I.

Definition
End Stage Renal Disease (ESRD) - also known as Chronic Kidney Disease
(CKD) specifically, the 5th stage of CKD. It means it is the complete failure of the
kidneys to function. The kidneys can no longer remove wastes, concentrate urine,
and regulate many other important body functions.
ESRD almost always follows CKD. A person may have gradual worsening of
kidney function for 10-20 years or more before progressing to ESRD. Patients who
have reached this stage needs dialysis or renal transplant.

II. Risk Factors

Person with the following conditions:
• Chronic glumerulonephritis
• Acute Renal Failure
• Excessive intake of drugs
• Changed smoker and alcoholic beverages drinker
• Polycystic kidney disease
• Obstruction
• Repeated episodes of pyelonephritis
• Diabetes Mellitus- is the leading cause and accounts for more
than 30% of the client who receive dialysis.
• Hypertension
• Lupus erythematous
• Polyarteristis
• Sickle cell disease
• Amyloidosis

III. Signs and Symptoms

Electrolyte Imbalances
• Hyperkalemia
• Hyponatremia
• Hypocalcemia
• Hyperphosphalemia
• Hypercalcemia
 • Mildly elevated serum Mg

Metabolic Changes
• Increased serum creatinine
• Proteinuria
• Increased uric acid
• Carbohydrate intolerance
• Elevated triglycerides
• Metabolic acidosis
• Pericarditis

Hematologic Changes
• Anemia
• Iron of folate depletion
• Hemolysis and platelet abnormality

Gastrointestinal Changes
• Transient anorexia, nausea and vomiting
• Constant bitter taste
• Fetid, fishy or ammonia like breath smell
• Metallic or salty taste
• Increased serum amylase
• Constipation

Immunologic Changes
• Depression of hormonal body function
• Suppression of delayed hypersensitivity
• Decreased chemotactic function of the leukocytes

Changes in Medication Metabolism

• Medication toxicity
Cardiovascular
• Hypertension
• Arterial calcifications
• Left ventricular hypertrophy and heart failure
• Chest pain
• Dysrrhythmias
• Atherosclerosis
• Anasarca

Respiratory Changes
• Pulmonary edema
• Pleuritis

Musculoskeletal Changes
• Osteomalacia
• Osteoleitis fibrosa
• Osteoporosis
• Osteoclerosis
• Muscle cramps

Integumentary Changes
• Intractable pruritus
• Brittle hair
• Pallor
• Nails are thin

Neurologic
• Peripheral neuropathy
• Inability to concentrate
• Twitching