End-Stage Kidney Disease
When the kidneys fall to the end of their work — what end-stage kidney disease feels like, why we plan ahead, and the options that can replace what the kidneys used to do.
Key Points
- End-stage kidney disease means kidney function has fallen below fifteen percent of normal and the kidneys may no longer keep the body in balance on their own.
- Symptoms — tiredness, breathlessness, swelling, nausea, itching, poor sleep, less urine — often come on slowly and may feel mild until the function is very low.
- The main kidney replacement therapy options are haemodialysis, peritoneal dialysis, and kidney transplantation. A transplant is the preferred option for most people who are medically fit.
- Home haemodialysis needs a home-dialysis programme and training and may not be available everywhere. Incremental haemodialysis does not need a special centre; it is an individualised prescription for selected patients and requires regular monitoring of remaining kidney function.
- A pre-emptive transplant — a transplant arranged before dialysis ever starts — gives the best outcomes for the new kidney whenever a willing donor and a clear workup are available in time.
- Good blood-pressure control, sensible salt and fluid limits, anaemia treatment, and balanced calcium and phosphate keep you in better shape for whichever treatment you choose.
- Paperwork, family conversations, and financial planning are part of preparing for treatment — start them early so the medical decisions are not made under pressure.
Clinical review
Reviewed by Dr Osama Ashry Gheith, Consultant Transplant Nephrologist. Kuwait Center for Nephrology and Kidney Transplantation (KCNKT). Mansoura Urology and Nephrology Center, Egypt. Reviewed 1 August 2026.
About the Transplant Patient Portal
This chapter is part of ASNRT's bilingual (Arabic / English) transplant patient-education portal — 14 clinical chapters covering kidney transplantation from preparation through long-term follow-up, plus decision-aid tools for Ramadan fasting, drug-food interactions, and red-flag symptom triage.
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