What is end-stage renal disease?
End-stage renal disease (ESRD), also known as end-stage kidney disease, stage 5 kidney disease, or kidney failure, is the final, most severe stage of long-term kidney disease. It happens when the kidneys can no longer remove waste and extra fluid from the body well enough to support daily life. At this point, kidney function is so low that without medical support a person cannot stay healthy.
Penn Medicine provides comprehensive kidney care from early disease through ESRD. As an academic medical center, we also participate in research and clinical trials that help improve treatments and outcomes for people with kidney failure.
Symptoms of end-stage kidney disease
In many cases, symptoms of ESRD develop slowly as kidney function worsens. Some people may not notice early changes until the disease is advanced. Symptoms of kidney failure may include:
- Feeling very tired or weak
- Nausea, vomiting, or loss of appetite
- Changes in urination (less urine or none at all)
- Swelling in feet, ankles, or hands (edema)
- Shortness of breath if fluid builds up
- Persistent itching or dry skin
- Headache, difficulty sleeping, or trouble concentrating
Symptoms can vary from person to person and may overlap with other health problems.
What are the causes of end-stage kidney disease?
Kidney failure usually develops after damage over time from chronic kidney disease. Long-term conditions that strain or injure the kidneys include:
- Type 1 diabetes
- Type 2 diabetes
- High blood pressure (hypertension)
- Chronic inflammation or infection of the kidneys
- Polycystic kidney disease and other inherited disorders
- Long-term obstruction of the urinary tract or repeated kidney infections
These and other underlying conditions slowly reduce kidney function until the kidneys no longer work well enough to meet the body’s needs.
Diagnosing end-stage kidney failure
Doctors diagnose end-stage renal disease using a combination of clinical exams and medical tests that assess kidney function and structure. Blood and urine tests help confirm that the kidneys are no longer filtering waste effectively, while imaging studies can show changes such as small or scarred kidneys.
Common end-stage renal disease treatments
Along with supportive care and medications, ESRD requires treatments that take over some functions of the kidneys or replace them entirely. Typically, kidney failure is treated with dialysis, which removes waste and excess fluid from the blood when the kidneys can’t. A kidney transplant can offer long-term improvement in quality of life for many people. Penn Medicine’s multidisciplinary teams include nephrologists, transplant surgeons, dialysis specialists, and dietitians who work together to create personalized treatment plans tailored to each person’s health, preferences, and medical needs.