End–Stage Renal Disease: Diagnosis and Treatment

Diagnosis

• The evaluation begins with a medical history and a physical examination.
  
• Blood testing to measure kidney function is generally performed.
• Testing to determine the underlying cause may include urine testing, ultrasound and CT scan of the kidneys, and kidney biopsy.

Treatment

In general, ESRD is irreversible. Treatment is aimed at treating the complications and replacing renal function via dialysis or transplantation.

• Kidney transplantation is often the treatment of choice. Early identification of kidney replacement candidates is important so that adequate preparation and planning can be done. Referral to a nephrologist should occur as early as possible in order to plan for long–term therapy.
• There are two options for dialysis. Both methods have advantages and disadvantages, and outcomes are similar.
  
  The most widely used method is hemodialysis, which involves the creation of a dialysis port, usually in the arm, and treatment at a dialysis center, typically three times a week.
  
  The other option is continuous peritoneal dialysis, which involves inserting the dialysis material into the patient’s abdomen and allowing dialysis to occur continuously or intermittently without need for the patient to travel regularly to a dialysis center.
• It is essential to treat ESRD complications that may arise. These include hypertension, excessive body fluids, electrolyte imbalances (e.g., high potassium, low calcium, and high phosphate), and anemia.
• Psychiatric disorders are common and can interfere with treatment. Adherence to recommended diet and fluid restrictions increases life expectancy and can help to reduce medical complications, treatment side effects, and improve quality of life. However, psychiatric disorders may interfere with treatment compliance.
  
  Depression is the most common psychiatric problem in ESRD patients. Antidepressant treatment with medications and psychotherapy combined is not only effective in improving mood, but also improves nutritional status in dialysis patients.
• Exercise should be encouraged in ESRD patients. Exercise training in patients with ESRD and hypertension reduces blood pressure and has other cardiovascular benefits, such as reducing the risk for cardiac arrhythmias and functioning of the heart. Exercise also reduces the occurrence of depression.