Chronic kidney failure, also known as end-stage kidney disease (ESKD), occurs when the kidneys permanently lose their ability to filter waste and excess fluid from the blood. When kidney function declines to this stage, the body can no longer maintain proper balance on its own. Without treatment, waste products and toxins accumulate in the bloodstream, affecting nearly every organ system.

At this advanced stage, treatment typically requires dialysis or a kidney transplant to sustain life.

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Signs You Might Have Chronic Kidney Failure

Kidney failure develops gradually in most cases. Because the kidneys are highly adaptable, symptoms often appear only after significant damage has already occurred.

When your kidneys cannot effectively filter waste and toxins, these substances build up in the bloodstream and disrupt normal body functions. This can lead to a wide range of symptoms, including:

• Urinating less often or not at all

• Frequent headaches, lower back pain, or muscle cramps

• Swelling in the legs, ankles, feet, hands, or face

• Itchy, dry, or discolored skin

• Nausea, vomiting, fatigue, and weakness

• Loss of appetite and excessive thirst

• Shortness of breath

• Breath that smells fishy or like ammonia (urine-like odor)

• Difficulty concentrating or sleeping

• Nosebleeds, easy bruising, or blood in stools

• Sexual dysfunction or decreased libido

These symptoms may worsen over time if the condition is not treated.

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Why Do the Kidneys Fail Over Time?

Your kidneys perform several essential functions. They:

• Filter waste and excess fluid from the blood

• Balance electrolytes such as sodium, potassium, and calcium

• Help regulate blood pressure

• Stimulate red blood cell production

• Support strong, healthy bones

Chronic kidney failure happens when long-term damage prevents the kidneys from performing these vital roles. As kidney function declines, toxins and fluid accumulate in the body, leading to complications that affect the heart, lungs, brain, and other organs.

Several major risk factors increase the likelihood of developing kidney failure:

Diabetes

High blood sugar levels damage the tiny blood vessels inside the kidneys. Over time, this reduces their ability to filter blood properly.

High Blood Pressure

Elevated blood pressure narrows and stiffens kidney blood vessels, reducing blood flow. This creates a harmful cycle: kidney damage raises blood pressure further, which then causes even more kidney damage.

Glomerulonephritis

This condition causes inflammation of the glomeruli—the tiny filtering units inside the kidneys. If untreated, it can lead to permanent damage.

Autoimmune Disorders

Conditions such as lupus nephritis and IgA nephropathy occur when the immune system mistakenly attacks kidney tissue, causing progressive injury.

Polycystic Kidney Disease

This inherited disorder causes numerous cysts to grow inside the kidneys. As the cysts enlarge, they damage healthy kidney tissue and can eventually lead to kidney failure.

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Steps to Confirm a Diagnosis

Diagnosing chronic kidney failure requires medical evaluation and laboratory testing. A doctor will review your medical history, discuss symptoms, and perform tests to assess kidney function.

Estimated Glomerular Filtration Rate (eGFR)

The eGFR test measures how well your kidneys filter blood. It estimates how much blood passes through the glomeruli each minute by measuring creatinine levels—a waste product produced by muscles.

Healthy kidneys filter about half a cup of blood every minute. When kidney function declines, creatinine builds up in the bloodstream.

Because creatinine levels vary between individuals, doctors use a formula that includes age, sex, body size, and other factors to calculate your eGFR.

• Normal eGFR: 90 or higher

• eGFR below 60: Moderate to severe kidney damage

• eGFR of 15 or lower: Kidney failure

A diagnosis of kidney failure is typically confirmed when eGFR remains at 15 or below for three months or longer.

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Urine Tests

Urine tests help detect protein, blood, and other abnormal substances that signal kidney damage.

Common tests include:

• Urinalysis: Screens for protein, blood, bacteria, and glucose

• Urine Albumin-Creatinine Ratio (uACR): Measures albumin levels relative to creatinine

• 24-Hour Urine Collection: Evaluates total urine output and measures substances like protein, sodium, calcium, uric acid, and more

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Additional Testing

To determine the underlying cause of kidney failure, doctors may order:

• Imaging tests (ultrasound, CT scan, MRI) to examine kidney structure

• Kidney biopsy, where a small tissue sample is examined under a microscope

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Treatment Options

There is currently no cure for chronic kidney failure. However, treatment can extend life expectancy and significantly improve quality of life.

Dialysis

Dialysis replaces some kidney functions by removing waste and excess fluid.

Hemodialysis:
Blood is filtered through a machine (dialyzer) at a dialysis center several times per week.

Peritoneal Dialysis:
A catheter is surgically placed in the abdomen. A cleansing solution (dialysate) is introduced into the abdominal cavity, where it absorbs waste before being drained. This method can be performed at home.

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Kidney Transplant

A kidney transplant involves surgically placing a healthy donor kidney into your body. Most patients undergo dialysis before receiving a transplant.

Transplants are highly successful:

• Living donor kidney: Typically lasts 15–20 years

• Deceased donor kidney: Typically lasts 8–12 years

A transplant can restore near-normal kidney function and greatly enhance quality of life.

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Conservative Management

For some individuals, dialysis or transplantation may not be appropriate. Conservative management focuses on symptom control and preserving remaining kidney function.

Treatment may include:

• Medications for nausea, appetite loss, or fluid retention

• Managing anemia and other complications

• Specialized kidney-friendly dietary plans

• Blood pressure and blood sugar control

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How Can You Prevent Kidney Failure?

Kidney disease is often called a “silent” condition because symptoms may not appear until damage is advanced. Early detection and healthy lifestyle habits are crucial.

Prevention strategies include:

• Regular medical check-ups and kidney function testing

• Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins

• Managing diabetes and high blood pressure carefully

• Engaging in at least 30 minutes of physical activity most days

• Avoiding smoking

• Staying hydrated and limiting excessive salt intake

Early intervention can slow or even prevent progression to kidney failure.

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Related Conditions to Watch For

Kidney failure increases the risk of several complications, including:

• Gout (a painful type of arthritis)

• High phosphorus levels

• Anemia

• Bone disease and fractures

• Heart disease

• Metabolic acidosis

• Secondary hyperparathyroidism

• High potassium levels (which can affect heart rhythm)

Careful monitoring helps reduce these risks.

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Living Well With Chronic Kidney Failure

Although kidney failure is a serious condition, many people live fulfilling lives with proper treatment and support. Dialysis and transplantation have dramatically improved life expectancy and quality of life.

Managing kidney failure requires:

• Following a kidney-friendly diet

• Adhering strictly to treatment plans

• Attending regular medical appointments

• Monitoring fluid intake

• Seeking emotional and psychological support

Living with a chronic illness can be challenging, but support from family, healthcare providers, and patient communities can make a meaningful difference.

With proactive care, informed decisions, and consistent treatment, individuals with chronic kidney failure can maintain stability, independence, and a meaningful quality of life for many years.