Over 88,000 Americans live with end-stage kidney disease (ESKD), requiring either a kidney transplant or dialysis to survive. With 100,000+ people on transplant waiting lists—87% awaiting kidneys—and approximately 70% of ESKD patients relying on dialysis at a cost of at least $40,000 per year, early detection is crucial for better management and survival.

What is Kidney Failure?

Kidneys primarily clean the blood by filtering out excess fluid and waste products. End-stage kidney disease (ESKD) represents the final stage (stage five) of chronic kidney disease, when kidneys are severely damaged and have lost most of their ability to function properly.

ESKD is particularly common in patients with hypertension, cardiovascular diseases, and diabetes. The condition is characterized by toxin buildup (uremia), meaning that fluids, electrolytes, waste substances, and other toxins that should normally be eliminated remain in the blood, producing serious symptoms that impact overall health.

Nine Warning Signs of Kidney Failure

1. Persistent Fatigue

One of the most common symptoms is ongoing fatigue. When kidneys don't work properly:

• Toxins and waste accumulate in the blood
• Less erythropoietin is produced, leading to fewer red blood cells and anemia
• Everyday tasks become difficult to perform

Therefore, regular physical activity has been shown to improve fatigue in ESKD patients. Some doctors prescribe erythropoiesis-stimulating agents to treat anemia, though their effectiveness for fatigue remains controversial.

2. Muscle Cramps

Painful muscle spasms result from imbalanced blood electrolyte levels. Common causes include:

• Alkalosis (blood becoming too alkaline) after dialysis
• Low magnesium levels (hypomagnesemia)
• Abnormal potassium levels (either too high or too low)

Treatment options:

• Adding magnesium to dialysis solution
• Adjusting medications to help balance electrolytes

3. Swelling (Edema)

As kidney function decreases, you might experience swelling, especially in legs, ankles, and feet. This occurs because:

• Failing kidneys can't remove extra sodium and fluid
• Fluid retention in tissues forms edema

Management approaches:

• Diuretic medications to increase urination
• Reducing salt intake to approximately 2.3 grams per day

4. Loss of Appetite

Decreased appetite is common in advanced kidney disease due to:

• Waste and toxin accumulation in the blood
• Oral or gastrointestinal problems
• Dialysis treatment
• Mental health concerns

Diabetic patients with CKD have higher risk of decreased appetite due to diabetic gastroparesis, where food empties from the stomach more slowly, creating constant fullness, nausea, and abdominal pain.

Important: Maintaining proper nutrition is essential, as poor nutrition can worsen CKD. Following a kidney specialist's nutritional advice is crucial.

5. Persistent Itching (Pruritus)

More than 40% of hemodialysis patients experience constant itching, sometimes severe enough to disrupt sleep. Causes may include:

• Increased inflammatory molecules and immune cells in the blood
• Imbalance in opioid receptors
• Accumulation of toxins and electrolytes

Treatment options:

• Adjusting dialysis dose
• Medications like gabapentin or pregabalin
• Phototherapy
• Opioid receptor modulators

6. Shortness of Breath (Dyspnea)

This dangerous symptom has several possible causes:

• Fluid accumulation in lungs (pulmonary edema)
• Scarring or hypertension in lungs
• Anemia reducing oxygen delivery
• Inflammatory substances in blood leading to protein-energy wasting syndrome

Best treatments: Respiratory support plus management of specific causes

7. Cognitive Issues

Patients may experience cognitive deficits including:

• Trouble concentrating
• Memory loss
• Difficulty learning or making decisions
• Confusion or dementia

These issues result from waste product accumulation, blood vessel damage in the brain, anemia, depression, and sleep problems.

Prevention and treatment:

• Intensive control of hypertension reduces risk of mild cognitive impairment
• Kidney transplants can improve memory function

8. Uremic Fetor and Taste Abnormalities

When kidneys aren't eliminating waste:

• High ammonia levels cause urine-like breath odor
• Patients may experience metallic taste (dysgeusia)
• Abnormal saliva composition contributes to taste issues

Possible solutions:

• Bicarbonate mouthwash
• Regular dental checkups to maintain oral health

9. Skin Changes

Approximately 40% of ESKD patients experience skin issues:

• Discoloration and pale skin due to anemia
• Darkening of skin (hyperpigmentation) from hormonal imbalances
• Yellowish skin tone from accumulated substances
• Very dry skin (xerosis) from reduced function of oil and sweat glands

Management approaches:

• Increasing hemoglobin levels to improve pallor
• Using sunscreen to prevent worsening hyperpigmentation
• Reducing bathing frequency
• Using moisturizing lotions
• Avoiding irritating fabrics

Essential Tests for Early Detection

1. Serum Creatinine Level
   • Measures creatinine (waste product) in blood
   • Used to calculate glomerular filtration rate (GFR)
   • High creatinine and low GFR indicate CKD
2. Blood Urea Nitrogen (BUN) Level
   • Measures urea nitrogen in blood
   • Elevated levels suggest poor kidney filtration
3. Urine Protein Level
   • Detects protein in urine (proteinuria)
   • Healthy kidneys excrete minimal protein
   • Proteinuria indicates kidney dysfunction
4. Ultrasound
   • Uses sound waves to image kidneys
   • Detects structural problems or irregular blood flow
   • Helps identify CKD risk

Treatment Options for Kidney Disease

1. Medications

Crucial for managing both symptoms and complications:

• Anti-hypertensive medications for high blood pressure
• Diuretics to reduce fluid accumulation
• Erythropoiesis-stimulating agents for anemia
• Anti-hyperglycemic drugs for diabetes management

2. Kidney Transplant

The preferred treatment for ESKD:

• Replaces damaged kidney with healthy donor kidney
• Eliminates need for dialysis
• Offers longer survival and better quality of life
• Requires donor match, surgery, and lifelong immunosuppressive medication

Important warning: Avoid seeking transplants in China, where organs are harvested illegally from prisoners of conscience to fuel a billion-dollar transplant business.

3. Dialysis

Necessary when kidneys can no longer effectively filter waste:

• Hemodialysis: Uses machine to filter blood outside the body; typically performed at clinics several times weekly
• Peritoneal dialysis: Uses abdominal cavity and peritoneal membrane for filtration; can be performed overnight at home

4. Lifestyle Changes

Patients benefit greatly from:

• Kidney-friendly diet to prevent malnutrition and complications
• Regular exercise to improve blood pressure, physical capacity, heart function
• Quitting smoking to reduce progression risk
• Limiting intake of protein, sodium, potassium, fluids, and phosphate as recommended

Conclusion

Recognizing and understanding ESKD symptoms can significantly improve quality of life. Early detection and management of fatigue, itching, edema, or shortness of breath allows for more comfortable living with the disease.

Stay in close contact with your kidney specialist and follow their advice on treatments and lifestyle changes. Whether through medication, dialysis, or dietary and habit modifications, taking proactive steps can make a meaningful difference in managing ESKD and improving overall well-being.