End-stage renal disease
End-stage renal disease (ESRD) is the final stage of chronic kidney disease, wherein kidney function declines to less than 10% of normal, leading to significant health risks. This condition is primarily caused by long-standing diabetes and uncontrolled hypertension, both of which can result in irreversible kidney damage. Common symptoms include swollen feet and ankles, persistent fatigue, itching, and shortness of breath, as well as more serious complications such as anemia and metabolic imbalances. Without treatment, ESRD is fatal, but patients can manage their health through dialysis or kidney transplantation.
Dialysis serves as a replacement for kidney function, either through hemodialysis, which filters blood externally, or peritoneal dialysis, which filters blood internally via the abdominal cavity. Unfortunately, there is a substantial waitlist for kidney transplants, as many patients face prolonged delays. The increasing prevalence of conditions like obesity and diabetes in society highlights the importance of early intervention and lifestyle changes to prevent the progression to ESRD. Understanding the risks and maintaining regular health monitoring can significantly impact outcomes for individuals at risk of kidney disease.
End-stage renal disease
ANATOMY OR SYSTEM AFFECTED: Blood, blood vessels, circulatory system, endocrine system, heart, kidneys, urinary system
DEFINITION: Stage 5 of chronic kidney disease, which causes irreversible damage to and near-complete failure of the kidneys.
CAUSES: Diabetes and hypertension
SYMPTOMS: Swollen feet and ankles, fatigue/lethargy/weakness, itching, pale skin, loss of mental alertness, shortness of breath, recurrent or chronic heart failure
DURATION: Variable, fatal if not treated
TREATMENTS: Dialysis or kidney transplant
Causes and Symptoms
End-stage renal disease (ESRD) is stage 5 of chronic kidney disease, defined as kidney function at less than 10 percent of normal and a rate of less than 15 milliliters per minute. Both diseases are characterized by the inability to remove wastes and concentrate urine, have poor outcomes, and are usually the result of long-standing diabetes and/or uncontrolled hypertension.
ESRD is a serious, life-threatening systematic disease characterized by renal failure, decreased production of and active vitamin D3, and excess excretion of acid, potassium, salt, and water. Many metabolic abnormalities and imbalances occur, causing complications, such as anemia, acidemia or acidosis, hyperkalemia, hyperphosphatemia, hyperparathyroidism, and hypocalcemia. Symptoms include swollen feet and ankles, fatigue, lethargy or weakness, itching, skin color changes, loss of mental alertness, shortness of breath, and recurrent or chronic heart failure.
Tests that measure the level of and in blood and urine are conducted to determine the extent of kidney damage and the filtration capacity of the kidneys. High levels of these waste products found in the blood but not in the urine are signs of kidney damage. ESRD may be suspected when very high levels of protein are detected in the urine (proteinuria). The results of a creatinine clearance are used to determine the glomerular filtration rate, the standard measurement used to assess kidney function.
Diabetes mellitus is the most common cause of ESRD, due to its underlying kidney disease—diabetic nephropathy. Approximately 20 to 40 percent of patients with diabetes develop the disease, and nearly half of them progress to ESRD within five to ten years. Diabetic nephropathy develops with changes in the microvasculature (tiny blood vessels) of the glomerulus and is characterized by a progressive and aggressive disease course: wastes increase, building up in the blood; leak larger amounts of albumin, causing proteinuria; and nodular glomerulosclerosis lesions proliferate and destroy the glomeruli.
Hypertension (high blood pressure) is a major cause of ESRD, estimated at approximately 30 percent of all cases. Although are elastic, they can become overstretched from and narrow, weaken, or harden. This is especially deadly in the kidneys, which are highly and carry large volumes of blood. Damaged blood vessels and filters prevent the kidneys from functioning adequately, including reducing the hormone that they normally produce to help the body regulate its own blood pressure. Thus, hypertension is both a cause and a symptom of ESRD.
Uremia is a syndrome that develops with ESRD when metabolic, fluid, electrolyte, and hormone imbalances emerge concurrently. Clinical symptoms include or vomiting, fatigue, weight loss, muscle cramps, pruritus (itching), mental status changes, visual disturbances, and increased thirst.
Renal osteodystrophy is a degenerative bone disease that develops with metabolic imbalances in the phosphorus and calcium. High levels of phosphorus in the blood draw calcium out of the bones, causing them to become brittle and break. The excess of phosphorus and calcium salts in the blood deposit and harden, forming metastatic calcifications in the skin, blood vessels, and other soft tissues.
Treatment and Therapy
Dialysis and are the only treatments for ESRD and provide a means of prolonging a patient’s life span and maintaining quality of life.
Dialysis is a means of cleansing the blood when the kidneys do not function and is done by the process of diffusion, in which blood is passed through a filter in contact with a dialysate (salt solution), separating the smaller molecules (solute particles) from the larger molecules (colloid particles). There are two types of dialysis—hemodialysis and peritoneal dialysis—each of which has several variants.
In hemodialysis, blood is filtered by diverting it outside the body through a and flows across a semipermeable in the unit in a direction countercurrent to the dialysate. Hemodialysis takes three to four hours to complete and must be done three to five times a week, usually in a dialysis clinic. In peritoneal dialysis, blood is filtered internally through the peritoneum, a thin membrane inside the and is infused into the cavity via a catheter. Exchanges are repeated four to six times a day by the patient, and the process must be done every day.
Kidney transplants are another option for most ESRD patients. The United Network for Organ Sharing recommends that patients be put on the cadaveric renal transplant list when their glomerular filtration rate is less than 18 milliliters per minute. Improvements in their policies provide for a more equitable allocation system, broaden the classification of expanded donor criteria, and are expected to increase the donor pool. Unfortunately, thousands of patients die each year waiting for an available kidney.
Perspective and Prospects
Chronic kidney disease and ESRD represent a growing problem and reflect the disturbing health profile of present-day society—rising numbers of people with obesity, diabetes, hypertension, disease, and metabolic syndrome. The prevalence of chronic kidney disease has risen steadily since the 1980s. Changes in lifestyle and increased awareness of disease risk—including the monitoring of one's blood sugar levels and blood pressure—are key to preventing chronic kidney disease and reducing the number of patients who progress to ESRD.
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