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End-stage kidney disease is the complete, or almost complete failure of the kidneys to function. The kidneys can no longer remove wastes, concentrate urine, and regulate electrolytes.

Renal failure - end stage; Kidney failure - end stage; ESRD

End-stage kidney disease occurs when the kidneys are no longer able to function at a level that is necessary for day-to-day life. It usually occurs when chronic kidney failure has progressed to the point where kidney function is less than 10% of normal.

The most common cause of ESRD in the U.S. is diabetes. ESRD almost always follows chronic kidney failure. A person may have kidney failure for 10 - 20 years or more before progressing to ESRD.

• Decreased alertness
  • Drowsiness, somnolence, lethargy
  • Confusion, delirium
  • Coma
• Decreased sensation in the hands, feet, or other areas
• Decreased urine output
• Easy bruising or bleeding
• Fatigue
• Frequent hiccups
• General ill feeling
• Headache
• Increased skin color (pigmentation)
• Itching
• May have blood in the vomit or stools
• Muscle twitching or cramps
• Nail abnormalities
• Nausea or vomiting
• No urine output
• Seizures
• Skin may appear yellow or brown
• Unintentional weight loss

There may be a long history of chronic kidney failure, which has progressed. The urine volume may decrease or urine production may stop totally. Signs of complications commonly are present.

Tests may include:

• Creatinine and BUN levels
• Creatinine clearance

For additional resources, see kidney disease support group.

Without dialysis or a kidney transplant, death will occur from the buildup of fluids and waste products in the body. Both of these treatments can have serious risks and consequences. The outcome is different for each person.

• Anemia
• Brain dysfunction, nervous system damage, dementia
• Changes in electrolyte levels
• Changes in sugar (glucose) metabolism
• Congestive heart failure
• Decreased functioning of white blood cells and immune system
• Decreased libido, impotence
• Excessive bleeding (hemorrhage)
• Hepatitis B, hepatitis C, liver failure
• High blood pressure
• Infection
• Loss of blood in the gastrointestinal tract; duodenal or peptic ulcers
• Miscarriage, menstrual irregularities, infertility
• Pericarditis, cardiac tamponade
• Peripheral neuropathy
• Platelet dysfunction
• Permanent skin color (pigmentation) changes
• Seizures
• Skin dryness, itching/scratching, leading to skin infection
• Weakening of the bones, fractures, joint disorders

Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of end-stage kidney disease. Call your health care provider if you have acute or chronic kidney failure and it continues or gets worse.

Treatment of chronic kidney failure may delay or prevent progression to ESRD. Some cases may not be preventable.

Tolkoff-Rubin N. Treatment of irreversible renal failure. In: Goldman L, Ausiello D, eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 133.

Mitch WE. Chronic kidney disease. In: Goldman L, Ausiello D, eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 131.