End Stage Kidney Disease - Causes, Symptoms, Diagnosis and Prevention

End-Stage Kidney Disease (ESKD)

Dr.Sanjiv Saxena profile Authored by Dr.Sanjiv Saxena on 12 Feb 2015 - 15:14.

End Stage Kidney Disease ESKD

End-stage kidney disease (ESKD) or end-stage renal disease (ESRD) as the name suggests is the last stage (stage-five) of kidney disease, when a kidney function reduces to less than 10 percent of its normal capacity. When ESKD occurs, both the kidneys fail to perform optimum functions or may not perform at all, causing life-threatening consequences, including death.  It is a progressive and slow disease that may take years (about 10 to 20) after the diagnosis of chronic kidney disease (CKD). ESKD is prominent in those with prolonged kidney disease and among the elderly males above 70 years.

How does ESKD differ from CKD?

In CKD, despite having a damaged kidney or injury, the kidneys may perform optimum functions to sustain one’s life. On the other hand, CKD may lead to ESKD where the kidneys fail to perform its basic functions and often needs dialysis or kidney transplant to restore life.



A range of conditions, underlying causes and other factors may affect kidneys, causing damage, which progressively may lead to ESKD. The most common causes of kidney damage are believed to be diabetes mellitus (high levels of blood glucose may damage the units of kidney/nephrons), diabetic nephropathy and high blood pressure (hypertension). Apart from these, other causes may include:

As discussed, ESKD is a progressive disease that may result as a consequence of prolonged medical condition(s) or certain medications. Having any of the above listed disease or condition may increase the risk of developing ESKD. 



The end-stage kidney disease may present with several signs and symptoms. These may include:

  • Fatigue and weakness
  • Decreased urine output
  • Difficulty in passing urine
  • Dry skin                          
  • Skin irritation
  • Abnormally darkening or lightening of the skin
  • Headache
  • Sudden and unexpected weight loss
  • Reduced hunger
  • Nausea and vomiting
  • Altered nail structure
  • Joints/bone pain
  • Altered mental state e.g. confusion, lack of concentration, etc.
  • Muscle pain or cramps
  • Numbness
  • Foul breath
  • Appearance of blood in the stool
  • Nose bleeding
  • Feeling thirsty
  • Hiccups
  • Amenorrhea in women (absence of menstrual periods)
  • Disturbed sleep pattern
  • Swelling of feet and hands
  • Impotency

When to see a doctor?

Regular kidney screening can any underlying disease or condition that may lead to ESKD; especially, those who have diabetes or hypertension. See your doctor if you notice difficulty in urination, decreased urine output or any other symptom of ESKD. 

Complications: End-stage kidney disease may lead to following complications:

  • Various skin infections
  • Hepatitis B and/ or Hepatitis C
  • Liver failure
  • Wide range of heart diseases
  • Edema (buildup of fluid)
  • Malnutrition
  • Nerve injury
  • Increased levels of thyroid hormone
  • Anemia
  • Internal bleeding
  • Epilepsy/ Seizures
  • Bone disorders
  • Muscle weakness
  • Stroke



Diagnosis of ESKD may involve a series of tests and exams. These may include:

  • Physical exam
  • Blood pressure check
  • Blood tests – To look for altered blood levels of several components, including potassium, calcium, sodium, albumin, phosphorus, electrolytes, cholesterol, etc.
  • Blood test – To look for eGFR (Estimated Glomerular Filtration Rate) and erythropoietin (EPO) in blood.
  • Parathyroid hormone (PTH) blood test – To check for parathyroid hormone levels.
  • Urine tests – To look for abnormal findings in urine output that may indicate extensive kidney damage.
  • A bone mineral density (BMD) test




There are two mainstream treatments for ESKD: Dialysis and kidney transplants.

Dialysis: is a procedure to enable artificial functioning of the kidney.

Kidney transplant: It is procedure of replacing a diseased kidney with a healthy kidney donated by compatible donor.

Other treatment options: may include the following:

  • Drugs and medications
  • Treatment of anemia: These may include iron diet, medication erythropoietin, and blood transfusion.
  • Lifestyle interventions such as:
  • Eating a diet low in sodium, potassium, phosphorous and some other electrolytes
  • Restricting high protein food
  • Consuming plenty of caloric food
  • Eating foods rich in calcium and vitamin D

Alternative medicine: Certain herbs and supplements help to keep kidneys healthy and prevent extensive damage. E.g. Folic acid, multi-vitamin supplements, L-carnitine, blond psyllium, N-acetyl cysteine, etc.

(Note: None of the alternative treatment is recommended by Dr Sanjiv Saxena. Hence, reach out to a respective specialist/s before choosing any alternative treatment approach.)



The following measures can be implemented to prevent ESKD:

  • Eating healthy (as recommended by dietician)
  • Keeping track of your blood glucose level and blood pressure
  • Managing the underlying diseases effectively
  • Ensuring all the medications and treatments are taken on time
  • Exercising daily (ask your doctor before choosing forms of exercise suitable for you)
  • Restricting alcohol consumption
  • Avoiding smoking
  • Getting yourself vaccinated against hepatitis, flu and pneumonia.




*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.