End-Stage Renal Disease - Complications, Diagnosis, and Treatment Strategies

What Is End-Stage Renal Disease (ESRD)?

The end-stage renal disease is a medical condition also known as end-stage kidney disease or kidney failure occurring from an untreated kidney disease that has reached an advanced stage where the kidneys do not work properly to meet the needs of the body. Persons with the end-stage renal disease need dialysis or kidney transplant for survival.

Kidney diseases are progressive, and the progression of the disease depends on how the disease is being treated. ESRD is regarded as the fifth stage of chronic kidney disease. The staging is done based on the glomerular filtration rate. If the glomerular filtration rate drops below fifteen milliliters per minute, it is known to have an established end-stage renal disease (ESRD).

What Causes an End-Stage Renal Disease?

Kidney diseases occur as a result of underlying medical conditions or diseases. The diseases that lead to kidney disease include:

• High blood pressure.

• Diabetes (type I or type II).

• Chronic urinary tract obstructions like kidney stones, prostate enlargement, or certain types of cancers.

• Congenital abnormalities (birth defects).

• Polycystic kidney disease.

• Interstitial nephritis is where there is inflammation of the tubules of the kidney and surrounding tissues.

• Pyelonephritis condition when there are recurrent kidney infections that occur.

What Are the Symptoms of End-Stage Renal Disease?

Individuals in the early stages of kidney disease might not show any significant symptoms. As the disease progresses, the symptoms are shown up, and they include :

• Loss of appetite.

• Fatigue and weakness.

• Nausea.

• Vomiting.

• Changes in skin color.

• Dry skin and itching.

• Unexplained weight loss.

• Bone pain.

• Headaches.

• A general feeling of illness.

• Confusion and loss of concentration.

• High blood pressure.

• Edema (swelling, especially in hands and legs).

• Difficulty sleeping.

• Excessive thirst.

• Numbness of hands and legs.

• Bruises.

The symptoms associated with kidney disease can be similar to those of other renal illnesses. Therefore, you should consult your doctor if you notice any problems associated with the kidneys.

What Are the Possible Risk Factors for End-Stage Renal Disease?

Specific individuals have a high risk of developing ESRD. They are:

• People who have someone with kidney disease in the family.

• People with diabetes.

• Hypertension (high blood pressure).

Other risk factors include:

• Autoimmune diseases like systemic lupus erythematosus.

• Genetic conditions such as polycystic kidney disease.

• Some pain-relieving medications.

• Exposure to toxic drugs that might include certain antibiotics, chemotherapy, and contrast dyes.

How Do You Diagnose an End-Stage Renal Disease?

The doctor diagnoses ESRD using physical examination and tests to check your kidney function. These kidney function tests include:

1. Urine Analysis: This test helps check the protein and blood in your urine.

2. Serum Creatinine Testing: It helps your doctor check whether creatinine grows in your blood. Creatinine is a polluting product that your kidneys need to filter out.

3. Nitrogen Test: The nitrogen test checks how much nitrogen is in your blood.

4. Test for Glomerular Filtration Rate (GFR): This allows your doctor to estimate how well your kidneys filter waste.

How Do You Treat an End-Stage Renal Disease?

The end-stage kidney disease has two treatments available, dialysis and kidney transplantation.

In a few cases, medications and lifestyle changes can help with end-stage renal disease.

• Dialysis: This can be either hemodialysis or peritoneal dialysis.

  • Hemodialysis - In hemodialysis, the blood is removed from a vein and is run through filters to remove waste materials. The cleaned blood is then re-infused into the body. This process is usually done in three to four-hour sessions at a dialysis center three times a week.

  • Peritoneal Dialysis - In peritoneal dialysis, sterile fluid is infused into the abdomen. All the waste products gradually accumulate in the fluid, and it is later removed with the help of a catheter. This can be done at home and must be done four to five times a day, and this process is automated so that it can also be done while the individual is sleeping.

• Kidney Transplantation: The kidney transplant process involves the removal of the damaged kidney or kidneys and replacing them with a new healthy kidney obtained from a donor. This is best in severe cases to avoid frequent dialysis. However, even a kidney transplant is not a complete cure, but it helps to increase the life span. Anyone who receives a kidney transplant should take immunosuppressive drugs unless the kidney is received from their identical twin. These prevent the body from rejecting the newly placed kidney.

Other treatment options include drugs and lifestyle changes.

• Drugs: People with diabetes or high blood pressure should control their condition to help prevent ESRD. Both cases benefit from drug treatment using angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs).

  • Kerendia (Finerenone) is prescribed to reduce the risk of further GFR decline, end-stage renal disease, cardiovascular mortality, nonfatal myocardial infarction, and heart failure hospitalizations in adults with CKD associated with type 2 diabetes.

• Lifestyle Changes: Lifestyle changes help prevent the disease condition from worsening further and help achieve better treatment results. Some of the lifestyle changes recommended are :

  • Monitoring the weight is essential as there will be fluid retention.

  • Calorie intake should be increased, and protein intake should be decreased.

  • A diet low in sodium and potassium is needed with electrolytes.

  • Taking vitamin supplements prescribed by the doctor can help better the absorption of nutrients.

  • Limiting the foods which contain high sodium and potassium content. Some of the foods to avoid include:

    • Tomatoes.

    • Bananas.

    • Spinach.

    • Oranges.

    • Fried foods.

    • Avocados.

    • Peanut butter.

What Can Be the Complications of End-Stage Kidney Disease?

Kidney damage, once it has occurred, cannot be reversed. Possible complications can affect almost every part of your body and can include:

• Fluid retention can lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema).

• Heart problems.

• Weak bones with increased risk of bone fractures.

• The sudden increase in potassium levels in your blood (hyperkalemia) affects your heart rate and may endanger life.

• Reduced immune response, making you at greater risk of infections.

• Anemia.

• Malnutrition.

• Pregnancy complications carry risks to the mother and the developing baby.

• Damage to your central nervous system can cause difficulty concentrating, personality changes, or fainting.

• Decreased sexual arousal, erectile dysfunction, or infertility.

• Pericarditis is a condition where there is an inflammation of the membrane that covers your heart (pericardium).

• Irreversible damage to your kidneys ultimately requires dialysis or a kidney transplant to survive.

How Can You Prevent End-Stage Kidney Disease?

You can prevent the progression of chronic kidney disease to end-stage kidney disease by making lifestyle changes, managing your diabetes and hypertension, being active, maintaining a healthy weight, and scheduling and attending regular checkups helps to prevent the progression of end-stage kidney disease.

Conclusion:

Technological development and medical innovations allow people with ESRD to live longer. ESRD can be dangerous, but you will probably live many years later with treatment. Without treatment, you can only live without your kidneys for a few months. If you suffer from other health problems, like heart problems or other medical conditions, you may face additional problems that could affect your lifespan. Sometimes it is not easy as you experience the effects of ESRD or lifestyle changes that come with dialysis. If this happens, seek professional help through counseling sessions or support from your family and friends. They can help you stay active in your daily life activities and ensure that you maintain a high standard of living.