End renal disease, commonly referred to as end-stage renal disease (ESRD) or end-stage kidney disease (ESKD), describes advanced kidney failure in which the kidneys have lost most of their ability to perform their normal functions.

Kidney failure is generally defined when kidney function falls to less than about 15% of normal, corresponding broadly to an eGFR below 15 mL/min/1.73 m². However, an eGFR value by itself does not determine when dialysis must begin. The decision depends on symptoms, laboratory abnormalities, fluid balance, quality of life and the overall clinical situation.

At this stage, the kidneys may no longer adequately remove waste products and excess fluid or maintain normal electrolyte and acid-base balance.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized evaluation and management for patients with advanced kidney disease and kidney failure.

How Does Chronic Kidney Disease Reach the End Stage?

End renal disease usually develops after significant, progressive kidney damage.

Common conditions that can contribute include:

• Diabetes-related kidney disease

• Long-standing high blood pressure

• Glomerular diseases

• Polycystic kidney disease

• Recurrent or severe kidney injury

• Chronic urinary obstruction

• Certain inherited kidney disorders

• Autoimmune kidney diseases

• Other long-standing kidney conditions

Not everyone with chronic kidney disease progresses to kidney failure.

The speed of progression varies depending on the underlying disease, albuminuria, blood-pressure control, diabetes, cardiovascular health, recurrent acute kidney injury and other factors.

What Happens When Kidney Function Becomes Very Low?

Healthy kidneys perform several important functions beyond simply producing urine.

They help:

• Remove metabolic waste

• Control fluid balance

• Maintain electrolyte levels

• Regulate acid-base balance

• Contribute to blood-pressure regulation

• Support red blood cell production

• Maintain bone and mineral balance

When kidney function becomes severely reduced, abnormalities can develop in several of these areas.

As waste and excess fluid accumulate, a person may begin to develop symptoms and complications.

Symptoms of End Renal Disease

Symptoms can develop gradually, and some people may not recognize how serious the kidney dysfunction has become until laboratory tests reveal advanced disease.

Possible symptoms include:

Swelling

Fluid retention can cause swelling around the:

• Feet

• Ankles

• Legs

• Hands

• Face

Significant fluid accumulation may also contribute to breathlessness.

Changes in Urine

A person may notice:

• Reduced urine output

• Very little urine

• Changes in frequency of urination

• Foamy urine in some kidney diseases

• Changes in urine appearance

However, urine output does not always accurately reflect the degree of kidney failure.

Persistent Tiredness

Anemia and the effects of advanced kidney disease can contribute to significant fatigue and reduced physical capacity.

Nausea and Reduced Appetite

Accumulation of waste products can contribute to:

• Nausea

• Loss of appetite

• Altered taste

• Weight loss

Itching

Persistent itching can occur in advanced kidney disease and may be particularly troublesome in patients receiving dialysis.

Muscle Cramps and Weakness

Changes in electrolytes, fluid balance and other complications can contribute to cramps, weakness or abnormal sensations.

Difficulty Concentrating

Advanced kidney dysfunction can affect mental clarity and may cause confusion or difficulty concentrating in severe cases.

Does End Renal Disease Always Cause Symptoms?

No.

Kidney disease can progress silently, and symptoms may appear only after substantial loss of kidney function.

This is one reason regular monitoring is important for people with diabetes, hypertension, known CKD, proteinuria or other kidney-risk factors.

Blood tests and urine tests can detect changes before severe symptoms develop.

How Is End Renal Disease Diagnosed?

Diagnosis involves more than a single creatinine result.

eGFR

Estimated glomerular filtration rate is one of the primary measurements used to assess kidney filtration.

An eGFR below 15 mL/min/1.73 m² is generally within the kidney-failure range.

Serum Creatinine

Creatinine is used to estimate kidney filtration, but its interpretation depends on factors such as age, muscle mass, medications and the clinical situation.

Urine Testing

Urine tests may evaluate:

• Albumin

• Protein

• Blood

• Infection

• Other abnormalities

Electrolytes and Acid-Base Tests

Advanced kidney disease can cause abnormalities involving:

• Potassium

• Sodium

• Bicarbonate

• Calcium

• Phosphorus

Hemoglobin

Anemia is common in advanced CKD and may contribute to fatigue and weakness.

Imaging

Ultrasound or other imaging may be recommended when doctors need to assess kidney size, obstruction, structural abnormalities or another underlying cause.

What Is the Difference Between Stage 5 CKD and End Renal Disease?

The terms are related but should not always be treated as interchangeable.

Stage 5 CKD generally refers to an eGFR below 15 mL/min/1.73 m².

Kidney failure refers to kidney function that is insufficient to meet the body's needs.

End-stage renal disease is commonly used when kidney failure is being treated with dialysis or kidney transplantation. NIDDK uses ESRD to describe kidney failure treated with dialysis or a kidney transplant.

A nephrologist therefore considers the patient's symptoms, complications and treatment needs rather than relying solely on a label.

Does End Renal Disease Mean Dialysis Must Start Immediately?

Not necessarily.

One of the most important misconceptions about advanced kidney disease is that dialysis begins automatically when creatinine or eGFR reaches a particular number.

Current KDIGO guidance recommends that dialysis initiation should be based on a composite assessment involving symptoms, signs, quality of life, patient preferences, GFR and laboratory abnormalities.

Dialysis may become necessary when complications cannot be adequately controlled through medical treatment.

Potential indications include:

• Symptoms attributable to kidney failure

• Medically resistant electrolyte abnormalities

• Significant acid-base abnormalities

• Uncontrolled fluid overload

• Difficult-to-control blood pressure related to kidney failure

• Uremic complications

• Progressive nutritional deterioration

• Significant cognitive or neurological complications

Main Treatment Options for End Renal Disease

Once kidney function reaches kidney-failure territory, treatment planning generally focuses on kidney replacement therapy or comprehensive conservative management.

The main approaches include:

1. Hemodialysis

2. Peritoneal dialysis

3. Kidney transplantation

4. Conservative kidney management

NIDDK identifies hemodialysis, peritoneal dialysis and kidney transplantation as kidney replacement options, while conservative management provides symptom-focused care without dialysis or transplant.

Hemodialysis for End Renal Disease

Hemodialysis uses a dialysis machine and a specialized filter to remove waste products and excess fluid from the blood.

Treatment may be performed:

• In a dialysis center

• At home in selected patients

Many center-based patients receive hemodialysis several times each week, but the exact prescription depends on individual needs.

Vascular Access

Hemodialysis requires reliable access to the bloodstream.

Possible access types include:

• Arteriovenous fistula

• Arteriovenous graft

• Dialysis catheter

When kidney failure is progressing, planning access before dialysis becomes urgently necessary can help avoid emergency catheter-based dialysis.

Peritoneal Dialysis

Peritoneal dialysis uses the lining of the abdomen, called the peritoneum, as a natural filtering membrane.

Dialysis fluid is introduced into the abdominal cavity through a catheter.

Waste products and excess fluid move into the dialysis solution, which is then drained and replaced.

Peritoneal dialysis can be performed at home and may offer flexibility for selected patients.

The suitability of this option depends on medical conditions, home circumstances, patient preference and the ability to perform the treatment safely.

Kidney Transplantation for End Renal Disease

A kidney transplant places a functioning donor kidney into a person with kidney failure.

For appropriately selected patients, transplantation can provide an alternative to long-term dialysis.

A transplant may come from:

• A living donor

• A deceased donor

However, transplantation is not suitable for everyone. Candidates require comprehensive medical evaluation to determine whether surgery and lifelong anti-rejection treatment can be undertaken safely.

A transplant is a treatment for kidney failure rather than a guaranteed permanent cure, and ongoing medical follow-up is required.

Can Kidney Transplant Be Done Before Dialysis?

In selected patients, preemptive kidney transplantation may be considered before dialysis begins.

Early planning is important because transplant evaluation, donor assessment and other preparations can take time.

NIDDK notes that transplant evaluation may begin before dialysis, and transplant centers can place appropriate patients on a waiting list before dialysis when kidney function is sufficiently reduced.

A nephrologist and transplant team can determine whether this approach is appropriate.

Conservative Management of End Renal Disease

Dialysis and transplantation are not the only possible approaches.

Conservative kidney management focuses on:

• Symptom control

• Managing complications

• Supporting quality of life

• Individualized medicines

• Nutrition and fluid management

• Psychosocial support

• Advance care planning

This approach does not use dialysis or kidney transplantation and may be considered according to a person's health, goals, preferences and overall circumstances.

The decision should be made through a detailed discussion between the patient, family and healthcare team.

Can End Renal Disease Be Reversed?

Established end-stage kidney disease caused by irreversible chronic kidney damage generally cannot simply be reversed with a medicine or home remedy.

However, doctors may sometimes identify acute or potentially reversible factors contributing to a sudden deterioration in kidney function.

For example, dehydration, certain medications, infection or urinary obstruction may worsen kidney function and require urgent treatment.

This is why a sudden deterioration should not automatically be assumed to represent permanent irreversible kidney failure.

What Complications Can Occur in End Renal Disease?

Advanced kidney failure can affect multiple body systems.

Potential complications include:

• Fluid overload

• High potassium

• Metabolic acidosis

• Anemia

• Bone and mineral abnormalities

• High blood pressure

• Malnutrition

• Uremic symptoms

• Cardiovascular complications

• Persistent itching

• Sleep disturbance

Regular nephrology follow-up helps identify and manage these complications.

Diet and Fluid Management in End Renal Disease

There is no single kidney-failure diet that is appropriate for everyone.

Dietary recommendations may need to consider:

• Potassium

• Sodium

• Phosphorus

• Protein

• Calories

• Fluid intake

• Diabetes

• Dialysis status

Fluid intake is particularly important.

A person with significant fluid retention may require a fluid restriction, while another patient may have different requirements.

Therefore, do not force yourself to drink large quantities of water because you have kidney disease.

Likewise, do not severely restrict fluids or nutrients without professional guidance.

Medicines in End Renal Disease

Medication management becomes especially important when kidney function is severely reduced.

Some medicines require:

• Dose adjustment

• Different timing

• Avoidance

• Additional laboratory monitoring

Patients should tell their nephrologist about:

• Prescription medicines

• Over-the-counter painkillers

• Herbal products

• Vitamins

• Supplements

Do not stop essential medicines or start supplements without professional advice.

Preparing for Kidney Replacement Therapy

Early preparation can make the transition to kidney replacement therapy safer.

Planning may include:

• Understanding dialysis choices

• Discussing home versus center-based treatment

• Planning vascular access

• Discussing peritoneal dialysis

• Starting transplant evaluation

• Reviewing medicines

• Assessing nutrition

• Preparing the patient and family for treatment

NIDDK recommends early education and preparation for people approaching kidney failure because decisions about dialysis modality, access and transplantation can require time.

When Should a Person With Advanced Kidney Disease See a Nephrologist?

Specialist care is particularly important when there is:

• eGFR below 30

• Rapidly declining kidney function

• Persistent significant proteinuria

• Difficult-to-control blood pressure

• Recurrent electrolyte abnormalities

• Severe anemia related to CKD

• Progressive swelling or fluid overload

• Symptoms suggestive of uremia

• eGFR approaching the kidney-failure range

• Need for dialysis or transplant planning

Early specialist involvement allows time to investigate the cause, manage complications and plan appropriate kidney replacement therapy.

When Is End Renal Disease an Emergency?

Seek urgent medical attention if advanced kidney disease is accompanied by:

• Severe breathlessness

• Chest pain

• Confusion or altered consciousness

• Very little or no urine

• Severe weakness

• Persistent vomiting

• Rapidly worsening swelling

• Severe symptoms associated with high potassium

• Sudden deterioration in overall health

These symptoms can indicate serious complications that may require immediate treatment.

End Renal Disease Care at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized care for patients with advanced CKD and kidney failure.

Depending on the patient's condition, care may involve:

• Evaluation of declining kidney function

• Review of creatinine and eGFR trends

• Proteinuria and urine assessment

• Management of CKD complications

• Blood-pressure and diabetes-related kidney care

• Fluid and electrolyte management

• Dialysis planning

• Hemodialysis-related evaluation

• Peritoneal dialysis counselling

• Kidney transplant evaluation

• Conservative kidney management discussions

• Long-term nephrology follow-up

Treatment decisions are based on kidney function, symptoms, complications, medical history and patient preferences.

Frequently Asked Questions

What is end renal disease?

End renal disease generally refers to advanced kidney failure in which kidney function has fallen to the kidney-failure range and kidney replacement therapy such as dialysis or transplantation may be required.

What eGFR is considered end-stage kidney disease?

An eGFR below 15 mL/min/1.73 m² is generally considered the kidney-failure range. However, dialysis does not automatically begin at a particular eGFR value.

Does end renal disease always require dialysis?

Not immediately and not in every situation. Dialysis initiation depends on symptoms, complications, laboratory abnormalities, fluid status, quality of life and patient preferences. Conservative management and transplantation are also possible approaches for selected patients.

Can a person with end-stage kidney disease receive a transplant?

Yes, appropriately selected patients may undergo kidney transplantation after a comprehensive medical evaluation.

Is kidney failure reversible?

Permanent kidney failure from advanced chronic kidney damage is generally not reversible. However, an acute deterioration caused by a treatable problem may improve if the cause is identified and treated promptly.

What are the common symptoms of end renal disease?

Possible symptoms include swelling, fatigue, nausea, poor appetite, itching, muscle cramps, reduced urine output, weakness, difficulty concentrating and breathlessness. Some people may have few symptoms despite severe kidney dysfunction.

Can end renal disease be treated without dialysis?

Selected patients may receive conservative kidney management focused on symptom control, quality of life and management of complications without dialysis or transplantation.

When should dialysis planning begin?

Planning should begin before dialysis is urgently required. KDIGO suggests considering preparation for kidney replacement therapy, including dialysis access or preemptive transplantation, when GFR is approximately below 15–20 mL/min/1.73 m² or when predicted kidney-replacement risk is sufficiently high.

Conclusion

End renal disease represents advanced kidney failure in which the kidneys can no longer adequately perform their essential functions.

An eGFR below 15 mL/min/1.73 m² is generally within the kidney-failure range, but a laboratory value alone does not determine when dialysis should begin. Symptoms, fluid balance, electrolyte and acid-base abnormalities, nutritional status, quality of life and patient preferences all contribute to the decision.

Treatment options may include hemodialysis, peritoneal dialysis, kidney transplantation or conservative kidney management, depending on the patient's medical condition and treatment goals.

Early nephrology care is important because dialysis access, home dialysis planning and transplant evaluation may require significant preparation.

For individualized evaluation and advanced kidney care, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is intended for general educational and informational purposes only and should not be considered a substitute for professional medical diagnosis, treatment or individualized medical advice. End renal disease and kidney failure require specialist assessment, and dialysis should not be started or delayed based solely on an eGFR or creatinine value. Treatment decisions depend on symptoms, laboratory abnormalities, fluid status, nutritional condition, other medical problems and patient preferences. Do not change prescription medicines, fluid intake, diet or dialysis treatment without guidance from your healthcare team. Seek urgent medical attention for severe breathlessness, chest pain, confusion, very little or no urine, severe weakness, persistent vomiting, rapidly worsening swelling or sudden deterioration in health. Consult Dr. Sandip Prabhakar Bhurke or another qualified nephrologist for personalized kidney care.