Kidney Diseases

Kidney Failure – Understanding End Stage Renal Disease (ESRD)

Although careful management of CKD may delay its progression, kidney disease may eventually progress to the point where renal replacement therapy (RRT), such as either dialysis or transplantation, is required. The stage at which the kidneys fail so that they can no longer sustain life unaided is known as "end stage renal disease," or ESRD.

Diagnosing End Stage Renal Disease

How can we determine when someone has reached end stage renal disease, and when dialysis is needed? Although renal failure occurs gradually and there is usually no exact moment when it becomes clear that dialysis is needed, the patient's lab results provide an important guide.

Lab tests for ESRD

BUN and Serum Creatinine - Two blood tests that are monitored in CKD patients are the BUN and serum creatinine [link], which reflect the kidneys' waste-excreting function.

Estimated Glomerular Filtration Rate (eGFR) - The filtering and waste-removal functions of the kidneys are also measured by the "estimated glomerular filtration rate" (eGFR), which can be calculated by a formula [link].

Understanding the results

The kidneys have reached the stage of needing help when:

BUN increases from its normal value of less than 20 mg/dL (7.1 mmol/L) to more than 70-80 (29 mmol/L).
Creatinine increases from its normal of less than 1.0 mg/dL (88 mg/L) to more than 7 (619 mg/L).
eGFR falls to less than 15 ml/1.73 m2.

Eventually the deterioration of lab values is accompanied by the onset of symptoms of advanced kidney failure and ESRD, such as the following:

Loss of appetite, nausea and vomiting
Metallic taste in the mouth, ammonia-like odor to the breath
Severe fatigue, inability to stay awake and to concentrate
Swelling of the legs, arms, and face
Shortness of breath
Itching
Muscle twitching

Not all of these symptoms occur in a single patient, and not all occur at the same time. In general, the aim of managing a patient with CKD is to arrange to start dialysis as renal function declines (as measured by the lab tests above) but before the patient develops the symptoms of ESRD, or "uremia."

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Last Reviewed: Sep 09, 2009

Mildred Lam, MD
Associate Professor
Nephrology Division
MetroHealth Medical Center
School of Medicine
Case Western Reserve University