Your kidneys perform many vital functions.  When they fail, a lot of things in your body can go wrong.  End Stage Renal Disease (ESRD) can cause a wide variety of symptoms, and it can also cause other health conditions which manifest their own symptoms. In addition, the dialysis process can cause its own side effects and complications. The first part of this article describes some of the end stage renal failure symptoms and complications, the second part of this article will describe complications associated with the dialysis process.

This article is not an exhaustive list.  Each patient may experience a different combination of symptoms.  Report any symptoms you are concerned about to your nephrologist. He or she has a variety of treatments available to alleviate your symptoms.

Symptoms and Complications of ESRD

Here are many end stage renal failure symptoms.  You may experience some but not all of them.

Edema:  When the kidneys fail, they can no longer excrete as much sodium and fluid from the body.  The amount of fluid in the body increases, leading to edema:  Swelling in the face, hands, or ankles.  Excess fluid in the lungs can also cause shortness of breath.

Uremia:  Failing kidneys can no longer filter out enough wastes from the blood.  The waste products—such as urea—accumulate, a condition called uremia.  Uremia can cause nausea, loss of appetite (particularly for protein-rich foods like meat), a metallic taste in one’s mouth, ammonia odor on one’s breath, difficulty concentrating, and itchiness (pruritus).

Additionally, the quality and quantity of urine produced may change.  The kidneys may produce more or less urine than normal.  They may excrete abnormally high amounts of protein into the urine, causing it to look foamy.   Even tiny amounts of blood may appear in the urine.

Uremic neuropathy:  ESRD can lead to nerve damage, probably from the buildup of uremic toxins.  This condition, called uremic neuropathy, can cause paresthesia:  Sensations like burning or tingling or “pins and needles,” particularly in the lower extremities.

Anemia:  Healthy kidneys produce a hormone, erythropoietin, which stimulates the bone marrow to produce more red blood cells.  Failing kidneys cannot produce enough of this hormone.  Therefore, the bone marrow will produce fewer healthy red blood cells, a condition called anemia.  Anemia manifests itself in a variety of ways:  Fatigue; weakness; feeling colder than normal; pale skin and gums; headaches; mental confusion; or irritability.

Metabolic acidosis:  Healthy kidneys remove excess acid from the blood; failing kidneys cannot do this job well.  The blood becomes more acidic (its pH declines).  This condition is called metabolic acidosis.  It can cause loss of appetite, nausea, fatigue, and either rapid, shallow breathing or deep, labored breathing.

Secondary hyperparathyroidism:   This condition is caused by a complex interaction between failing kidneys and the parathyroid glands.  These are four small glands located behind the thyroid gland in the neck.

end stage renal failure

(If you do not wish to understand the details of this condition, you can skip the next three paragraphs.)

The parathyroid glands constantly monitor the level of calcium ions in the blood.  These ions are important to the proper functioning of the nervous system, including the brain.  If the level of calcium in the blood falls too low, the parathyroid glands produce more of a hormone called parathyroid hormone (PTH).  This hormone acts on receptors in the bones—the body’s major store of calcium—to put more calcium back into the blood.

We get calcium and vitamin D from food, and our skin also produces vitamin D when exposed to sunlight. But all this vitamin D is in a chemically inactive form.  The kidneys must activate the vitamin D (a chemical process called hydroxylation) before the vitamin can promote the absorption of calcium by the intestines into the bloodstream.  Failing kidneys are unable to activate vitamin D well.  As a result, the calcium we consume is not absorbed well.  The level of calcium in the blood declines to a low level, a condition called hypocalcemia.  (Failing kidneys also filter less phosphorus from the blood.  This excess phosphorus can combine chemically with some of the calcium in the blood, further lowering the level of free calcium ions in the blood.)

In response to the lower blood calcium level, the parathyroid glands produce more and more PTH to try to get calcium from the bones to raise blood calcium levels.  This chronic overproduction of PTH by the parathyroid glands in response to hypocalcemia is called secondary hyperparathyroidism.  (The term “secondary” means that the cause of this type of hyperparathyroidism is external to the parathyroid glands.)

This overproduction of parathyroid hormone (PTH) results in a chronic drawdown of calcium from the bones.  The structure of the bones may weaken and become brittle, a condition called renal osteodystrophy.  Its symptoms include joint pain and bone pain.  The risk of bone fractures increases too.

Sexual dysfunction:  ESRD and dialysis may adversely affect sexuality.  This can manifest itself as reduced libido or difficulty reaching orgasm.  Men may experience erectile dysfunction (ED); women may experience vaginal dryness.   A dialysis patient may also have body image concerns, such as how the dialysis access looks to his or her partner.

Side Effects and Complications of Hemodialysis

The process of hemodialysis can cause certain side effects.  There are also potential complications of the hemodialysis process.

Disequilibrium syndrome:  When a patient starts hemodialysis, he or she may experience disequilibrium syndrome:  The hemodialysis process may make some major changes to the blood at first.  This can adversely affect the patient’s brain, causing nausea, vomiting, or headache.

Hypotension:  The most common side effect of hemodialysis is hypotension—a fall in blood pressure caused by the removal of fluid.  This may lead to dizziness.  The removal of fluid may also lead to muscle cramping.

Dry skin:  While dry skin (xerosis) has been observed in some ESRD patients before they start dialysis, it seems to be a more common problem among dialysis patients.

Access problems:  The hemodialysis access can stop working because of a clot or because of a narrowing of the access (stenosis).  The access can also get infected.

Side Effects and Complications of Peritoneal Dialysis

The process of peritoneal dialysis can cause certain side effects.  There are also potential complications of the peritoneal dialysis process.

Bloating: Dialysate solution introduced into the abdomen can cause bloating.  And peritoneal dialysis filters excess fluid from the bloodstream into the abdomen as well, further increasing the feeling of bloat.  Bloating may cause some loss of appetite.  Plus, the dialysate solution contains glucose.  Those extra calories can lead to weight gain.

Drier skin:  Peritoneal dialysis may dry out the skin even more than hemodialysis does.

Peritonitis:  The access site in the abdomen can become infected.  If the infection spreads, it can infect the peritoneum causing peritonitis, a life-threatening condition.

Abdominal hernia:  The insertion of a catheter into the abdomen can weaken the abdominal muscles.  Dialysate fluid introduced into the abdomen during an exchange can further strain those already weak muscles, possibly leading to a hernia:  A hole in the abdominal wall through which part of the internal abdomen may protrude.