Understanding End-Stage Kidney Disease: Causes and Symptoms

 More than 500,000 people in the United States are living with End-Stage Renal Disease (ESRD), a condition that marks the advanced stages of chronic kidney disease (CKD), where the kidneys can no longer adequately perform their vital functions to support the body’s needs. This debilitating ailment significantly impacts the quality of life and is associated with premature mortality.  This article is dedicated to providing a comprehensive understanding of ESKD, shedding light on its causes, symptoms, and available treatment options.

What is End-Stage Kidney Disease?

End-stage kidney disease (ESKD), also known as end-stage renal disease (ESRD), signifies the final stage of chronic kidney disease. At this point, the kidneys have lost their ability to function effectively, posing significant health challenges for affected individuals.

The Underlying Causes

ESRD typically arises as a consequence of prolonged, untreated chronic kidney disease. During this period, which can span anywhere from 10 to 20 years, the kidneys gradually deteriorate, culminating in end-stage disease. While there can be various factors contributing to ESRD, major predominant causes are particularly prevalent in the United States:

  1. Diabetes: Diabetes is a widespread condition that can significantly affect kidney health. Prolonged high blood sugar levels can lead to kidney damage over time, making it one of the leading causes of ESRD.
  2. High Blood Pressure (Hypertension): Elevated blood pressure places excessive strain on the delicate blood vessels within the kidneys. Over time, this can impair their functionality and lead to ESRD.
  3. Genetic or Mitochondrial mutations
  4. Vascular diseases
  5. Glomerular diseases
  6. Cystic kidney diseases (PCKD)
  7. Recurrent kidney infection, also called pyelonephritis

Recognizing the Symptoms

End-stage kidney disease manifests a range of distressing symptoms that can significantly impact a person’s quality of life. It’s crucial to be aware of these signs, which may include:

  • General Malaise and Fatigue: A persistent feeling of tiredness and weakness.
  • Itching (Pruritus) and Dry Skin: Uncomfortable itching and dry, flaky skin.
  • Headaches: Frequent headaches may be experienced.
  • Unexplained Weight Loss: Losing weight without intentional efforts to do so.
  • Loss of Appetite: A reduced desire to eat or a lack of interest in food.
  • Nausea: Frequent episodes of nausea can occur.
  • Other Symptoms: Additional symptoms might involve changes in skin color, nail abnormalities, bone pain, cognitive issues, muscle cramps, breath odor, excessive thirst, and more.
Stages of Chronic Kidney Disease (CKD)
Chronic kidney disease is classified into five stages based on the GFR level:
Stage 1: Kidney damage with normal GFR (greater than 90 ml/min)
Stage 2: Mild reduction in GFR (60-89 mL/min)
Stage 3a: Moderate reduction in GFR (45 to 59 mL/min)
Stage 3b: Moderate reduction in GFR (30 to 44 mL/min)
Stage 4: Severe reduction in GFR (15 to 29 mL/min)
Stage 5: Renal failure (GFR less than 15 mL/min)
Diagnosis and Examination

To determine ESRD, healthcare providers typically perform a thorough physical examination along with specific blood tests. It’s worth noting that individuals with ESRD often have high blood pressure, which is a common indicator of the condition. In addition to the routine blood tests, certain tests are essential in monitoring and managing ESRD:

  • Potassium Levels: Maintaining safe potassium levels is crucial for overall health.
  • Sodium Levels: Sodium balance is crucial for maintaining fluid balance.
  • Albumin Levels: Albumin is a protein that can reflect kidney function.
  • Phosphorous Levels: Controlling phosphorous is essential to avoid complications.
  • Calcium Levels: Proper calcium levels are critical for bone health.
  • Cholesterol Levels: Monitoring cholesterol is vital to assess cardiovascular health.
  • Magnesium Levels: Adequate magnesium levels are necessary for various bodily functions.
  • Complete Blood Count (CBC): This test provides valuable information about overall health and the blood’s components.
  • Electrolytes: Maintaining the balance of electrolytes is essential for bodily functions.

For early detection of chronic kidney disease (CKD) and …

68 naturopathic interventions spanning over 14 amazing chapters, supported by hundreds of medical studies published in journals of medicine, biochemistry and nephrology, to improve kidney’s health

Treatment Options for ESRD

End-stage kidney disease necessitates appropriate treatment to manage its complications and enhance the patient’s quality of life. The primary treatment options for ESRD include:


Dialysis serves as a crucial intervention when the kidneys can no longer function effectively. It can help in several ways, such as:

  • Removing Excess Substances: Dialysis eliminates excess salt, water, and waste products from the body to prevent their accumulation.
  • Balancing Minerals and Vitamins: It helps in maintaining safe levels of essential nutrients.
  • Blood Pressure Control: Dialysis aids in regulating blood pressure.
  • Stimulating Red Blood Cell Production: It supports the production of red blood cells.

Dialysis is typically initiated when kidney function drops to 10% to 15% or less. Even individuals awaiting kidney transplants may require dialysis in the interim. There are two primary methods of dialysis: hemodialysis and peritoneal dialysis, each with its unique approach.

  • Hemodialysis: During hemodialysis, the patient’s blood is circulated through an artificial kidney, or filter, which can be performed either at home or in a dialysis center.
  • Peritoneal Dialysis: This method involves introducing a special solution into the patient’s abdominal cavity through a catheter tube. After a specified time, the solution is removed. Peritoneal dialysis offers flexibility, allowing patients to perform it at home, work, or while traveling.

Kidney Transplant

A kidney transplant involves the surgical placement of a healthy kidney into an individual with end-stage kidney disease. This procedure provides a long-term solution, and the recipient must undergo thorough evaluations to determine eligibility.

Special Diet

Maintaining a specialized diet is often necessary for individuals with ESRD. This diet may include:

  • Low-Protein Foods: Consuming foods with reduced protein content.
  • Caloric Intake Management: Ensuring an adequate calorie intake, especially if there’s unintentional weight loss.
  • Fluid Restriction: Limiting fluid intake.
  • Sodium, Potassium, and Phosphorous Management: Monitoring these electrolytes to maintain a balanced diet.

Other Treatments

Depending on the patient’s specific symptoms, additional treatments may be recommended, including:

  • Supplementing Calcium and Vitamin D: These supplements may be necessary but should always be discussed with a healthcare provider. (Hypocalcemia should also be monitored. A 25-OH vitamin D level less than 10 ng/mL warrants initiation of ergocalciferol 50,000 IU weekly for 6 to 8 weeks before switching to cholecalciferol 800 to 1000 IU daily. Hyperparathyroidism should be treated with calcitriol, vitamin D analogs, or calcimimetics.) Ref:1
  • Phosphate Binders: Medications that help control high phosphorous levels (Hyperphosphatemia).
  • Anemia Treatment: Approaches to address anemia include iron supplements, erythropoietin injections, and blood transfusions.
  • Blood Pressure Medications: Managing blood pressure is vital to prevent complications.
  • Diaphoresis Therapy: Medical-grade NIR Sauna Therapy (or Diaphoresis Therapy) is a scientifically validated alternate therapy for ESKD patients. Additionally, compared to expensive Hemodialysis, it’s much cheaper especially for less-wealthy segments of patients. One researcher observed –

    It is not unlikely that in wealthier societies where dialysis treatment is readily available and is not paid for by individual patients, a rather small proportion of CKD or ESKD patients might be willing to accept diaphoresis therapy. However, in less wealthy societies, where some patients either do not have access to chronic dialysis treatments or may be required to pay for part or all of the costs of such treatment, the willingness of patients to undergo diaphoresis therapy

Alternate interventions (like Diaphoresis) for various stages of Chronic Kidney Disease

68 naturopathic interventions spanning over 14 amazing chapters, supported by hundreds of medical studies published in journals of medicine, biochemistry and nephrology, to improve kidney’s health

Support Groups

Support groups can provide valuable emotional and practical support to individuals dealing with ESRD. Engaging with a kidney disease support group can help in coping with the challenges and uncertainties that the condition presents.

Outlook and Potential Complications

End-stage kidney disease is a serious condition that, without appropriate intervention through dialysis or a kidney transplant, can lead to dire consequences. The outlook varies from person to person, and it’s essential to consult healthcare providers to determine the most suitable treatment plan.

Potential complications associated with ESRD include:

  • Anemia
  • Gastrointestinal bleeding
  • Bone, joint, and muscle pain
  • Glucose abnormalities
  • Peripheral neuropathy
  • Pulmonary edema
  • Cardiovascular issues
  • High potassium levels
  • Infection susceptibility
  • Liver damage
  • Malnutrition
  • Reproductive issues
  • Restless legs syndrome
  • Neurological complications
  • Edema and swelling
  • Bone fragility due to mineral imbalances

Understanding the complexity of ESRD and its potential complications underscores the importance of early diagnosis and prompt intervention to optimize the chances of a favorable outcome.


In conclusion, end-stage kidney disease is a critical medical condition that necessitates comprehensive care and informed decision-making. By grasping the causes, symptoms, and treatment options available, individuals affected by ESRD can make informed choices and better manage their health. Remember that this information serves as a general overview, and consulting a healthcare provider for personalized guidance is crucial.


  1. Hashmi MF, Benjamin O, Lappin SL. End-Stage Renal Disease. [Updated 2023 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499861/

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