressure being the leading culprits.^[2]

Diabetes mellitus, whether type 1 or type 2, is the single most common cause of end-stage renal disease. When blood sugar levels remain elevated over long periods, the excess glucose damages the tiny blood vessels in the kidneys that perform the filtering work. This damage accumulates over years and eventually leads to kidney failure. Poor control of blood sugar significantly increases the risk of reaching end-stage disease.^[8]

High blood pressure, or hypertension, is the second leading cause. The kidneys contain thousands of small blood vessels, and persistently elevated blood pressure damages these delicate structures. Ironically, kidney disease itself can also cause high blood pressure, creating a vicious cycle where each condition worsens the other.^[2]

Beyond diabetes and hypertension, several other conditions can lead to end-stage renal disease. Glomerular diseases, which affect the kidney’s filtering units, can progressively destroy kidney function. Atherosclerosis, the buildup of fatty deposits in blood vessels, can reduce blood flow to the kidneys and cause damage. Autoimmune diseases like systemic lupus erythematosus attack the kidneys as part of their broader assault on the body’s tissues.^[2]

Genetic disorders also play a role in some cases. Polycystic kidney disease, an inherited condition where fluid-filled cysts grow in the kidneys, gradually destroys normal kidney tissue. Additionally, exposure to certain toxic substances can damage the kidneys. These include some antibiotics, chemotherapy drugs, contrast dyes used in medical imaging, and even some over-the-counter pain relievers when used excessively or inappropriately.^[8]

Who Is at Higher Risk?

Certain groups of people face elevated risk of developing end-stage renal disease. Understanding these risk factors is crucial because early identification allows for preventive measures and closer monitoring. Approximately one in three adults with diabetes and one in five adults with high blood pressure may develop chronic kidney disease, which can progress to end-stage disease.^[16]

Having diabetes or high blood pressure represents the most significant risk factors. These conditions cause much of the kidney damage seen in end-stage renal disease patients. People with heart disease also face increased risk, as the cardiovascular system and kidneys are closely linked. Damage to one often affects the other.^[8]

Family history matters considerably. If you have close relatives who developed kidney failure, your own risk increases. Certain genetic conditions that run in families, like polycystic kidney disease, directly cause progressive kidney damage. Even without specific genetic disorders, a family tendency toward diabetes, high blood pressure, or kidney disease can elevate your risk.^[8]

Race and ethnicity play documented roles in kidney disease risk. Some populations experience higher rates of end-stage renal disease, though the reasons involve complex interactions between genetics, social factors, and access to healthcare. Age is another factor, as kidney function naturally declines somewhat as we grow older, though normal aging alone does not cause kidney failure.^[17]

Lifestyle behaviors can increase risk as well. Smoking damages blood vessels throughout the body, including those in the kidneys. Obesity strains the kidneys and increases the likelihood of developing diabetes and high blood pressure. Excessive use of certain medications, particularly nonsteroidal anti-inflammatory drugs like ibuprofen, can harm kidney function over time.^[18]

What Are the Symptoms?

The symptoms of end-stage renal disease develop gradually and may not appear until kidney function has severely declined. Early in chronic kidney disease, you might have no signs or symptoms at all. This silent progression makes regular medical checkups and kidney function testing important for people at risk.^[1]

As chronic kidney disease advances to end-stage renal disease, various symptoms emerge. Nausea and vomiting become common, often accompanied by loss of appetite. These digestive symptoms occur because waste products accumulating in the blood affect the stomach and intestines. Many patients experience persistent fatigue and weakness that interferes with daily activities. This exhaustion results partly from anemia, a condition where the blood doesn’t carry enough oxygen because damaged kidneys can’t produce sufficient amounts of a hormone that stimulates red blood cell production.^[1]

Changes in urination patterns often occur. Some people urinate much more or much less than normal. The urine may appear foamy due to protein leaking into it, or it may contain blood. Swelling of the feet and ankles is common because the kidneys can’t remove excess fluid from the body. This fluid can also build up around the lining of the heart, causing chest pain, or in the lungs, leading to shortness of breath.^[1]

Patients may notice changes in mental function. Difficulty concentrating, decreased alertness, or confusion can develop as waste products affect brain function. Sleep problems are frequent, and some people develop persistent hiccups or severe itching. Easy bruising or bleeding may occur because kidney failure affects blood clotting. Some patients experience muscle cramps, particularly in the legs.^[1]

Weight loss can happen even without trying, often because of poor appetite and nausea. Conversely, some people gain weight from fluid retention. A general feeling of being unwell, called malaise, pervades daily life. Headaches may become more frequent. These symptoms collectively indicate that the body’s internal environment has become dangerously imbalanced.^[1]

How Can End-Stage Renal Disease Be Prevented?

While you cannot reverse kidney damage that has already occurred, you can take important steps to slow the progression of chronic kidney disease and potentially prevent it from reaching end-stage renal disease. Prevention strategies focus on managing the underlying conditions that damage kidneys and adopting healthy lifestyle behaviors.^[17]

If you have diabetes, controlling your blood sugar is paramount. Keeping blood sugar levels within your target range as much as possible protects your kidneys from further damage. This involves careful attention to diet, regular physical activity, taking medications as prescribed, and monitoring your blood sugar regularly. Similarly, if you have high blood pressure, keeping it below 140/90 mm Hg (or whatever target your doctor sets) is crucial. High blood pressure directly damages kidney blood vessels, so controlling it helps preserve kidney function.^[16]

Adopting a healthy diet benefits your kidneys in multiple ways. Choose fresh fruits and vegetables, whole grains, and low-fat or fat-free dairy products. Limit your salt intake to less than 2,300 milligrams of sodium daily, as excess salt raises blood pressure and forces kidneys to work harder. Reduce added sugars to less than 10% of your daily calories. Cook at home using herbs and spices for flavor instead of salt, and choose foods that naturally contain little sodium.^[17]

Regular physical activity helps maintain healthy blood pressure and blood sugar levels while strengthening your overall health. Aim for regular exercise appropriate to your fitness level. If you smoke, quitting is one of the best things you can do for your kidneys. Smoking damages blood vessels and accelerates kidney disease progression. Limit alcohol consumption, as excessive drinking can increase blood pressure.^[16]

Be cautious with medications. Avoid excessive use of over-the-counter pain relievers, especially nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen, as these can damage kidneys. Always check with your doctor or pharmacist before taking any new medications, supplements, or herbal products. Some can interact with your prescribed medications or harm your kidneys.^[19]

Regular medical care is essential. See your healthcare provider as recommended to monitor your kidney function through blood and urine tests. Early detection of kidney problems allows for earlier intervention. Stay up to date with vaccinations, including annual flu shots and pneumococcal vaccination, as kidney disease makes you more vulnerable to infections.^[16]

How Does End-Stage Renal Disease Affect the Body?

Understanding what happens inside the body when kidneys fail helps explain why end-stage renal disease causes such widespread symptoms. The kidneys perform several critical jobs, and when they fail, multiple body systems suffer the consequences. Normal kidneys filter approximately 120 to 150 quarts of blood daily, removing waste products and excess water to form one to two quarts of urine. In end-stage renal disease, this filtering capacity drops below 15% of normal.^[7]

When kidneys can’t filter waste properly, toxic substances accumulate in the blood. Two key waste products are creatinine and urea. Creatinine comes from normal muscle breakdown, while urea results from protein metabolism. High levels of these substances in the blood indicate kidney failure. These and other accumulated wastes cause many of the symptoms patients experience, including nausea, fatigue, and changes in mental function.^[7]

The body’s fluid balance becomes severely disrupted. Healthy kidneys adjust how much water they remove based on your body’s needs. Failed kidneys lose this ability, leading to fluid overload. Excess fluid accumulates in tissues, causing swelling in the legs, ankles, and sometimes the face and hands. Fluid can back up into the lungs, making breathing difficult, or around the heart, causing chest pain. Conversely, some patients with kidney failure urinate excessively, leading to dehydration.^[1]

Electrolyte imbalances create serious problems. Kidneys normally regulate levels of sodium, potassium, calcium, and phosphorus in the blood. When they fail, potassium can rise to dangerous levels that affect heart rhythm and can potentially cause sudden cardiac arrest. Calcium and phosphorus balance becomes disturbed, weakening bones and causing deposits of minerals in blood vessels and other soft tissues. The blood also becomes more acidic because kidneys can’t remove acids produced by normal metabolism.^[2]

Hormone production suffers when kidneys fail. Healthy kidneys produce erythropoietin, a hormone that signals bone marrow to make red blood cells. Without adequate erythropoietin, patients develop anemia, explaining the fatigue and weakness they experience. Kidneys also help regulate blood pressure through the renin-angiotensin system. Kidney failure disrupts this system, often causing difficult-to-control hypertension that further damages the cardiovascular system.^[2]

The cardiovascular system faces multiple threats. Kidney disease increases the risk of heart disease and stroke. The accumulated toxins, fluid overload, high blood pressure, and electrolyte imbalances all strain the heart. Patients with end-stage renal disease have significantly elevated risks of heart attacks and heart failure. In fact, cardiovascular disease is the leading cause of death in people with kidney failure.^[2]

The immune system weakens, making patients more susceptible to infections. Nutritional status often deteriorates because of poor appetite, nausea, and dietary restrictions. Many patients develop protein-energy wasting, a form of malnutrition that causes muscle loss and weakness. Bone health declines due to mineral imbalances and vitamin D deficiency. Nerve function may be affected, causing numbness, tingling, or pain in the extremities, a condition called uremic neuropathy.^[2]

The skin often shows signs of kidney failure. Many patients experience persistent, intense itching that can be difficult to relieve. Skin may become dry and discolored. Easy bruising and bleeding occur because kidney failure affects blood clotting factors. The buildup of waste products can even cause a metallic taste in the mouth and bad breath, further contributing to poor appetite and reduced quality of life.^[1]