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End-Stage Renal Failure - Causes, Symptoms, and Treatment

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End-stage renal failure is also known as end-stage kidney disease. This condition occurs when the kidneys cannot function properly. The topic further explains the state.

Medically reviewed by

Dr. Manzoor Ahmad Parry

Published At December 12, 2022
Reviewed AtDecember 12, 2022

Introduction:

The kidneys are the excretory systems of the human body, and they filter waste and excess water from the blood. Chronic kidney diseases hamper kidney function. End-stage renal failure, also known as end-stage kidney disease (ESRD), is the last chronic kidney disease stage. In people with end-stage kidney failure, the kidneys function below ten percent of their standard capability, meaning they are not working as they should. Kidney diseases are progressive. The duration of each stage depends on how the kidney disease is treated. Kidney disease takes around ten to twenty years to reach the end stage. ESRD is the fifth stage of chronic kidney disease progression.

What Causes End-Stage Renal Failure?

Most kidney diseases attack the tiny filtering units of the kidneys- nephrons. This leads to poor blood filtering, eventually leading to end-stage renal disease.

The most common causes of end-stage renal failure are -

  • Diabetes - In diabetes or high blood sugar, the body cannot break down sugar properly, so blood sugar levels are always high. This increased blood sugar level damages the nephrons causing end-stage kidney failure.

  • Hypertension - High blood pressure puts extra pressure on the kidneys' tiny blood vessels, damaging them. This damage prevents the kidney blood vessels from performing the filtration of blood.

  • Kidney Stones.

  • Enlarged Prostate.

  • Cancer.

  • Glomerulonephritis - It is the inflammation of the tiny filters of the kidney.

  • Vesicoureteral Reflux - The urine flows back into the kidneys in this condition.

  • Congenital Abnormalities - Abnormalities present since birth.

What Are the Symptoms of End-Stage Renal Failure?

End-stage renal failure presents a wide range of symptoms. They are:

  • Decrease in the frequency of urination.

  • Not able to urinate.

  • Fatigue.

  • Malaise.

  • Headaches.

  • Unexplained weight loss.

  • Loss of appetite.

  • Nausea and vomiting.

  • Dry and itchy skin.

  • Change in the color of skin.

  • Bone pain.

  • Confusion.

  • Difficulty in concentrating.

  • Easily bruised.

  • Epistaxis - Nose bleeding.

  • Numbness of hands and feet.

  • Foul-smelling breath.

  • Excessive thirst.

  • Hiccups.

  • Absence of menstrual cycles.

  • Obstructive sleep apnea.

  • Restless leg syndrome.

  • Low libido/ impotence.

  • Edema - Swelling in the hands and feet.

How Is End-Stage Renal Failure Diagnosed?

  • A thorough physical examination.

  • Urinalysis - This urine test detects protein and blood in the urine. The presence of protein and blood in the urine suggests that the kidneys are not properly filtering waste.

  • Serum Creatinine Test - Creatinine is the waste product of normal wear and tear of the muscles. This test helps the doctor determine how well the kidneys are functioning.

  • Blood Urea Nitrogen Test - This test checks the amount of nitrogen in the blood.

  • Estimated Glomerular Filtration Rate (GFR) - This test determines how well the kidneys filter waste. Glomeruli are tiny filters in the kidneys. This test tells how much blood passes through these filters per minute.

How Is End-Stage Renal Failure Treated?

The treatment modalities of end-stage renal failure are dialysis and kidney transplant.

  • Dialysis - Dialysis is when waste products and extra fluid are removed from the blood when the kidneys stop working. The blood is diverted to an external machine to be filtered. Dialysis can help in removing excess salt, water, and waste from the body, keeping the levels of minerals and vitamins within normal limits, and controlling high blood pressure and red blood cell synthesis. Two types of dialysis can be carried out. They are:

    1. Hemodialysis - This process uses a machine to filter the blood. The machine filters the waste with the help of a solution. The filtered blood is then placed back into the body. This is carried out three to four times a week and takes around three hours for each cycle.
    2. Peritoneal Dialysis - This procedure involves using a cleansing fluid in the abdomen with the help of a tube or catheter. After some time, the fluid and waste products are removed from the catheter. This dialysis can be done at home or overnight during sleep.
  • Kidney Transplant - A kidney transplant involves the removal of diseased kidneys and replacing them with a healthy donor kidney. A person can survive with one healthy kidney.

  • Medications - Drugs used to control high blood pressure and diabetes so that end-stage renal failure can be prevented.

    1. Angiotensin converting enzyme inhibitors (ACE Inhibitors) and Angiotensin receptor blockers (ARBs)
    2. Finerenone- It is a prescribed drug used to reduce the risk of cardiovascular death, heart attack, and hospitalization for heart failure in people with chronic kidney disease associated with type 2 diabetes.
    3. Phosphate binders- These help to prevent the level of phosphorus from becoming high.
    4. Erythropoietin- To treat fewer blood cells or anemia.
  • Vaccines - Hepatitis A and B vaccines, Pneumococcal polysaccharide (PPSV23) vaccines, and Flu vaccines can produce positive results if taken before and during dialysis.

  • Lifestyle Modification - Water retention in the body due to end-stage kidney failure can lead to a gain in weight. So maintaining a healthy weight should be a priority.

    1. Calorie intake should be increased.
    2. A diet high in protein, sodium, and potassium should be avoided.
    3. Fluid intake should be restricted.
    4. Foods such as bananas, tomatoes, oranges, chocolate, nuts, spinach, and avocados should be consumed mindfully.
    5. Supplements like calcium, vitamins C, and D, and iron may help the kidneys function well.

What Is the Prognosis of End Stage Renal Failure?

End-stage renal failure can lead to mortality if prompt treatment with dialysis or a kidney transplant is not carried out. The prognosis depends upon the extent of the disease progression and differs for different patients.

What Are the Complications of End-Stage Renal Failure?

  • Anemia - Lack of healthy blood cells.

  • Bleeding from the stomach or intestines.

  • Pain in the bones, joints, and muscles.

  • Changes in the level of blood sugar.

  • Damage to the nerves of arms and legs.

  • Pleurisy - Fluid deposition around lungs.

  • High blood pressure.

  • Risk of heart attack and heart failure.

  • High level of potassium.

  • Increased risk of infection.

  • Liver failure.

  • Malnutrition.

  • Miscarriage.

  • Infertility.

  • Restless Leg Syndrome - A condition with an uncontrollable urge to move the legs.

  • Strokes and seizures.

  • Edema - A condition where there is swelling of the body.

  • Weak and fracture-prone bones.

Conclusion:

As the name suggests, end-stage renal failure is the last chronic kidney disease stage. After that, the level of kidney function drops drastically. It is a life-threatening condition that can be treated with the help of dialysis or kidney transplantation. If one has kidney disease, keeping a watch and getting regular check-ups can help them avoid progressing to end-stage renal failure.

Frequently Asked Questions

1.

What Happens in End-Stage Renal Failure?

 
End-stage kidney disease is the last stage of chronic kidney failure. It is a very severe stage where the kidney can no longer support the body’s demands.  In end-stage renal failure, there is fluid retention in the arms, legs, and also lungs that leads to swelling of the legs and feet. A sudden rise in potassium levels impairs heart functioning. The kidneys remove the excess fluid and waste from the body. So in this stage, the kidney completely ceases its functioning on a permanent basis that will need long-term dialysis or a kidney transplant to improve life.

2.

For How Long Does the End Stage Renal Failure Last?

The kidneys lose the ability to filter the waste from the body as a result all the waste starts accumulating in the body. The patient will need dialysis at this point. Death can occur within a few weeks if the patient doesn't undergo dialysis or a transplant. The patient can last for a few weeks or a month without treatment.  So to stay alive the patient needs either a dialysis or kidney transplant. If the patient doesn't want to undergo dialysis then he or she can choose conservative management for the remaining days.

3.

Can a Person Survive End Stage Renal Disease?

The patient can choose conservative treatment to manage the symptoms aiming for the best quality of life for the remaining days. But if the patient wishes to live for a longer time then they should either go for dialysis or kidney transplantation. The life expectancy of those receiving dialysis is 10 to 20 years though some people may live up to 30 years.

4.

What Is the Reason for Death in End Stage Renal Disease?

 
The risk factors for developing kidney disease are diabetes, heart disease, and high blood pressure. Cardiovascular disease is the leading cause of death among dialysis patients. Chronic kidney failure is historically a deadly disease. Heart disease is the leading cause of death in kidney failure patients. End stage kidney disease is the last stage of long-term chronic kidney disease. There is an increase in potassium levels in the body and the body is not able to excrete them. High potassium levels above 5.5 milliequivalent per liter causes heart diseases.

5.

Can Kidney Failure Cause Sudden Death?

If the treatment is not provided at the appropriate time kidney failure can worsen leading to diabetes, and heart disease. So to stay alive the patient needs either a dialysis or kidney transplant. If the patient doesn't want to undergo dialysis then he or she can choose conservative management for the remaining days. A person with end-stage kidney disease has had chronic kidney disease for a long time. The risk factors for developing kidney disease are diabetes, heart disease, and high blood pressure. Cardiovascular disease is the leading cause of death among dialysis patients.

6.

What Is the Treatment for End Stage Kidney Disease?

The kidneys remove the excess fluid and waste from the body. So in this stage, the kidney completely ceases its functioning on a permanent basis that will need long-term dialysis or a kidney transplant to improve life. So to stay alive the patient needs either a dialysis or kidney transplant. If the patient doesn't want to undergo dialysis then he or she can choose conservative management for the symptoms for the remaining days.

7.

Does Dialysis Cure End-Stage Renal Failure?

Yes, dialysis will cure end-stage kidney failure. It is not a permanent cure for kidney disease. In dialysis waste products and extra fluid are removed from the blood when the kidneys stop working. The blood is diverted to an external machine to be filtered. Dialysis can help in removing excess salt, water, and waste from the body, keep the levels of minerals and vitamins within normal limits, and control high blood pressure and red blood cell synthesis.

8.

How Long Can a Person Live Without Dialysis?

A person can live for a few weeks to a month without dialysis. It is a life-threatening condition that can be treated with the help of dialysis or kidney transplantation. If one doesn't do dialysis all the waste, and electrolytes start accumulating in the body leading to death. If the patient wants to live then he or she should do dialysis.

9.

What Are the Signs of End Stage Renal Failure?

The signs of end-stage kidney disease are-
- Swelling.
- Retention of fluid and water.
- Salt retention.
- Decrease in the frequency of urination.
- Not able to urinate.
- Unexplained weight loss.
- Loss of appetite.
- Nausea and vomiting.
- Dry and itchy skin.
- Change in the color of skin.
- Bone pain.
- Difficulty in concentrating.
- Easily bruised.
- Numbness of hands and feet.
- Foul-smelling breath.
- Excessive thirst.
- Low libido/ impotence.
- Edema - Swelling in the hands and feet.

10.

Is Death Painless in Kidney Disease?

People with kidney failure who undergo kidney transplants live longer. If dialysis is not done the toxins build up in the body and death occurs too quickly after this stage. It is a slow poisoning of the body but mostly is painless. Ischaemic (low blood supply to organs) diseases like diabetic neuropathy, and long-standing high blood pressure result in pain. Autosomal dominant polycystic kidney disease (an inherited condition that causes small fluid-filled sacs called cysts to develop in the kidneys) is an important cause of pain.

11.

How High Creatinine Lead To Death?

The kidneys filter the creatinine and excrete it through urine. Creatinine is a byproduct of muscle breakdown. If the kidney is not functioning properly the creatinine starts accumulating in the body. If creatinine goes above 0.5 to 1.2 milligrams per decilitre then it is considered very high. High creatinine levels indicate that the kidneys are not working properly. High creatinine levels occur in the following conditions-
- Kidney stones.
- Kidney failure.
- Kidney infection.
- Glomerulonephritis (inflammation of the kidney).

12.

What Happens if the Patient Does Not Do Dialysis?

As the name suggests, end-stage renal failure is the last chronic kidney disease stage. After that, the level of kidney function drops drastically. It is a life-threatening condition that can be treated with the help of dialysis or kidney transplantation. If one doesn't do dialysis all the waste, and electrolytes start accumulating in the body leading to death. If the patient wants to live then he or she should do dialysis or kidney transplant.

13.

How Serious Is End Stage Renal Disease?

End-stage renal failure can lead to mortality if prompt treatment with dialysis or a kidney transplant is not carried out. The prognosis depends upon the extent of the disease progression and differs for different patients. The complications include-
- Anemia - Lack of healthy blood cells.
- Bleeding from the stomach or intestines.
- Pain in the bones, joints, and muscles.
- Changes in the level of blood sugar.
- Damage to the nerves of arms and legs.

14.

Is End Stage Renal Failure Painful?

Pain is one of the major health issues during end-stage renal disease that affects half of the dialysis patients. There is a moderate to severe degree of pain. The consequences of kidney pain are often underestimated. Mostly the patient who is under conservative treatment will not require treatment for a long time. So there are chances that the patient may die within a few weeks. In such situations there is not much pain involved.
Dr. Manzoor Ahmad Parry
Dr. Manzoor Ahmad Parry

Nephrology

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renal failure
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