Kidney Failure (ESRD) Treatment in India

Overview of the Condition

What is End-Stage Renal Disease (ESRD)?

End-stage renal disease (ESRD), also known as kidney failure or end-stage kidney disease (ESKD), is the most advanced stage of chronic kidney disease. It occurs when the kidneys no longer function well enough to meet the body's needs.

Why is it important?

ESRD is a serious condition because the kidneys can no longer effectively remove waste products and excess fluid from the body. People with ESRD usually require dialysis or a kidney transplant to stay alive. Some people may choose conservative (supportive) care to help manage their symptoms.

Causes / Why it happens

Underlying causes

ESRD develops when chronic kidney disease progresses, and the kidneys can no longer function adequately. Common causes include:

Type 1 or type 2 diabetes
High blood pressure
Autoimmune diseases, such as lupus, sarcoidosis, and Sjögren syndrome
Polycystic kidney disease and other inherited kidney diseases
Long-term blockage of the urinary tract, such as from an enlarged prostate or urinary tract tumors
Backward flow of urine into the kidneys
Certain medicines, such as lithium and high doses of ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs)

Risk factors

Factors that increase the risk of developing ESRD include:

Diabetes
High blood pressure
Heart disease
Polycystic kidney disease
Smoking
Being overweight
Family history of kidney disease
Changes or abnormalities in the shape or size of the kidneys
Older age
Frequent use of medicines that can damage the kidneys

These factors may contribute to the progression of chronic kidney disease to ESRD.

Complications

ESRD can affect many parts of the body and may lead to the following complications:

High blood pressure
Acid buildup (metabolic acidosis), which can affect bone health
High blood potassium levels (hyperkalemia), which can affect the heart and may be life-threatening
Anemia (low blood count)
Heart disease
Sexual health problems, including erectile dysfunction, reduced sex drive, or reduced fertility
Pregnancy complications

Signs and symptoms

Common symptoms

In the early stages of kidney disease, there may be no signs or symptoms. As kidney disease progresses, symptoms become more noticeable and may include:

Vomiting or upset stomach
Loss of appetite
Feeling tired and weak
Changes in how much you urinate
Swelling of the feet and ankles
High blood pressure that is difficult to control
Trouble sleeping
Reduced mental sharpness
Muscle twitches and cramps
Constant itching

Warning signs

Seek medical attention if you experience:

Chest pain, which may occur if fluid builds up around the lining of the heart
Shortness of breath, which may occur if fluid builds up in the lungs

Symptoms of kidney disease are often vague, and they may not appear until the kidneys have sustained irreversible damage.

When to see a doctor

Patients should consult a healthcare provider if they experience symptoms of kidney disease. Early diagnosis and treatment may help slow the progression to kidney failure.

People with medical conditions that increase the risk of kidney disease may require regular monitoring of kidney function, including:

Urine tests
Blood tests
Blood pressure checks

Talk to your healthcare provider to determine if regular kidney function monitoring is appropriate for you.

Diagnosis and investigations

Clinical evaluation

To diagnose ESRD, the healthcare provider may:

Review your medical history
Ask about your family history
Perform a physical examination
Perform a neurological examination

Tests

Blood tests: Kidney function tests measure waste products such as creatinine and urea
Urine tests: A urine sample is checked for signs of chronic kidney disease and possible underlying causes
Imaging tests: Ultrasound is commonly used to assess the size and structure of the kidneys. CT scans or MRI scans may be performed in some cases
Kidney biopsy: A small sample of kidney tissue may be removed and examined in a laboratory to determine the cause of kidney disease

Some tests may be repeated over time to monitor changes in kidney function and help guide treatment.

Treatment options

ESRD cannot be cured. Treatment aims to keep you alive, slow disease progression where possible, and manage symptoms.

Medications

Depending on the cause of kidney disease, your healthcare provider may prescribe:

ACE inhibitors, ARBs, or other blood pressure medicines to control blood pressure
Diuretics to remove excess fluid from the body
Statins to lower cholesterol levels
Erythropoietin-stimulating agents and iron supplements to treat anemia
Vitamin D and calcium to help prevent bone loss
Phosphate binders to reduce excess phosphorus in the blood

Non-surgical management

Dialysis to remove waste products and excess fluid from the blood
Conservative (supportive) care to manage symptoms and improve quality of life for people who choose not to undergo dialysis or kidney transplantation
Regular blood tests and blood pressure checks to monitor kidney function and overall health

When a procedure/surgery is needed

Kidney transplant may be recommended for suitable patients with ESRD

Lifestyle modifications

Follow a kidney-friendly diet as recommended by your healthcare provider
Reduce sodium (salt) intake to help reduce the workload on the kidneys
Make appropriate food and fluid choices to support kidney function
Consult a renal dietitian for personalized dietary advice based on your kidney condition

Follow up

Attend regular follow-up appointments with your healthcare team to monitor your condition and ongoing treatment
If needed, you may be referred to a nephrologist, a doctor who specializes in kidney diseases, for continued care and management

Myths and Facts

Myth

End-stage renal disease happens suddenly.

Fact

ESRD usually develops gradually as chronic kidney disease progresses over time.

Myth

A diagnosis of ESRD means there are no treatment options.

Fact

Although ESRD cannot be cured, treatments such as dialysis, kidney transplantation, or supportive care can help manage the condition and improve quality of life.

Myth

If I still make urine, my kidneys are working normally.

Fact

Some people with ESRD may continue to produce urine, but their kidneys may no longer remove enough waste products and excess fluid from the body.

Myth

Only older adults develop ESRD.

Fact

Although the risk increases with age, ESRD can occur in people of any age, especially those with diabetes, high blood pressure, or certain kidney diseases.