World Kidney Day: What is the last stage of long-term (chronic) kidney disease?

End-stage kidney disease (ESKD), also known as end-stage renal disease (ESRD) is the last stage of long-term (chronic) kidney disease. In this stage, kidneys can no longer support the body’s needs.

Causes of ESRD

The kidneys remove waste and excess water from the body. ESRD occurs when the kidneys are no longer able to work at a level needed for day-to-day life. Some of the common causes of ESRD are diabetes and high blood pressure. ESRD almost always comes after chronic kidney disease. The kidneys may slowly stop working during a period of 10 to 20 years before end-stage disease results.


Common symptoms may include:

General ill feeling and fatigue, itching (pruritus) and dry skin, headache, weight loss without trying, loss of appetite and nausea. Other symptoms may include abnormally dark or light skin, nail changes, bone pain, drowsiness and confusion, problems concentrating or thinking, numbness in the hands, feet, or other areas, muscle twitching or cramps, breath odour, easy bruising, nosebleeds, or blood in the stool, excessive thirst, frequent hiccups, problems with sexual function, menstrual periods stop (amenorrhea), sleep problems, swelling of the feet and hands (edema) and vomiting, often in the morning.

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People with ESRD will make much less urine, or their kidneys no longer make urine. ESRD changes the results of many tests. People receiving dialysis need these and other tests done often:

  • Potassium
  • Sodium
  • Albumin
  • Phosphorous
  • Calcium
  • Cholesterol
  • Magnesium
  • Complete blood count (CBC)
  • Electrolytes

This disease may also change the results of the following tests:

  • Vitamin D
  • Parathyroid hormone
  • Bone density test


ESRD may need to be treated with dialysis or a kidney transplant. A person may need to stay on a special diet or take medicines to help his body work well.


Dialysis does the job of kidneys when they stop working well.

Dialysis can:

  • Remove extra salt, water, and waste products so they do not build up in your body
  • Keep safe levels of minerals and vitamins in your body
  • Help control blood pressure
  • Help the body make red blood cells

Dialysis removes waste from the blood when kidneys can no longer do their job.

  • Usually, people go on dialysis when they have only 10% to 15% of their kidney function left.
  • Even people who are waiting for a kidney transplant may need dialysis while waiting.

Two different methods are used to perform dialysis:

  • During hemodialysis, blood passes through a tube into an artificial kidney or filter. This method can be done at home or at a dialysis centre.
  • During peritoneal dialysis, a special solution passes into the belly through a catheter tube. The solution remains in the abdomen for a period of time and then is removed. This method can be done at home, at work, or while travelling.


A kidney transplant is a surgery to place a healthy kidney into a person with kidney failure.


A person may need to continue following a special diet for chronic kidney disease. The diet may include:

  • Eating foods low in protein
  • Getting enough calories if you are losing weight
  • Limiting fluids
  • Limiting salt, potassium, phosphorous, and other electrolytes


End-stage kidney disease leads to death if you do not have dialysis or a kidney transplant. Both of these treatments have risks. The outcome is different for each person.

Possible Complications

Health problems that can result from ESRD include:

  • Anemia
  • Bleeding from the stomach or intestines
  • Bone, joint, and muscle pain
  • Changes in blood sugar (glucose)
  • Damage to nerves of the legs and arms
  • Fluid buildup around the lungs
  • High blood pressure, heart attack, and heart failure
  • High potassium level
  • Increased risk of infection
  • Liver damage or failure
  • Malnutrition
  • Miscarriages or infertility
  • Restless legs syndrome
  • Stroke, seizures, and dementia
  • Swelling and edema
  • Weakening of the bones and fractures related to high phosphorus and low calcium levels

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