End-stage renal disease is a condition in which the kidneys no longer function normally. (Renal describes anything having to do with the kidneys.) Usually, in end-stage renal disease, the kidneys are functioning at less than 15% of their normal capacity. When this occurs, dialysis (a mechanical process that does the kidneys' work) or a kidney transplant usually is needed.

In the United States, more than a third of people with end-stage renal disease have diabetes. Renal disease caused by diabetes is called diabetic nephropathy. Diabetes is the leading cause of end-stage renal disease. Up to 10% 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 or autoimmune 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 remain mild or absent until kidney function drops to less than 20% of normal.

Usually, someone has kidney disease that progresses over many years before end-stage renal disease occurs. A blood test will show high levels of creatinine and blood urea nitrogen, chemicals usually removed by the kidneys. Dialysis is considered urgent when one or more of the following problems has developed, such as:

• Inflammation of the covering of the heart (pericarditis)
• Fluid overload or congestive heart failure, in which fluid backs up behind the heart into the lungs, that cannot be improved enough with medications that encourage elimination of fluid (diuretics)
• Dangerous elevations of blood components that can affect other organ function such as potassium, sodium and acids
• Confusion, decreased alertness or seizures
• Bleeding related to kidney failure that cannot be improved through other means
• Severe, unrelenting nausea and vomiting
• Dialysis may also be indicated if symptoms affect quality of life or nutritional status, especially in the presence of severe abnormalities in blood tests. This may occur even if the problems mentioned above have not yet developed.

Kidney disease is diagnosed by analyzing urine and measuring certain blood chemicals, such as creatinine and urea nitrogen. Additional tests may be necessary to determine the exact reason that the kidneys have stopped working.

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

If you have diabetes, control your blood sugar to reduce your chances of developing end-stage renal disease.

Close monitoring and aggressive treatment of high blood pressure also plays a key role in preventing kidney disease. Lowering blood pressure also prevents kidney disease from getting worse, regardless of why kidney disease developed. Many doctors prescribe medications called angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptors (ARBs) at the first signs of elevated blood pressure or protein in the urine (a sign of kidney injury). A low-protein diet (10% to 12% or less of total calories) also may slow 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 done at a dialysis center three times a week, in three- to four-hour sessions. During treatments, blood is removed from a vein, run through filters to remove waste products, and then returned to the body.



• Peritoneal dialysis is done at home, but takes longer and must be done daily. During peritoneal dialysis, sterile fluid is infused (by gravity) into the abdomen and waste products gradually accumulate in the fluid, which is drained several hours later. This process must be repeated four to five times a day, but can be automated to occur during sleep.

Kidney transplants have allowed people with many forms of severe kidney disease to avoid or discontinue dialysis treatments. However, a successful kidney transplant is not a cure, and drugs that suppress the immune system to prevent the body from rejecting the donated organ must be taken for life. In addition, a good genetic match between the donor and the recipient helps reduce the risk of rejection and contributes to the long-term success of the donated kidney. Most transplant candidates wait one to three years before they qualify for a kidney from an unrelated donor.

If you have diabetes, high blood pressure or other diseases that put you at risk of end-stage renal disease, you should have regular checkups along with urine and blood tests to measure your kidney function. When blood tests reveal a reduction in kidney function or protein in the urine your doctor should refer you to a kidney specialist (called a nephrologist). Call your doctor if you notice any decrease in urination or other symptoms of end-stage renal disease, especially if know you have kidney disease or its risk factors.

When kidney failure occurs, treatments offer hope for good recovery. Many people on dialysis and those who have received transplants lead near normal lives. Advancing technology continues to brighten the outlook for those with end-stage renal disease.

National Institute of Diabetes & Digestive & Kidney Disorders
Office of Communications and Public Liaison
Building 31, Room 9A04
31 Center Drive, MSC 2560
Bethesda, MD 20892-2560
Phone: 301-496-4000
Email: niddk_inquiries@nih.gov
http://www.niddk.nih.gov/

National Kidney Foundation
30 East 33rd St.
New York, NY 10016
Phone: 212-889-2210
Toll-Free: 1-800-622-9010
Fax: 212-689-9261
Email: info@kidney.org
http://www.kidney.org/