End Stage Renal Disease

End Stage Renal Disease

Disease Definition

End stage renal disease is when the kidneys stop functioning at a level needed for day-to-day life. This is defined as complete or almost complete failure of the kidneys to function (<10% of normal function). End stage renal disease is permanent. People with end stage renal disease will need dialysis or a kidney transplant to survive.





Causes of End Stage Renal Disease

The two main causes of end stage renal disease are diabetes and high blood pressure. Injury or trauma to the kidneys, major blood loss, and reactions to medication can also be causes. End stage renal disease is frequently caused by chronic kidney disease. Chronic kidney disease could cause kidney function to gradually worsen over a period of 10-20 years before it is considered to be end stage renal disease.

Signs & Symptoms of End Stage Renal Disease

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End stage renal disease can present with a variety of signs and symptoms including:
  • Fatigue
  • A general ill feeling
  • Itchy/dry skin
  • Headaches
  • Loss of appetite
  • Nausea/vomiting
  • Unintentional weight loss
  • Nail changes
  • Bone pain
  • Drowsiness/confusion
  • Concentration problems
  • Numbness in hands or feet
  • Muscle twitching/cramping
  • Breath odor
  • Brusing easily
  • Nosebleeds
  • Excessive thirst
  • Frequent hiccups
  • Amenorrhea
  • Sleep problems
  • Edema



Medical Treatment

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  • Hemodialysis-harmful toxins and wastes found in the blood are filtered across a semipermeable membrane and then the blood is returned to the body
    • Temporary access hemodialysis
      • when blood is filtered through a catheter which is put into a large vein in the neck, chest or leg near the groin
      • this is used in case of an emergency or for short periods of time
    • Permanent access hemodialysis
      • when blood is filtered after surgically joining an artery to a vein in the arm
      • this can be done by directly connecting a vein and an artery together and after a few months an arteriovenous fistula (AVF) is formed
      • If the patient is to receive dialysis, the process differs and a human-made bridge, also known as an arteriovenous graft (AVG) is used to connect the artery and vein. Once the AVG is placed, one or two needles are placed in the area to continue with dialysis.
    • Hemodialysis can be administered at a special dialysis center or at home. If administered at a dialysis center, it usually takes 3-4hours each time, three times a week. If administered at home it can be done by using shorter treatments during more days a week (5-7 days a week for 2-3 hours each time) or longer treatments done only at night (3-6 hours each night).
    • Night treatments have shown to be better at removing waste from the blood and tend to be easier on the patient's heart.

Arteriovenous fistula (AVF)

Picture of a surgically created arteriovenous fistula
Picture of a surgically created arteriovenous fistula

Arteriovenous Graft (AVG)
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  • Peritoneal Dialysis-harmful toxins and wastes are filtered through the peritoneum
    • The blood vessels in the abdomen (peritoneum) are used along with dialysate fluid to fill in for the kidneys.
    • This procedure can be performed at home, at work or even if the patient is traveling, but it is not fit for all patients with kidney failure.

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  • Kidney Transplant-one kidney is donated to replace the function of the failing kidneysA kidney can be donated from a living related donor (parent, sibling, or child), a living unrelated donor (friend or spouse), or a deceased donor.
    • Procedure:
      • A healthy kidney is kept in a saline solution, to help preserve the organ, and tests are performed to match the donor and recipient's blood and tissue before it is transplanted.
      • The patient receiving the kidney is given genereal anasthesia and an incision is made in the lower belly area. In this area is where the new kidney is placed and the artery and vein of the new kidney is connected to an artery and vein in the pelvis. The new kidney also has a ureter which is then attached to the patient's bladder.
        • Normally the patient's failing kidneys are left in place unless they are causing damage to the body (ie. high blood pressure or infection)

Nutritional Treatment

In general, the most important nutritional factors in dealing with end stage renal disease are related to maintenance of acceptable weight and serum proteins, minimizing cardiovascular risk, and avoiding renal osteodystrophy (bone mineralization deficiency). Nutrition support across many different areas can help increase the quality of life and overall health of people with end stage renal disease. Some literature even states that nutritional intervention targeting increasing serum albumin levels by 0.2 g/dL or greater may lead to

  • Protein Requirements and Weight Support
    • Patients with End Stage Renal Disease require higher protein needs because of increase losses during dialysis. Those patients that have stable maintenance with hemodialysis are recommended to have 1.2 g protein/kg/day, whereas those with peritoneal hemodialysis are recommended to have 1.2-1.5 g/kg/day of protein intake.
    • Nearly 50% of patients with end stage renal disease are malnourished, and it is thus important to constantly assess nutritional status and intake. In fact, it is recommended that all patients with end stage renal disease have a diet plan and have periodic nutritional assessments. Caloric recommendations for patients with end stage renal disease are lower than the normal 30-35 kcal/kg/day.
  • Sodium and Potassium Recommendations
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    • Hypertension is a risk with patients that have end stage renal disease because of positive sodium balance increased volume retention, and it is thus important to avoid high sodium diets (less than or equal to 2g/day of sodium). Though many patients with ESRD are able to control their hypertension, many are placed on antihypertensive medicine.
    • Potassium excretion is affected in patients with end stage renal disease, so patients should avoid a high-potassium diet. Foods like bananas, melons, bran cereal, squash, legumes, potatoes, orange juice, and spinach should be avoided to prevent hyperkalemic levels and potentially arrhythmia. external image micronutrient-supplementation.jpg

  • Fluid Restriction
    • In order to prevent high blood pressure and congestive heart failure, patients with end stage renal disease need to be onfluid restriction. The recommendation is 700 to 1000 ml/day plus added urine output.
  • Supplementation
    • Micronutrient supplementation is critical for patients with end stage renal disease, as individuals on dialysis commonly suffer from deficiencies. The National Kidney Foundation clinical practice guidelines recommends that patients with end stage renal disease receive 100% Daily Recommended Intake of the following micronutrients: vitamins A, C, E, and K, thiamin (B1), riboflavin (B2), pyridoxin (B6), vitamin B12, folic acid, copper, and zinc.