Kidney Failure: End-Stage Renal Disease - Diabetes and ...

Kidney Failure: End-Stage Renal Disease

Kidney Failure: End-Stage Renal Disease

Date Last Reviewed: 2/23/2005
Date Last Modified: 4/21/2005
Online Medical Reviewer: Winshall, James MD

What Is It?

End-stage renal disease is a condition in which the kidneys no longer function normally. (Renal describes anything having to do with the kidneys.) Usually, in end-stage renal disease, the kidneys are functioning at less than 10% of their normal capacity. When this occurs, dialysis (a mechanical process that performs the kidneys work) or a kidney transplant usually is needed.

In the United States, more than a third of people with end-stage renal disease have diabetes. Renal disease caused by diabetes is called diabetic nephropathy. Diabetes is the leading cause of end-stage renal disease. Up to 10% of all people with type 1 (insulin dependent or juvenile) diabetes eventually develop end-stage renal disease. Kidney disease also can develop in people with type 2 (non-insulin dependent or adult onset) diabetes. With either type, poor control of blood sugar increases the risk of end-stage renal disease.

Among other causes of end-stage renal disease, the most common are:

* High blood pressure (hypertension)
* Vascular disease (atherosclerosis)
* Rheumatic diseases, such as lupus
* Genetic disorders, such as polycystic kidney disease
* Exposure to toxic drugs, including certain antibiotics, chemotherapy, contrast dyes and pain relievers

Symptoms

Symptoms of end-stage renal disease include weight loss, nausea or vomiting, general malaise, fatigue, headache, hiccups, itching, decreased urination, easy bruising or bleeding, lethargy, difficulty breathing and seizures. Symptoms may remain mild until kidney function drops to less than 10% of normal.

Usually, someone has kidney disease for many years before end-stage renal disease occurs. A blood test will show high levels of creatinine and blood urea nitrogen, chemicals usually removed by the kidneys. Dialysis is considered when a specific set of problems has developed, such as:

* Inflammation of the covering of the heart (pericarditis)
* Fluid overload or congestive heart failure, in which fluid backs up behind the heart into the lungs, that cannot be improved enough with medications that encourage elimination of fluid (diuretics)
* Severely elevated blood pressure that is not improved by antihypertensive medications
* Confusion, decreased alertness or seizures
* Bleeding related to kidney failure that cannot be improved through other means
* Severe, unrelenting nausea and vomiting
* Severe abnormalities in blood tests indicating that dialysis will soon be necessary, even if the problems mentioned above have not yet developed

Diagnosis

Kidney disease is diagnosed by analyzing urine and measuring certain blood chemicals, such as creatinine and urea nitrogen. Additional tests may be necessary to determine the exact reason that the kidneys have stopped working.
Expected Duration

End-stage renal disease is a lifelong condition unless a kidney transplant is performed.

Prevention

If you have diabetes, control your blood sugar to reduce your chances of developing end-stage renal disease.

Close monitoring and aggressive treatment of high blood pressure also plays a key role in preventing kidney disease. Lowering blood pressure also prevents kidney disease from getting worse, regardless of why kidney disease developed. Many doctors prescribe medications called angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptors (ARBs) at the first signs of elevated blood pressure or protein in the urine (a sign of kidney injury). A low-protein diet (10% to 12% or less of total calories) also may slow or halt the progression of existing kidney disease, as will quitting smoking and lowering cholesterol levels.
Treatment

The two treatments for end-stage renal disease are dialysis and kidney transplant.

There are two types of dialysis:

* Hemodialysis usually is done at a dialysis center three times a week, in three- to four-hour sessions. During treatments, blood is removed from a vein, run through filters to remove waste products, and then returned to the body.
* Peritoneal dialysis may be done at home, but takes longer and must be done more frequently. During peritoneal dialysis, fluid is pumped into the abdomen and waste products accumulate in the fluid, which is removed later.

Kidney transplants have allowed people with many forms of severe kidney disease to avoid or discontinue dialysis treatment. However, a good genetic match is needed between the donor and the recipient, or the body will reject the new kidney. Most transplant candidates wait one to three years before they qualify for a kidney from an unrelated donor. New drugs that suppress the immune system help to prevent the body from rejecting the donated organ, but an organ recipient can expect to be on anti-rejection medications for life.

When To Call A Professional

If you have diabetes, high blood pressure or other diseases that put you at risk for end-stage renal disease, you should have regular checkups along with urine and blood tests to measure your kidney function. Call your doctor if you notice any decrease in urination or other symptoms of end-stage renal disease, especially if know you have kidney disease or its risk factors.
Prognosis

When kidney failure occurs, treatments offer hope for good recovery. Many people on dialysis and those who have received transplants lead near normal lives. Advancing technology continues to brighten the outlook for those with end-stage renal disease.

Additional Info

National Institute of Diabetes & Digestive & Kidney Disorders
Office of Communications and Public Liaison
Building 31, Room 9A04
31 Center Drive, MSC 2560
Bethesda, MD 20892-2560
Phone: (301) 496-4000
http://www.niddk.nih.gov/

National Kidney Foundation
30 East 33rd St.
New York, NY 10016
Phone: (212) 889-2210
Toll-Free: (800) 622-9010
Fax: (212) 689-9261
http://www.kidney.org/

Source: from Harvard Health Decision Guides, Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell