What are the other Names for this Condition? (Also known as/Synonyms)

• End-Stage Chronic Renal Failure
• End-Stage Renal Disease (ESRD)
• ESKD (End-Stage Kidney Disease)

What is End-Stage Kidney Disease? (Definition/Background Information)

• End-Stage Kidney Disease (ESKD) is a condition defined by near-complete or complete failure of the kidneys to excrete waste products and excess water from the body. Urine output is minimal or nil in individuals with End-Stage Kidney (or Renal) Disease
• Typically, the condition is a result of progressive worsening of chronic kidney disease (CKD); or, it is the most severe form of CKD
• An End-Stage Kidney Disease is characterized by a decrease in the glomerular filtration rate (GFR) of less than 15 mL/min/1.73 m2 (Normal GFR > 90 mL/min/1.73m2). GFR is an estimate of blood passing through the tiny filters (glomeruli) in the kidneys. The glomeruli filter-out waste from blood
• This condition is irreversible and dialysis may be indicated as glomerular filtration rate continues to get worse. A kidney transplant may help individuals with the condition, although the prognosis is generally guarded

Who gets End-Stage Kidney Disease? (Age and Sex Distribution)

• Individuals with chronic kidney disease are prone to End-Stage Kidney Disease; those above 65 years of age having a greater risk
• Males have a greater prevalence than females
• The disease is more prevalent in African-Americans and in native Americans, than Asians and Caucasians

What are the Risk Factors for End-Stage Kidney Disease? (Predisposing Factors)

The risk factors of End-Stage Kidney Disease include:

• Diabetes and hypertension are the most common risk factors
• Glomerular diseases also predispose one to End-Stage Kidney Disease
• Congenital diseases, like polycystic kidney disease, can progress to this kidney condition
• Autoimmune diseases, like systemic lupus erythematosus (SLE) and IgA nephropathy, can increase the risk
• Obesity also plays a role in the progression of this renal disease

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of End-Stage Kidney Disease? (Etiology)

• The most common cause of End-Stage Kidney Disease is diabetes, accounting for about one-third of the cases
• The second leading cause is high blood pressure (hypertension)

The other causes may be:

• Renal artery stenosis - narrowing of the blood vessels to the kidneys
• Glomerular diseases - malfunctioning of the tiny filters in the kidneys
• Tubulointerstitial diseases
• Vasculitides (inflammation of the vessels supplying the kidney), such as lupus nephritis, alongside autoimmune diseases that cause immunoglobulins to be deposited in the basement membrane, such as IgA nephropathy
• Kidney stones, strictures, and tumors, causing obstruction in the ureters, bladder, or prostate enlargement - these factors can lead to hydronephrosis of the kidneys

What are the Signs and Symptoms of End-Stage Kidney Disease?

The signs and symptoms of End-Stage Kidney Disease are of a general ill-being. These may include:

• Nausea, fatigue, and malaise, accompanied by weight loss
• Pruritus (generalized itching of skin) with dryness and changes in pigmentation
• Bone pain
• Generalized swelling, especially of the feet
• High blood pressure
• Headaches
• Menstrual abnormalities and loss of libido
• Change in mental status may also occur

How is End-Stage Kidney Disease Diagnosed?

A diagnosis of End-Stage Kidney Disease may involve the following:

• Physical examination which should include BP monitoring; an abdominal exam, to hear a bruit (indicative of renal artery stenosis)
• A thorough medical history including past medical, family, and drug history
• Urinalysis: Red blood cell casts indicate glomerular disease
• Basic metabolic profile, inclusive of renal function tests (blood urea nitrogen and creatinine, GFR) with electrolytes
• Imaging: Ultrasound scan of the kidneys
• Kidney biopsy (where possible) - the specimen is examined under a microscope by a pathologist, to arrive at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of End-Stage Kidney Disease?

The possible complications of End-Stage Kidney Disease may include:

• Due to the build-up of fluids, there can be damage to various organs; the most important organ to be affected is the heart
• The excess fluid causes an increase in blood pressure. There is an increase in the volume being received by the heart, which can cause failure of the heart to pump blood
• The lungs may become drowned with fluid - a condition called pulmonary edema
• There can be electrolyte derangements, which can cause altered mental status and seizures in the brain, arrhythmias in the heart, and possible death, if the condition is not treated
• Due to the accumulation of toxins and urea, a condition called uremia can develop. This is characterized by mental status changes, inflammation and irritation of the membrane covering the heart (pericarditis), and abnormal breathing
• The kidneys produce erythropoietin that helps make red blood cells. In End-Stage Kidney Disease, there is decreased production of red cells resulting in anemia that can manifest as pallor, fatigue, and lethargy

How is End-Stage Kidney Disease Treated?

The treatment measures of End-Stage Kidney Disease may include the following:

• Dialysis: It is an artificial means of performing the function of the kidneys, whereby blood is filtered through a semi-permeable membrane, and excess wastes and fluid are removed
• There are two types of dialysis - peritoneal dialysis and hemodialysis
  • Peritoneal dialysis utilizes the peritoneal membrane of the peritoneum as the semi-permeable membrane, and the process of dialysis takes place within the abdomen
  • Hemodialysis is the process of dialysis that takes place outside the body in an external filter, called dialyzer, which contains the semi-permeable membrane. There is counter-current flow of dialysate and blood, which flow in opposite directions on either side of the membrane, thus creating a sufficiently maximal concentration gradient for waste and fluids to be exchanged and removed
• Kidney transplant: A healthy kidney from either a live or deceased donor is used for transplant

How can End-Stage Kidney Disease be Prevented?

The prevention of End-Stage Kidney Disease is aimed at reducing the risk factors. These preventive measures include:

• There should be strict control of blood sugar in diabetes mellitus, with regular monitoring of blood sugars and compliance in taking treatment
• The blood pressure should be kept below 130/80 in diabetic patients. This is effectively achieved by angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers - drugs that are excellent for high blood pressure and diabetic-related kidney disease. They reduce the excretion of protein in urine
• Following healthy lifestyle habits and exercising to prevent obesity
• Statins are a group of drugs, which help keep the blood cholesterol and lipid levels under control
• Avoiding abuse of pain medications and illegal drugs

What is the Prognosis of End-Stage Kidney Disease? (Outcomes/Resolutions)

• With the advent of renal replacement therapy, the life of an individual with End-Stage Renal Disease can be prolonged, but the quality of life is severely affected
• High-intensity home-dialysis is associated with greater quality of life and better prognosis, as compared to other dialysis options
• Renal transplant increases the survival rate, but has risk of complications, due to surgery and possibility of rejection

Additional and Relevant Useful Information for End-Stage Kidney Disease:

• Kidney transplantation is a procedure to surgically remove a damaged or diseased kidney and replace it with a healthy kidney, from a compatible donor

The following article link will help you understand kidney transplantation surgical procedure:

http://www.dovemed.com/common-procedures/procedures-surgical/kidney-transplantation/