The肾脏filter waste and excess water from your blood as urine. Chronic kidney disease causes your kidneys to lose this function over time. End-stage kidney disease is the final stage of chronic kidney disease. It means your kidneys no longer function well enough to meet the needs of daily life.
End-stage kidney disease is also called end-stage renal disease (ESRD). The kidneys of people with ESRD function below 10 percent of their normal ability, which may mean they’re barely functioning or not functioning at all.
Kidney disease is usually progressive. The length of each stage varies and depends on how your kidney disease is treated, especially in relation to your diet and whether your doctor recommends dialysis.慢性肾病typically doesn’t reach the end stage until 10 to 20 years after you’re diagnosed. ESRD is the fifth stage of the progression of chronic kidney disease, which is measured by yourglomerular filtration rate (GFR):
| Stage | GFR (ml/min/1.73 m2) | Health of kidneys |
| 1 | ≥90 | 肾脏正常工作，但肾病的第一个迹象显示出来 |
| 2 | 60-89 | 肾功能略微减少 |
| 3A / 3B. | 45-59（3A）和30-44（3B） | 肾功能明显减少 |
| 4 | 15-29 | 肾功能极低了 |
| 5 | <15 | ESRD，也称为已建立的肾功能衰竭 |
许多肾脏疾病攻击肾脏，肾脏中的微小过滤单元。这导致血液过滤不良，最终导致ESRD。ESRD最常见的是糖尿病和hypertension(high blood pressure).
如果你有糖尿病，你的身体无法正确地分解葡萄糖（糖），所以你血液中的葡萄糖水平仍然很高。在血液中具有高水平的葡萄糖损坏了您的肾脏。
If you have hypertension, the increased pressure on the small vessels in your kidneys leads to damage. The damage prevents your blood vessels from performing their blood-filtering duties.
ESRD的其他原因包括：
- long-term blockage of the urinary tract by肾结石,前列腺肥大, or certain types of cancer
- glomerulonephritis，肾脏中过滤器的炎症（称为Glomeruli）
- vesicoureteral reflux, when urine flows into your kidneys
- congenital abnormalities
Certain people are at higher risk of developing ESRD, such as people who have:
- 糖尿病
- hypertension
- relatives with ESRD
Your risk of developing ESRD also rises when you have any type of kidney condition, including:
- polycystic kidney disease (PKD)
- Alport syndrome
- interstitial nephritis
- pyelonephritis
- certain autoimmune conditions, such aslupus
According to
You may experience a wide range of symptoms, including:
- adecreasein how much you urinate
- inability to urinate
- fatigue
- malaise, or a general ill feeling
- headaches
- 无法解释的减肥
- loss of appetite
- nausea and vomiting
- dry skin和itching
- changes in skin color
- bone pain
- confusion和难以集中
Other symptoms may include:
- 易于瘀伤
- 频繁流鼻血
- 用手麻木脚
- bad breath
- excessive thirst
- 频繁hiccups
- theabsence月经周期
- sleeping problems, such as阻塞性睡眠呼吸暂停和不安的腿综合征(RLS)
- 低利他性或阳痿
- edema, or swelling, especially in your legs and hands
See your doctor right away if any of these symptoms interfere with your life, especially if you can’t urinate or sleep, are vomiting frequently, or feel weak and unable to do daily tasks.
Your doctor diagnoses ESRD using a physical examination and tests to check your kidney function. Kidney function tests include:
- Urinalysis:This test helps your doctor check for protein and blood in your urine. These substances indicate that your kidneys aren’t processing waste properly.
- Serum creatinine test:This test helps your doctor check whether creatinine is building up in your blood. Creatinine is a waste product that your kidneys should filter out of your body.
- Blood urea nitrogen test:This test helps your doctor check how much nitrogen is in your blood.
- 估计肾小球过滤率（GFR）：This test allows your doctor to estimate how well your kidneys filter waste.
The treatments for ESRD are dialysis or a kidney transplant. In some cases, lifestyle changes and medications may help.
Dialysis
You have two options when you undergodialysis.
One option is hemodialysis, which uses a machine to process your blood. The machine filters out waste using a solution. It then places the clean blood back into your body. This method is usually used three times per week and takes three to four hours each time.
Your doctor may also prescribe peritoneal dialysis. This process involves placing a solution into your abdomen that’s later removed using a catheter. This type of dialysis can be done at home with proper training. It’s often done overnight while you sleep.
Kidney transplant
Kidney transplant surgeryinvolves removing your affected kidneys (if removal is needed) and placing a functioning donated organ. One healthy kidney is all you need, so donors are often living. They can donate one kidney and continue to function normally with the other. According to the National Kidney Foundation, more than17,000 kidney transplantswere performed in the United States in 2014.
Drugs
People with diabetes or hypertension should control their conditions to help prevent ESRD. Both conditions benefit from drug therapy usingangiotensin converting enzyme inhibitors (ACE inhibitors)要么血管紧张素受体阻滞剂（ARBS）.
Kerendia（Finerenone）is a prescription medicine that can reduce the risk of sustained GFR decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in adults with CKD associated with type 2 diabetes.
有些疫苗可以帮助预防ESRD的严重并发症。根据这一点
生活方式改变
液体保留会导致快速变化，因此监测您的体重很重要。您可能还需要增加热量摄入并降低蛋白质消耗。可能需要钠，钾和其他电解质中的饮食，以及流体限制。
限制这些食物以避免消耗过多的钠或钾：
- bananas
- 番茄
- 橘子
- chocolate
- 坚果和花生酱
- 菠菜
- avocadoes
Takingvitamin supplements, such as calcium, vitamin C, vitamin D, and iron, can help your kidney function and the absorption of essential nutrients.
Possible complications of ESRD include:
- skin infections from dry skin and itching
- increased risk of infections
- abnormal electrolyte levels
- joint, bone, and muscle pain
- weak bones
- 神经损伤
- changes in blood glucose level
Less common but more serious complications include:
- liver failure
- 心脏和血管问题
- fluid buildup around your lungs
- hyperparathyroidism
- malnutrition
- anemia
- stomach and intestinal bleeding
- brain dysfunction anddementia
- seizures
- joint disorders
- fractures
Your recovery depends on the type of treatment recommended by your doctor.
With dialysis, you can receive treatment at a facility or at home. In many cases, dialysis allows you to prolong your life by regularly filtering waste from your body. Some dialysis options allow you to use a portable machine so that you can continue your daily life without having to use a large machine or go to a dialysis center.
Kidney transplants are also likely to succeed. Failure rates of transplanted kidneys are low, ranging from3％到21％in the first five years. A transplant allows you to resume normal kidney function. If you follow your doctor’s recommendations for diet and lifestyle changes, a kidney transplant can help you live free from ESRD for many years.
进步让ESRD的人活得更长than ever before. ESRD can be life-threatening. With treatment, you’ll likely live for many years afterward. Without treatment, you may only be able to survive without your kidneys for a few months. If you have other accompanying conditions, such as heart issues, you may face additional complications that can affect your life expectancy.
It can be easy to withdraw as you experience the effects of ESRD or the lifestyle changes that come with dialysis. If this happens, seek professional counseling or positive support from your family and friends. They can help you stay actively engaged in your daily life. This can ensure that you maintain a high quality of life.
In some cases, ESRD isn’t preventable. However, you should control your blood glucose levels and your blood pressure. You should always call a doctor if you have any ESRD symptoms. Early detection and treatment can delay or prevent the disease from progressing.