Understanding End-Stage Kidney Disease

The last stage of chronic kidney disease when the kidneys fail

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End-stage kidney disease is the final stage of chronic kidney disease. At this last stage, the kidneys are unable to work on their own, which means that a person either needs dialysis or a kidney transplant to stay alive. While a transplant is an ideal choice as it offers a cure, not everyone is a candidate for one.

Even so, it's critical to note that most people with chronic kidney disease do not end up needing dialysis.

This is because, with early care, a person can usually slow down the disease.

Definition of Chronic Kidney Disease

Your kidneys filter waste and water out of the bloodstream. When your kidney function declines, waste accumulates in the body, and this waste buildup can eventually lead to symptoms like severe nausea and vomiting, loss of appetite, and feeling sick and weak overall.

A loss of normal kidney function may occur suddenly (called acute kidney disease) or over a period of three or more months (called chronic kidney disease). Acute kidney disease has the potential to reverse itself. But in chronic kidney disease, kidney function gradually worsens with time.

There are five stages of chronic kidney disease, with the fifth stage representing end-stage kidney disease. In other words, without a lifesaving measure like dialysis or a kidney transplant, a person would die within a week or so.

It's important to note that a person's kidney function tends to slowly get worse, although the rate at which kidney function declines and transitions from one stage to the next depends on many factors (for example, the underlying health condition that caused the kidney disease in the first place).

Causes 

There are many different causes of chronic kidney disease; the two most common ones are diabetes and high blood pressure.

Other causes include:

  • Lupus
  • Nephrotic syndrome
  • Polycystic kidney disease
  • Repeated urinary tract infections
  • Prolonged blockage of the urinary tract (for example, a tumor or an enlarged prostate gland in men)

It's important for a doctor to diagnose the "why" behind your kidney disease because he may be able to slow your disease down. For example, if high blood pressure is the culprit, then your doctor may be more aggressive with monitoring your blood pressure and keeping it within a normal range. 

Diagnosis 

There are a number of tests that a doctor may perform to properly diagnosis your chronic kidney disease, and some of these tests (for example, blood tests) will be repeated many times, even as you progress to the final stage.

Examples of tests that your doctor will perform to diagnosis and monitor your kidney function include:

  • Blood tests that measure your kidney function (for example, creatinine level) and electrolyte levels (for example, potassium level)
  • Urine tests
  • Ultrasound of your kidney
  • Biopsy of your kidney (a procedure in which a small tissue sample is taken of your kidney and examined under a microscope)
  • CT scan of your kidneys

Your doctor will also want to determine your glomerular filtration rate (GFR).

This number allows your doctor to best understand your kidney function and how to stage it. The GFR is easily calculated using your blood creatinine level, age, gender, and race.

While some of these tests are initially ordered by an internist or family medicine doctor, a person with chronic kidney disease is eventually referred to a kidney specialist called a nephrologist, especially as he progresses to later stages. 

A nephrologist can follow your kidney function carefully and discuss a treatment plan with you if your kidneys fail. He can also monitor any complications that arise as a result of your kidney diseases like anemia or bone disease.

Symptoms 

Just as the progression of chronic kidney disease is variable, so are the symptoms associated with it. In addition, the timing at which a person begins to experience symptoms of his or her kidney disease is not cut and dry. In fact, many people feel relatively OK until their disease is advanced.

Some of the symptoms a person may experience in chronic kidney disease, especially as it advances towards the final stage, include:

Loss of Energy 

The first thing you might notice is feeling more sleepy or tired than usual. Your sleeping patterns might change. You might sleep more during the day or have difficulty sleeping at night. 

Mental Changes

You might notice mild confusion or problems concentrating early on that might progress to disorientation, anxiety, irritability, or even delirium. When a person develops severe waste buildup from kidney failure, seizures and coma may occur. 

Abnormal Sensations

Restless legs, burning feet, or other sensory problems may develop as a result of a significant waste buildup in the body. In fact, when this happens, it can be a sign that dialysis is urgently needed.

Muscle Changes

As minerals build up in the blood, you might notice muscle twitching or cramps, especially at night. 

Skin Changes

The build-up of a chemical called urea in the blood may cause your skin to itch, and you might even develop a fine white powder on your skin. Itching can usually be controlled with topical creams or antihistamines, such as Benadryl (diphenhydramine).

Appetite and Weight Changes

Your appetite will decrease, and you might lose weight. Alternatively, you might gain weight as your body retains extra fluid.

If you are not producing much urine but still drinking fluids, you might notice that your feet, legs, and ankles swell, which is called edema. 

Malnutrition in chronic kidney disease is a major problem, which is why people will often follow a special diet to optimize their nutritional status.

Changes in Urination

You might pass little or no urine at all. If this is the case for you, limiting the amount of fluid you drink might improve your comfort level by decreasing the amount of excess fluid in your body.

Others may experience changes in their pattern of urination like urinating more, losing control of their urine (called incontinence), or developing more urinary tract infections.  

Sexual Dysfunction

Women often develop menstrual and fertility problems in chronic kidney disease whereas men develop erectile dysfunction. In addition, most women who reach end-stage kidney disease stop having periods.

Breathing Changes

The build-up of acids in the blood might cause changes in breathing, such as breathing faster and more shallow, but these changes are generally not uncomfortable. However, fluid can build up in the lungs and chest wall causing shortness of breath and chest pain. 

Other Changes

There are other health issues associated with chronic kidney disease like a low blood count, low platelets (which help clot your blood), bone problems, malnutrition, fluid shifts, and electrolyte abnormalities. 

Treatment

Treatment of your chronic kidney disease depends on the functioning of your individual kidneys. For instance, a person in a lower stage of chronic kidney disease may be able to take a diuretic to urinate out excess fluid. On the other hand, a person with end-stage kidney disease who makes no urine needs dialysis to remove excess fluid from the body. 

Your doctor will also treat any complications related to your kidney disease. For example, you may need medication for anemia or a drug to prevent bone density loss. 

A Word From Verywell

If you have chronic kidney disease, you may experience anxiety thinking about the future. Remain resilient and continue to work closely with your doctor. Careful monitoring and early detection of kidney disease are paramount in protecting your kidneys. 

If you have end-stage kidney disease and are on dialysis or very close to starting dialysis, please be sure to discuss all your questions, worries, expectations, and goals of care with your doctor.

Sources:

John Hopkins Medicine Health Library. End Stage Renal Disease.

National Institute of Diabetes and Digestive and Kidney Diseases. (2017). What is Chronic Kidney Disease?

National Kidney Foundation. (2017). About Chronic Kidney Disease.

Rosenberg M. Overview of the management of chronic kidney disease in adults. In: UpToDate, Curhan GC (Ed), UpToDate, Waltham, MA. 

Stevens LA, Viswanathan G, Weiner DE. Chronic kidney disease and end-stage renal disease in the elderly population: current prevalence, future projections, and clinical significance. Adv Chronic Kidney Dis. 2010 Jul;17(4):293-301.

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