End-Stage Renal Disease (ESRD)
End-stage renal disease, or ESRD, is a condition in which the kidneys function at less than 10 percent of their normal capacity. When this occurs, dialysis or kidney transplant is needed.
In the United States, more than a third of people with ESRD have diabetes, and diabetic nephropathy (renal disease due to diabetes) is the leading cause of ESRD. Up to 40 percent of all people with type 1 diabetes (the type that usually begins in childhood or young adults, nearly always requiring insulin therapy) eventually develop ESRD. Kidney disease can also develop in people with type 2 diabetes, and with either type, poor control of blood sugar increases the risk of ESRD. Among other causes of ESRD, the most common are hypertension (high blood pressure), vascular disease, certain rheumatic diseases (such as lupus) and some genetic disorders, such as polycystic kidney disease.
Symptoms of ESRD 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 be mild until kidney function has dropped to 15 percent or less of normal.
Usually by the time ESRD occurs there is a long history of kidney disease. Levels of creatinine and blood urea nitrogen, chemicals ordinarily removed by the kidneys, are markedly elevated. Dialysis is generally considered when a specific set of problems has developed, including:
- Pericarditis (inflammation of the lining of the heart)
- Fluid overload or congestive heart failure (in which fluid backs up behind the heart into the lungs) that cannot be adequately improved with diuretics (medications that encourage elimination of fluid)
- Severely elevated blood pressure that is not improved by antihypertensive medications
- A decrease in nervous system functions marked by confusion, decreased alertness or seizures
- Bleeding related to kidney failure that cannot be improved through other means
- Severe, unrelenting nausea and vomiting
- Severe abnormalities in blood tests indicating that dialysis will soon be necessary, even if the problems mentioned above have not yet developed
Kidney disease is diagnosed by analyzing urine and measuring elevated levels of creatinine and blood urea nitrogen in the blood. When kidney function has decreased to less than 10 percent of normal, ESRD is diagnosed.
Once ESRD is diagnosed, it is a lifelong condition, although a kidney transplant is an effective treatment.
If you have diabetes, control of blood sugar is an important way to reduce your chances of developing ESRD. Close monitoring of blood pressure and prompt treatment of hypertension can also help prevent kidney disease. Many doctors prescribe medications called angiotensin-converting enzyme inhibitors for hypertension and heart disease at the first signs of elevated blood pressure or protein in the urine (a sign of kidney injury), even without hypertension. A low-protein diet (10 percent to 12 percent or less of total diet) may also slow or halt the progression of existing kidney disease. Cigarette smoking and elevated lipid levels (such as cholesterol) are also risk factors that should be eliminated if possible.
The two treatments for ESRD are dialysis and kidney transplant.
There are two types of dialysis: hemodialysis and peritoneal dialysis.
- Hemodialysis is usually performed at a dialysis center in three- to four-hour sessions three times a week. During the treatments blood is removed, run through filters to remove waste products, and then returned.
- Peritoneal dialysis may be performed at home, but takes longer at each session and is required more frequently. During peritoneal dialysis, fluid is infused under the skin of the abdomen and waste products accumulate in the fluid, which is later removed.
Kidney transplantation has allowed patients with many forms of severe kidney disease to avoid or discontinue dialysis. However, a good genetic match is needed between the donor and the recipient, or the body will reject the new kidney. And there is a one- to three-year waiting period for obtaining a donor kidney. Improved anti-rejection drugs that suppress the immune system help the body to accept the donated organ, but an organ recipient can expect to be on such medication for life.
When To Call A Professional
If you have diabetes, hypertension, vascular disease or other risk factors for ESRD, you should have regular checkups along with tests for protein in the urine or abnormal blood levels (such as blood urea nitrogen and creatinine) that indicate reduced kidney function. Call your doctor if you notice any decrease in urine output or other symptoms of ESRD mentioned above, especially if you have known kidney disease or its risk factors.
When kidney failure does occur, treatments offer hope for good recovery, and many dialysis and transplant patients lead near-normal lives. Advancing technology continues to brighten the prognosis for those with ESRD.
National Institute of Diabetes and Digestive and Kidney Disorders 31 Center Dr.Bethesda, MD 20892Phone: (301) 496-3583Fax: (301) 496-7422
National Kidney Foundation30 East 33rd St.New York, NY 10016Toll-free: (800) 622-9010