End-stage kidney disease : Treatment

Treatment

Dialysis or kidney transplantation is the only treatment for ESRD. Your physical condition and other factors determine which treatment is used.

When you start dialysis depends on different factors, including your lab test results, severity of symptoms, and readiness. You should begin to prepare for dialysis before it is absolutely necessary. The preparation includes learning about dialysis and the types of dialysis therapies, and placement of a dialysis access.

See also: Dialysis

Treatment usually includes an ACE inhibitor, angiotensin receptor blocker, or other medications for high blood pressure.

You may need to make changes in your diet.

  • Eat a low-protein diet
  • Limit fluids
  • Limit salt, potassium, phosphorous, and other electrolytes
  • Get enough calories if you are losing weight

See Diet and chronic kidney disease for more detail.

Other treatments may include:

  • Treatment for anemia, such as extra iron in the diet, iron pills, special shots of a medicine called erythropoietin, and blood transfusions.
  • Special medicines called phosphate binders, to help prevent phosphorous levels from becoming too high
  • Extra calcium and vitamin D (always talk to your doctor before taking)

Different treatments are available for problems with sleep or restless leg syndrome.

Patients with chronic kidney disease should be up-to-date on important vaccinations, including:

  • Pneumococcal polysaccharide vaccine (PPV)
  • Influenza vaccine
  • H1N1 (swine flu) vaccine
  • Hepatitis B vaccine
  • Hepatitis A vaccine

Support Groups

For additional resources, see kidney disease support group.

Prognosis (Expectations)

Without dialysis or a kidney transplant, death will occur from the buildup of fluids and waste products in the body. Both of these treatments can have serious risks and consequences. The outcome is different for each person.

Complications

  • Anemia
  • Bleeding from the stomach or intestines
  • Bone, joint, and muscle pain
  • Brain dysfunction, confusion, and dementia
  • Changes in electrolyte levels
  • Changes in blood sugar (glucose)
  • Damage to nerves of the legs and arms
  • Fluid buildup around the lungs
  • Heart and blood vessel complications
    • Congestive heart failure
    • Coronary artery disease
    • High blood pressure
    • Pericarditis
    • Stroke
  • Hepatitis B, hepatitis C, liver failure
  • Hyperparathyroidism
  • Increased risk of infections
  • Malnutrition
  • Phosphorous levels become too high
  • Potassium levels become too high
  • Seizures
  • Skin dryness, itching/scratching, leading to skin infection
  • Weakening of the bones, fractures, joint disorders


Review Date : 8/12/2009
Reviewed By : Parul Patel, MD, Private practice specializing in Nephrology, Kidney and Pancreas Transplantation, affiliated with California Pacific Medical Center Department of Transplantation, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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