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End-stage kidney disease is the final stage of chronic kidney disease, when the kidneys are no longer able to clean the blood properly or keep the body’s fluids and minerals balanced. This usually happens when the filtering function, called the glomerular filtration rate (GFR), becomes very low.

The most common causes are long-standing diabetes and high blood pressure, which slowly damage the small blood vessels and filters in the kidneys. Over time, the kidneys develop scarring and fewer working units, which leads to kidney failure.

When this happens, waste products and fluids build up in the body. This causes swelling in the legs and lungs, tiredness, itching, and sometimes chest pain if the lining of the heart becomes irritated. The body cannot get rid of extra acid or potassium, so patients may develop dangerous heart rhythm problems. The kidneys also stop making enough of the hormone that helps form red blood cells, which causes anemia and makes people feel weak or short of breath. On top of that, the body cannot keep calcium and phosphorus in balance, which leads to bone problems over time.

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A machine outside the body cleans the blood through a special filter. Most people go to a dialysis center three times a week for about four hours. The nurse connects them to the machine through a blood vessel access, usually a fistula in the arm. Some people are trained to do this at home

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The inside lining of the belly is used as a natural filter. A soft tube stays in the abdomen, and fluid is put in and drained out several times a day, or with a machine overnight while sleeping. People do this themselves at home after training, with regular check-ins at the clinic.

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A donated kidney is placed by surgery. If successful, this can free a person from dialysis, but it requires lifelong daily medicines to prevent rejection.

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Anemia (low blood count): Iron (IV during dialysis), ESAs (shots under skin or into vein).

Bone/mineral problems: Phosphate binders (pills with meals), Vitamin D (Oral pills or IV during dialysis), Cinacalcet (oral pill) or Etelcalcetide (IV after dialysis).

Too much acid: Sodium bicarbonate oral tablets at home.

High potassium: Oral pills like patiromer or sodium zirconium at home.

Itching: Difelikefalin (IV after dialysis).

Blood pressure: Daily oral pills (diuretics, beta blockers, calcium channel blockers).

Transplant meds: Daily oral pills (tacrolimus, mycophenolate, prednisone) to prevent rejection.

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Norris, T. Porth’s Pathophysiology. (Course textbook – used for the explanation of disease mechanisms and symptoms.)

Flythe, J.E., & Watnick, S. (2024). Dialysis for chronic kidney failure: A review. JAMA, 332(18), 1559–1573. doi:10.1001/jama.2024.16338

KDIGO. (2024). Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International, 105(4S), S117–S314.

KDIGO. (2025). Clinical Practice Guideline for Anemia in Chronic Kidney Disease (Public Review Draft).

KDOQI. (2020). Vascular Access Guideline Update. American Journal of Kidney Diseases.

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Diet: Low salt, potassium, and phosphorus.

Fluids: Watch how much you drink, weigh yourself daily.

Access care: Keep dialysis site clean to prevent infection.

Clinic check-ins: Monthly if doing home dialysis.

Vaccines: Very important because infections are harder to fight.

Dialysis start: Not just lab numbers—start when symptoms (swelling, tiredness, acid or potassium issues) appear.