End-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD), marked by a significant decline in kidney function to the point where the kidneys can no longer adequately filter waste, balance fluids, electrolytes, and blood pressure, or maintain other critical body functions. ESRD occurs when the glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m², signifying that renal replacement therapy—either dialysis or kidney transplantation—is necessary for survival. Over 500,000 individuals in the United States live with ESRD, a condition associated with reduced quality of life, frequent hospitalizations, and an increased risk of mortality.
The progression to ESRD is often the result of underlying chronic conditions, most notably diabetes mellitus and hypertension, which are the leading causes of CKD worldwide. Other conditions such as glomerular diseases, cystic kidney diseases, and vascular disorders can also contribute to ESRD development. The ongoing decline in kidney function in CKD occurs over many years and is often asymptomatic in its early stages. However, as patients approach ESRD, they experience a range of symptoms and complications, including fluid overload, electrolyte imbalances, metabolic acidosis, anemia, bone disorders, and cardiovascular issues, all of which require careful management.
