What is End Stage Renal Disease?

End stage renal disease (ESRD) is the final and most severe stage of chronic kidney failure. Chronic kidney failure is the decline in kidney function over an extended period of time (usually many years).

Renal (kidney) failure is categorized into five (5) different stages.

Stage 1 is the least severe and kidney function is minimally reduced.

As kidney function continues to decline over time, it gets to a stage where the kidneys barely function or do not function at all. This is the most severe stage of kidney failure and is classified as stage 5 or end stage renal disease.

A patient is diagnosed with ESRD when the kidneys cease to function entirely, or function below 10% of capacity. Kidney function is significantly reduced and the kidneys are no longer able to function at a level that is required for day to day life.

What Causes ESRD

The terms "end stage renal failure" and "end stage renal disease" are used interchangeably and basically refer to the same condition. In most cases ESRD is the result of a natural progression of degenerative chronic kidney failure (kidney failure over an extended period of time). A patient might be affected by chronic renal failure for many years before it progresses to ESRD. In rare circumstances a patient might be affected by acute (or immediate) end stage renal failure, as a result of severe trauma.

Chronic renal failure, which may eventually lead to end stage renal disease, can be caused by a number of diseases. Most common causes include diabetes, hypertension and bacterial infections.

Signs and Symptoms of ESRD

Patients who are diagnosed with end stage renal disease usually have a long term history of renal failure. Over time the kidneys become damaged to the point where they are not able to function, thus resulting in ESRD.

Generally, a patient with a history of chronic kidney failure is diagnosed with ESRD when their kidney function falls below 10% of capacity. Symptoms are severe as a result of the accumulation of toxins and other fluids in the body. The patient becomes very sick and may display symptoms, such as:

  • Weight loss;

  • Nausea and vomiting;

  • Blood in the vomit or stool;

  • Significantly decreased urine output or no urine output;

  • Decreased alertness;

  • Muscle cramps;

  • Discolored skin pigmentation;

  • Decreased sensation in the hands, feet, or other areas.

These are just some of the symptoms which may be displayed by a patient with end stage renal disease. Other symptoms not listed above may also be experienced, such as seizures.

How is ESRD Treated?

In most cases, a patient who is diagnosed with end stage renal failure would have been receiving treatment for chronic renal failure, prior to the diagnosis. This may have included treatment of underlying causes, such as hypertension and diabetes. Usually, dialysis is also administered to remove toxins from the body.

With ESRD, however, the most effective treatment is kidney transplant. Additionally, frequent dialysis is also necessary to remove accumulated toxins in the body. Other treatments such as regulated diet and exercise may provide some assistance in the short term, but the focus should be urgent kidney transplant.

Unfortunately however, not all patients with end stage renal failure can be recommended for a kidney transplant. Before a patient is recommended for a kidney transplant, they must fulfill certain basic criteria. A patient must be in satisfactory physical health in order to undergoing a transplant operation. Doctors are usually hesitant to recommend a kidney transplant to a patient who has other life-threatening diseases, such as heart failure. A patient whose health is significantly compromised may not survive a kidney transplant surgery.

The decision by a doctor to recommend a kidney transplant depends on whether the doctor believes that the patient can survive a kidney transplant surgery, and whether such a surgery will improve the patient's overall health condition.

A doctor may also consider the patient's age. Kidney transplant success rates tend to be higher for patients below the age of 75 years.

Of course, finding a kidney donor with matching blood and tissue profile is an essential criterion. Unless a family member or close friend is willing to donate one of their kidneys, finding a compatible donor could be quite challenging.

The process of obtaining a donated kidney is often quite lengthy and costly. A patient should not wait until they are diagnosed with end stage renal disease before they start considering a kidney transplant. Once a patient is affected with chronic kidney failure, with no sign of improvement, they should start thinking about a kidney transplant and begin making the necessary plans.

While a patient with end stage renal disease is awaiting a transplant, all other viable treatment options (prescribed by their physician) should be pursued. This includes regular dialysis, restricted diet, and aggressive treatment of any underlying conditions such as hypertension, diabetes, and congestive heart failure.