End–Stage Renal Disease: Overview and Risk Factors

Chronic kidney disease is a syndrome in which the kidneys lose their ability to function. Normally, the kidneys filter the blood, produce urine, excrete wastes, and maintain electrolyte balance. End–stage renal disease (ESRD) is the most severe form of chronic kidney disease. It is characterized by severely limited kidney function that is insufficient to maintain the kidney’s normal actions. Thus, patients with ESRD require renal replacement therapy via dialysis or kidney transplantation.

Life expectancy for ESRD patients has improved since the advent of dialysis in the 1960s. Nonetheless, the five–year survival is less than 50 percent.

Symptoms may include shortness of breath, nausea, vomiting, poor appetite, weight loss, lethargy, confusion, itching, electrolyte imbalances, seizures, and coma. Further, more than half of patients with ESRD are malnourished, which is associated which increased risk of death.

Risk Factors

African–Americans have a significantly higher prevalence of chronic kidney disease compared with other racial groups, due, in part, to higher rates of hypertension. Other risk factors for chronic kidney disease and ESRD include:

• Older age
  
• Family history of chronic kidney disease
  
• Urinary tract disorders (e.g., kidney stones and urinary tract obstruction)
  
• Systemic medical disorders: diabetes mellitus, hypertension, autoimmune disorders (e.g., systemic lupus erythematosus), and systemic infections
  
• Medications that can be toxic to the kidneys: for example, nonsteroidal anti–inflammatory drugs (e.g., ibuprofen) and contrast dye
  
• Tobacco use