End-Stage Renal Disease: Symptoms, Causes, and Treatment
Updated: 3 days ago
Medically reviewed by [Dr. Baraa Alnahhal, MD](https://www.rinnit.com/dr-baraa-alnahhal). Last reviewed October 13, 2026. This content is for educational purposes and is not medical advice.
Quick Answer
End-stage renal disease is the most advanced stage of chronic kidney disease, also called kidney failure, in which the kidneys no longer meet the body's needs. Symptoms include nausea, fatigue, swelling, shortness of breath and itching. An eGFR consistently below 15 mL/min means kidney failure. Treatment options are kidney transplant, dialysis or palliative care.
What the research says
Some diabetes drugs lower the risk of kidney failure. A network meta-analysis of 816 trials (471,038 adults with type 2 diabetes) found that SGLT-2 inhibitors reduced all-cause death (odds ratio 0.88, 95% CI 0.83 to 0.94) and were superior to other drugs in reducing end-stage kidney disease (Shi et al., BMJ, 2023).
Peritoneal dialysis may offer slightly better quality of life than hemodialysis. Pooling 21 studies with about 29,000 participants, people on peritoneal dialysis scored higher on the SF-36 mental component (mean difference 1.86, 95% CI 0.47 to 3.24), with no clear difference in the physical component (Chuasuwan et al., Health and Quality of Life Outcomes, 2020).
Ketoanalogue supplements plus a low-protein diet may delay dialysis. In 16 trials with 1,344 people with stage 3 to 5 chronic kidney disease (median follow-up 13 months), this approach gave a higher GFR, lower urea nitrogen and phosphorus, and a marginally lower risk of kidney failure in people without diabetes, with similar survival (Chen et al., Journal of Nephrology, 2024).
What Is End-Stage Renal Disease?
The kidneys clean the blood. As blood circulates, it picks up extra fluid, chemicals, and waste. The kidneys separate this material from the blood and release it as urine [1].
This cleaning job happens inside tiny filtering units called nephrons. Each nephron contains a filter called a glomerulus, made of tiny blood vessels called capillaries. Water, minerals, nutrients, and waste molecules pass through the capillary walls. Large molecules, such as proteins and red blood cells, stay in the blood. The body reclaims the water, nutrients, and minerals it needs, and the leftover water and waste flow to the bladder as urine [1].
In chronic kidney disease, the kidneys slowly stop working as they should. Excess fluid and waste build up in the body. When the problem advances to the end stage, that buildup can become dangerous. People with end-stage kidney disease need dialysis or a kidney transplant to stay alive. Some people instead choose conservative care to manage symptoms and protect quality of life [1].
Symptoms: Warning Signs of Failing Kidneys
In the early stages of kidney disease, there may be no signs or symptoms at all. Because the kidneys can make up for lost function, problems may not show up until the damage cannot be reversed [1].
As the disease progresses, symptoms become clearer. End-stage kidney disease symptoms might include [1]:
Vomiting or upset stomach
Loss of appetite
Feeling tired and weak
Changes in how much you urinate
Chest pain, if fluid builds up around the lining of the heart
Shortness of breath, if fluid builds up in the lungs
Swelling of feet and ankles
High blood pressure that is hard to control
Trouble sleeping
Reduced mental sharpness
Muscle twitches and cramps
Constant itching
When to Seek Care
Make an appointment with a doctor or other healthcare professional if you have symptoms of kidney disease. Catching kidney disease early might keep it from turning into kidney failure [1].
If a medical condition raises your risk of kidney disease, your healthcare team may monitor your kidney function with urine and blood tests and blood pressure checks. Ask your provider whether this monitoring is right for you [1].
Causes and Risk Factors
Kidney disease develops over time. Often a disease or condition damages kidney function, and the damage worsens over months or years. Sometimes the damage keeps progressing even after the underlying cause has been treated [1].
Cause | Why it matters |
Type 1 or type 2 diabetes | The leading driver of kidney damage [1] |
High blood pressure | Raises pressure inside the kidney's filters [1] |
Autoimmune diseases | Lupus, sarcoidosis, and Sjogren syndrome can attack the kidneys [1] |
Polycystic kidney disease | An inherited condition that forms kidney cysts [1] |
Prolonged urinary blockage | Conditions such as an enlarged prostate or urinary tract tumors obstruct urine flow [1] |
Vesicoureteral reflux | Urine flows backward up into the kidneys [1] |
Certain medicines | Lithium and large doses of ibuprofen or other NSAIDs can harm the kidneys [1] |
Several factors raise the risk that chronic kidney disease will advance to the end stage [1]:
Risk factor | Why it matters |
Diabetes or high blood pressure | The two most common causes of kidney disease [1] |
Heart disease | Signals blood vessel damage that affects the kidneys [1] |
Smoking | Damages blood vessels throughout the body [1] |
Being overweight | Adds strain on kidney function [1] |
Race and ancestry | Being Black, Native American, or Asian American raises risk [1] |
Family history of kidney disease | Inherited conditions such as polycystic kidney disease run in families [1] |
Older age | Kidney function naturally declines with age [1] |
Frequent kidney-damaging medicines | Repeated use of certain drugs adds injury [1] |
Complications: Why Kidney Failure Affects the Whole Body
Once kidney damage happens, it cannot be reversed. Potential complications of end-stage kidney disease can affect almost any part of the body [1]:
Complication | What happens |
High blood pressure | Poor salt and water removal raises blood pressure, which damages kidneys further [1] |
Acid buildup (acidosis) | Unused acids harm bone health and break down protein [1] |
Fluid retention | Leg swelling, high blood pressure, or fluid in the lungs; a sudden weight gain can be a sign [1] |
High blood potassium | Called hyperkalemia, it can appear suddenly, damage the heart, and be life-threatening [1] |
Anemia | Not enough healthy red blood cells to carry oxygen [1] |
Heart disease | Arteries stiffen and clog as kidney disease advances [1] |
Bone weakness | Weak bones and a higher risk of fractures [1] |
Sexual health conditions | Lower sex drive, erectile dysfunction, or reduced fertility [1] |
Central nervous system damage | Trouble concentrating or personality changes in the last stages [1] |
Immune system changes | A lowered immune response raises infection risk [1] |
Pericarditis | Inflammation of the membrane covering the heart [1] |
Pregnancy complications | Risk to both mother and unborn baby [1] |
How End-Stage Kidney Disease Is Diagnosed
To diagnose end-stage kidney disease, a healthcare professional reviews your medical and family history and performs a physical and neurological exam. Tests may include [2]:
Test | What it does |
Blood tests | Measure waste products such as creatinine and urea in the blood [2] |
Urine tests | Reveal signs of chronic kidney disease and clues about the cause [2] |
Imaging tests | Ultrasound shows kidney structure and size; MRI or CT may also be used [2] |
Kidney biopsy | A needle removes a small tissue sample for lab testing to reveal the cause [2] |
Certain tests may be repeated over time to track changes in the condition [2].
The Five Stages of Kidney Disease
The key measurement is the estimated glomerular filtration rate (eGFR), which estimates how much blood the kidneys filter each minute, recorded in milliliters per minute (mL/min). A low eGFR means reduced kidney function, especially below 60 mL/min [2].
End-stage kidney disease is reached when the eGFR is consistently less than 15 mL/min [2].
Kidney disease stage | GFR (mL/min) | Kidney function |
Stage 1 | 90 or above | Healthy kidney function [2] |
Stage 2 | 60 to 89 | Mild loss of kidney function [2] |
Stage 3a | 45 to 59 | Mild to moderate loss [2] |
Stage 3b | 30 to 44 | Moderate to severe loss [2] |
Stage 4 | 15 to 29 | Severe loss [2] |
Stage 5 | Less than 15 | Kidney failure [2] |
A constant loss of protein in the urine is also a sign of kidney damage, even when the eGFR is in the healthy to mild range [2].
Treatment Options
The three treatment paths for end-stage kidney disease are a kidney transplant, dialysis, and supportive (palliative) care [2].
Kidney Transplant
A kidney transplant is often the treatment of choice for end-stage kidney disease. Without a transplant, lifetime dialysis is needed. A healthy kidney from a donor, living or deceased, is matched to the patient and surgically placed in the lower belly. The new kidney's blood vessels attach to vessels in the lower abdomen, and its urine tube (the ureter) connects to the bladder. The person's own kidneys are usually left in place unless they cause complications [2].
Recovery involves up to a week in the hospital and regular follow-up checkups. A number of medicines help keep the immune system from rejecting the new kidney, and they also lower the risk of complications such as infection. After a successful transplant, the new kidney filters the blood and dialysis is no longer needed [2].
Dialysis
Dialysis does some of the work of the kidneys: it removes extra fluid and waste, restores electrolyte levels, and helps control blood pressure. The two options are peritoneal dialysis and hemodialysis [2].
Approach | What is involved | What to know |
Peritoneal dialysis | A permanent catheter drains dialysis solution into the space around the abdominal organs; the peritoneal lining acts as a filter, then the solution drains out [2] | Done at home; the exchange of old solution for new is repeated several times a day [2] |
Hemodialysis | Blood runs through a filter that acts as an artificial kidney, then returns cleaned to the body; two needles are inserted for every treatment [2] | Done at a dialysis center or at home; requires an access point such as a fistula, graft, or catheter [2] |
For dialysis to be successful, lifestyle changes such as a special diet are usually needed [2].
Palliative Care
If you choose not to have a kidney transplant or dialysis, supportive or palliative care can manage symptoms and improve comfort. It can also be combined with dialysis or a transplant. Without either dialysis or a transplant, end-stage kidney disease gets worse, and death could come quickly or take several months or even years [2].
Lifestyle and Home Remedies
Following a special diet is an important part of kidney disease treatment. Careful food and drink choices limit how hard the kidneys have to work. Ask for a referral to a renal dietitian, a dietitian who specializes in kidney disease [2]:
Avoid products with added salt. Stay away from salty snacks, ready-made foods such as frozen dinners, canned soups and vegetables, and processed meats and cheeses [2].
Choose foods lower in potassium. Avoid high-potassium foods such as bananas, oranges, potatoes, spinach, and tomatoes. Better choices include apples, cabbage, carrots, green beans, grapes, and strawberries. Many salt substitutes contain potassium and should be avoided [2].
Limit protein. The dietitian estimates how many grams of protein are needed each day and suggests what to eat. High-protein foods include lean meats, eggs, milk, cheese, and beans; low-protein foods include vegetables, fruits, breads, and cereals [2].
Healthy lifestyle choices can slow the progress of kidney disease: maintain a healthy weight, stay active most days, eat a balanced low-sodium diet with limited protein, control blood pressure and blood sugar, take medicines as prescribed, have cholesterol checked yearly, and do not smoke [1].
Coping and Support
Learning you have end-stage kidney disease can come as a shock, and the dialysis schedule can be hard to manage. Support strategies include connecting with other people who have kidney disease through local support groups or organizations such as the American Association of Kidney Patients, the National Kidney Foundation, or the American Kidney Fund; keeping a routine and continuing to work if possible; staying active at least 30 minutes most days; and talking with a trusted friend, family member, faith leader, social worker, or counselor [2].
Preparing for the Appointment
You will likely keep seeing the same team that treated your chronic kidney disease, or be referred to a nephrologist, a doctor who specializes in kidney conditions. Before the appointment, write down your symptoms and when they started, list all medicines and supplements with doses, bring a family member or friend, and prepare questions such as: What is the level of damage to my kidneys? Is my kidney function getting worse? What are my treatment options and their side effects? Do I need a special diet or a dietitian referral? How often should my kidney function be tested? [2]
Conclusion and Next Steps
End-stage renal disease means the kidneys can no longer protect the body from waste and fluid. The condition usually traces back to diabetes or high blood pressure, and it takes a steady toll on the heart, bones, blood, and nerves. The good news is that treatment works. Dialysis filters the blood when the kidneys cannot, and a transplant can restore independence from the dialysis machine. A special diet, active daily habits, and close follow-up with a kidney specialist all help protect the quality of life.
Take action. If you or someone close to you has symptoms such as swelling, fatigue, or hard-to-control blood pressure, talk to a healthcare provider about a kidney function check. If end-stage kidney disease is already a reality, ask the care team about all three options, including transplant and dialysis types, and ask for a referral to a renal dietitian to protect the time ahead.
Frequently Asked Questions
Can end-stage kidney disease be seen on routine blood work? Yes. A simple blood test called the eGFR estimates how much blood the kidneys filter each minute, and a result consistently below 15 mL/min defines end-stage kidney disease [2].
Can I get pregnant with end-stage kidney disease? Pregnancy with advanced kidney disease carries risks for both the mother and the baby. Anyone considering pregnancy should discuss it with their healthcare team first [1].
Is end-stage kidney disease curable? Kidney damage cannot be reversed, but the disease is treatable. A kidney transplant can restore kidney function, and dialysis takes over the filtering job, often for years [2].
How long can you live with end-stage kidney disease without dialysis? Without dialysis or a transplant, the disease gets worse. Death could happen quickly or take several months, even years, depending on remaining kidney function and overall health [2].
Does end-stage kidney disease hurt? The disease itself is not typically painful, but complications such as fluid in the lungs (shortness of breath), chest pain around the heart lining, and constant itching can cause significant discomfort [1].
Related Reading on Rinnit
Trusted External Resources
National Institute of Diabetes and Digestive and Kidney Diseases: Chronic Kidney Disease
National Kidney Foundation: Stages of Chronic Kidney Disease
National Kidney Foundation: Risk Factors for Chronic Kidney Disease
Merck Manual Professional Version: Chronic Kidney Disease
Related Reading
Potassium Binders: Types, How They Work and Side Effects explains potassium binder medicines.
Learn more in our guide to Kidney Donation: Eligibility, Surgery, Risks and Recovery for Living Donors.
References
Mayo Clinic Staff. End-stage kidney disease: Symptoms and causes. Mayo Clinic. May 15, 2026. https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/symptoms-causes/syc-20354532
Mayo Clinic Staff. End-stage kidney disease: Diagnosis and treatment. Mayo Clinic. May 15, 2026. https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/diagnosis-treatment/drc-20354538
National Institute of Diabetes and Digestive and Kidney Diseases. Chronic Kidney Disease (CKD). NIDDK. Last Reviewed October 2016. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/all-content
National Kidney Foundation. Stages of Chronic Kidney Disease (CKD). National Kidney Foundation. Accessed October 14, 2026. https://www.kidney.org/kidney-topics/stages-chronic-kidney-disease-ckd
National Kidney Foundation. Risk Factors for Chronic Kidney Disease. National Kidney Foundation. Last updated February 21, 2025. https://www.kidney.org/kidney-topics/risk-factors-chronic-kidney-disease
Malkina A. Chronic Kidney Disease. Merck Manual Professional Edition. Full Review February 2025; Last updated February 2026. https://www.merckmanuals.com/professional/nephrology/chronic-kidney-disease/chronic-kidney-disease
Shi Q, Nong K, Vandvik PO, et al. Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2023;381:e074068. PMID 37024129. https://doi.org/10.1136/bmj-2022-074068
Chuasuwan A, Pooripussarakul S, Thakkinstian A, et al. Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis: a systematic review and meta-analysis. Health Qual Life Outcomes. 2020;18(1):191. PMID 32552800. https://doi.org/10.1186/s12955-020-01449-2
Chen CH, Tsai PH, Tsai WC, et al. Efficacy and safety of ketoanalogue supplementation combined with protein-restricted diets in advanced chronic kidney disease: a systematic review and meta-analysis. J Nephrol. 2024;37(8):2113-2125. PMID 39340710. https://doi.org/10.1007/s40620-024-02065-9
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