End-stage renal disease, also called end-stage kidney disease, occurs when chronic kidney disease — the gradual loss of kidney function — reaches an advanced state. In end-stage renal disease, your kidneys are no longer able to work as they should to meet your body's needs.
Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When your kidneys lose their filtering capabilities, dangerous levels of fluid, electrolytes and wastes can build up in your body.
With end-stage renal disease, you need dialysis or a kidney transplant to stay alive. But you may also choose to forgo dialysis or transplant and opt for conservative care to manage your symptoms — aiming for the best quality of life possible during your remaining time.
The Dialysis Process
To undergo dialysis, a physician first creates access to a patient’s blood vessel using one of three methods:
- a fistula, which is made by joining together an artery and vein to make a bigger high-flow blood vessel.
- a graft, in which a soft plastic tube is placed between an artery and a vein, creating an artificial high-flow blood vessel.
- Catheter access, in which a narrow plastic tube is inserted into a large vein in the neck or groin.
When fistulas and grafts become clogged or narrowed, which can prevent a patient from undergoing successful dialysis, interventional radiologists use image-guided interventions to solve the problem:
- Catheter-directed thrombolysis, which dissolves blood clots that build up in fistulas and grafts by injecting a medicine.
- Angioplasty and stenting, which uses mechanical devices, such as a balloon, to open fistulas and grafts and helps them remain open with a small implantable wire mesh tube called a stent.
Symptoms of End Stage Renal Disease
Early in chronic kidney disease, you may have no signs or symptoms. As chronic kidney disease progresses to end-stage renal disease, signs and symptoms might include:
- Loss of appetite
- Fatigue and weakness
- Sleep problems
- Changes in how much you urinate
- Decreased mental sharpness
- Muscle twitches and cramps
- Swelling of feet and ankles
- Persistent itching
- Chest pain, if fluid builds up around the lining of the heart
- Shortness of breath, if fluid builds up in the lungs
- High blood pressure (hypertension) that's difficult to control