From the Guidelines
End-stage renal disease (ESRD) typically presents with a constellation of symptoms resulting from the kidneys' inability to filter waste products and maintain fluid balance, including fatigue, weakness, shortness of breath, swelling, and changes in urination patterns, as well as gastrointestinal, skin, and cognitive effects. Patients with ESRD often experience a range of symptoms due to the buildup of waste products in the bloodstream, including:
- Fatigue and weakness due to anemia
- Shortness of breath due to fluid overload
- Swelling (edema) in the legs, ankles, feet, and around the eyes
- Changes in urination patterns, such as producing little to no urine or experiencing increased urination at night
- Gastrointestinal symptoms like nausea, vomiting, loss of appetite, and a metallic taste in the mouth
- Skin changes, including dryness, itching, and a yellowish-gray hue
- Cognitive effects, such as confusion, difficulty concentrating, and sleep problems
- Muscle cramps, bone pain, and easy bruising due to mineral imbalances and platelet dysfunction
- High blood pressure, which is nearly universal in ESRD as the kidneys can no longer regulate blood pressure effectively 1. These symptoms typically worsen as kidney function deteriorates, ultimately requiring dialysis or transplantation to sustain life when kidney function falls below 10-15% of normal capacity. It is essential to note that the diagnosis of ESRD is not solely based on the presence of these symptoms but also on the level of kidney function, as defined by the national kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification 1.
From the Research
Symptoms of End-Stage Renal Disease (ESRD)
The patient in question, diagnosed with end-stage renal disease (ESRD) at the age of 35, would likely exhibit a range of symptoms associated with this condition. These symptoms can be understood by considering the effects of ESRD on the body's ability to filter waste and excess fluids.
- Cardiovascular Issues: ESRD patients often experience cardiovascular disease, which can manifest as coronary artery disease, heart failure, or other cardiac conditions 2. The symptoms may include chest pain, shortness of breath, or fatigue.
- Hypertension: Almost all ESRD patients are hypertensive, which can lead to further cardiovascular complications 3, 4, 5. High blood pressure may not always present with noticeable symptoms but can lead to more severe health issues if not managed properly.
- Anemia and Fatigue: Anemia is a common complication in ESRD patients, resulting from the kidneys' reduced ability to produce erythropoietin, a hormone that stimulates red blood cell production 6. Symptoms of anemia include fatigue, weakness, and shortness of breath.
- Fluid Overload: The kidneys' inability to remove excess fluid can lead to swelling in the legs, ankles, and feet, as well as fluid buildup in the lungs (pulmonary edema), which can cause shortness of breath 4.
- Electrolyte Imbalances: ESRD can disrupt the balance of electrolytes such as potassium, sodium, and calcium, leading to muscle cramps, weakness, and heart arrhythmias 3.
- Uremic Symptoms: As waste products build up in the blood, patients may experience uremic symptoms such as nausea, vomiting, and changes in mental status 4.
These symptoms highlight the complex nature of ESRD and the need for comprehensive management, including dialysis, medication, and lifestyle adjustments, to alleviate symptoms and slow disease progression.