Kidney failure (ESRD) - Symptoms, causes and treatment options

Kidney failure, also called end-stage renal disease (ESRD) or end-stage kidney disease (ESKD), is the fifth and last stage of chronic kidney disease (CKD). Kidney failure cannot be reversed and is life-threatening if left untreated. However, dialysis or a kidney transplant can help you live for many more years.

What is kidney failure?

Kidney failure is when your kidneys have stopped working well enough for you to survive without dialysis or a kidney transplant. Your kidneys have lost their ability to filter waste from your blood. Kidney failure is also called end-stage kidney disease (ESKD) or end-stage renal disease (ESRD). It is stage 5 of chronic kidney disease (CKD).

What are the symptoms of kidney failure?

Symptoms of kidney failure may include:

• Itchy skin or rashes
• Muscle cramps
• Feeling sick to your stomach or throwing up
• Not feeling hungry than normal
• Swelling in your feet and ankles
• Urinating (peeing) more or less than normal
• Foamy, frothy or bubbly-looking urine
• Trouble catching your breath
• Trouble falling or staying asleep

Call your doctor right away if you notice any of these symptoms, especially if you already have kidney problems.

What causes kidney failure?

Kidney failure is usually caused by other health problems that have damaged your kidneys little by little throughout many years, including:

• Diabetes, which is the most common cause  
• High blood pressure, which is the second most common cause
• Autoimmune diseases, such as lupus and IgA nephropathy
• Genetic diseases (diseases passed down from one or both parents), such as polycystic kidney disease
• Nephrotic syndrome
• Problems in your urinary tract (organs that make urine and remove it from your body), such as kidney stones

• Smoking tobacco
• Drinking too much alcohol (no more than 1 drink a day for women, and no more than 2 drinks a day for men)

These health problems do not always lead to CKD or kidney failure. 

Sometimes a kidney problem called acute kidney injury (AKI) can also cause kidney failure. This type of kidney failure happens quickly, usually within two days, and is most common in people who are already hospitalized for other health problems. AKI is also known as acute kidney failure or acute renal failure. 

Talk with your doctor about how to help your kidneys work for as long as possible.

How will I know if I have kidney failure?

To see if you have kidney failure, doctors may do tests:

• eGFR blood test
• Urine test

• Kidney biopsy, which is a procedure where doctors take a small piece of tissue from your kidneys to look at it under a microscope

How do doctors treat kidney failure?

You will need to see a nephrologist (kidney doctor). Your nephrologist will talk with you about your treatment choices, which include:

• Dialysis, which is a treatment that uses a machine to clean your blood
• A kidney transplant:
  • Deceased donor kidney transplant, which is a surgery to give you a healthy kidney from someone who has just died
  • Living donor kidney transplant, which is a surgery to give you a healthy kidney from someone who is still alive 

How long can I live after my kidneys fail?

When your kidneys fail, they cannot get better. Your life expectancy depends on many things, including your age. However, treatment can help people with kidney failure live for many more years:

• Dialysis helps people live for another five to 10 years on average.
• Deceased donor kidney transplants last 10 to 15 years on average. 
• Living kidney donor transplants last 15 to 20 years on average. 

If you choose not to get treatment for kidney failure, you can get medical management. This is supportive care and treatment to relieve your symptoms, but it will not keep you alive. There is no way to know how long you will live if you choose medical management. Your doctor will help you stay as healthy as possible.

How do I cope with kidney failure?

Learning you have kidney failure can be a shock, even if you have known for a long time that your kidneys were not working well. You may feel sad or anxious. 

Reach out for support from your health care team and your family, friends and community. They can help you make changes to feel your best while you get dialysis and may be waiting for a kidney transplant.

To feel your best, your doctors will recommend that you:

• Go to every dialysis visit and consider getting a kidney transplant.
• Have visits with a nephrologist.
• Meet with a dietitian to help you create and follow a kidney-friendly eating plan.
• Keep your blood pressure at a healthy level. They may prescribe blood pressure medicines
• Keep your blood sugar at a healthy level if you have diabetes.
• Be active for 30 minutes on most days of the week.

• Drink less alcohol and quit smoking or using tobacco.

• Learn about mental health and kidney disease.

How do I adjust to starting dialysis?

Starting dialysis often means creating a new normal for yourself and your family. There is a lot to think about, such as choosing a type of dialysis and making time for it in your daily life. Learn about the FIRST30 program for people new to dialysis.

What should I eat when I have kidney failure?

Dialysis does some of the work your kidneys did when they were healthy, but it cannot do everything that healthy kidneys do. You will need to limit what and how much you eat and drink while on dialysis. 

Your doctor can help you find a dietitian to create a kidney-friendly eating plan.