End-Stage Renal Disease: Risk Factors and Diagnosis

Chronic kidney disease is a progressive syndrome in which the kidneys lose their ability to filter blood, concentrate urine, excrete wastes, and maintain electrolyte balance. End-stage renal disease (ESRD) is the end result of many forms of CKD. It is characterized by severely limited kidney function that is insufficient to maintain life. Thus, patients with ESRD require renal replacement therapy via dialysis or kidney transplantation.

The term uremia refers to the constellation of ESRD sequelae that include shortness of breath, nausea, vomiting, anorexia, weight loss, lethargy, encephalopathy, asterixis, pruritis, pericarditis, seizures, and coma. Further, more than half of patients with ESRD are malnourished, which is associated with increased mortality.

Life expectancy for ESRD patients has improved since the advent of dialysis in the 1960s. Nonetheless, the 5-year survival is less than 50%.

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 (CKD).
• Urinary tract disorders: urolithiasis and urinary tract obstruction.
• Systemic medical disorders: diabetes mellitus, hypertension, autoimmune disorders (eg, systemic lupus erythematosus), and systemic infections.
• Nephrotoxic medications, for example NSAIDs and contrast dye.
• Tobacco use.

Diagnosis

ESRD is defined by a glomerular filtration rate that is less than 15 mL/min per 1.73 m2, and the need for replacement therapy.

Creatinine and blood urea nitrogen (BUN) are significantly elevated.

Testing to determine the underlying etiology may include urinalysis, renal imaging, such as ultrasound and CT scan, and renal biopsy.

Due to the kidneys' importance in regulating electrolyte and acid-base balance, ESRD leads to hyperkalemia, hyperphosphatemia, often hypocalcemia, and anion gap metabolic acidosis.