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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, 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 using the Nephron Information Center MDRD GFR Calculator – (with SI Units) and the National Institutes of Health GFR MDRD Calculators for Adults.


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 approximately 80-100 (35 mmol/L).
  • Creatinine increases from its normal value of less than 1.0 mg/dL (88 mmol/L) to approximately 10 (884 mmol/L).
  • eGFR falls to less than 10-15 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 to end stage (as measured by the lab tests above) but before the patient actually develops the symptoms of ESRD, or “uremia.”


Kidney failure information:


Learn more about the kidneys:


Hope Through Research – You Can Be Part of the Answer!

Many research studies are underway to help us learn about End Stage Renal Disease. Would you like to find out more about being part of this exciting research? Please visit the following links:


For more information:

Go to the Kidney Diseases health topic.