End-stage renal disease (ESRD) occurs when your kidneys are functioning at less than 15% of normal. At this stage, your kidneys are no longer able to work well enough to keep you alive, and you will need dialysis or a kidney transplant.

The most common cause of end-stage renal disease is chronic kidney disease due to high blood pressure or diabetes.


Diabetes has become the most common cause of end-stage renal disease in the developed world, requiring dialysis or transplantation. This results from a steady increase in the aging population as well as better treatment of diabetes: people live longer and often long enough to develop complications such as kidney failure.

High blood pressure

The role of high blood pressure as a cause of end-stage renal disease is subject to debate. It is often difficult to determine whether high blood pressure has caused kidney failure or vice versa.

With end-stage renal disease, symptoms become more severe and can include:

  • confusion
  • difficulty breathing
  • difficulty sleeping
  • drowsiness
  • headaches
  • itchiness
  • nausea and vomiting
  • numbness of the hands or feet
  • skin changes
  • swelling of the feet and hands
  • weight loss

Treatment of end-stage renal disease involves dialysis (hemodialysis or peritoneal dialysis) or a kidney transplant. You may also be put on a low-protein diet and be asked to restrict your fluid, sodium, phosphate, and potassium intake. You may also be prescribed erythropoietin injections to help with anemia.

Written and reviewed by the MediResource Clinical Team