Kidney and bladder health

Updated 05 April 2016

End stage kidney failure

End-stage kidney disease means you are in the final stage of chronic kidney disease and your kidneys are not functioning optimally to meet the needs of daily life



- End-stage renal disease is the point at which the kidneys cannot sustain life any more

- It is a permanent condition

-It is treated with dialysis or a kidney transplant

Alternative name: End-stage renal disease.

What is end-stage renal failure (ESRF)?End-stage renal failure (ESRF) is a permanent condition that refers to the point at which the kidneys cannot sustain life any more.

While it usually follows longstanding chronic renal failure, it can sometimes be the result of acute renal failure. The treatment for ESRF is dialysis or a kidney transplant.


Symptoms are rare in the early stages of chronic renal failure, with most occurring when the disease is advanced. Symptoms can include lethargy, weakness, unpleasant breath, pale itchy skin, shortness of breath, bone pain nausea, vomiting, headache and confusion.


Diagnosis is made when patients with chronic kidney failure develop symptoms of end stage renal disease (ESRD). Normally diagnosis can be done by measuring the levels of urea, creatinine and eGFR.

However, other methods can be used e.g. cystatin C and the diagnosis is then confirmed by consistently high levels of certain blood chemicals. The kidneys are often small on special examination when using sonography or CT scan.  The eGFR is between 10 to 15% of what is expected in normal individuals.

Reversible factors such as dehydration and nephrotoxic drugs are first excluded. ESRD is treated with dialysis and/or transplantation, which can only occur after a suitable donor can be found.


The prognosis of this condition is closely related to the cause of CKD, co-morbid diseases and the age of the patient. Long term dialysis, especially in younger blacks or home dialysis has been associated with an excellent prognosis. Dialysis in the elderly is associated with a poor prognosis. Transplantation produces much better rehabilitation. The best option is to get a transplant from a related living donor.

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Reviewed and revised by Professor A M Meyers,MBBCh, FCP (SA), Cert Nephrology (SA), FRCP (London), Donald Gordon Medical Centre, Klerksdorp Hospital, and National Kidney Foundation of South Africa, March 2015.

Originally written by Dr K. Coetzee, reviewed by Dr R.Moosa, head of the Renal Unit,TygerbergAcademic Hospital.


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