Management of end-stage renal disease focuses on slowing disease progression, managing complications, and preparing patients for renal replacement therapy. For patients with residual kidney function, controlling blood pressure, reducing proteinuria, and managing comorbid conditions like diabetes are critical in delaying further kidney damage. Medications such as ACE inhibitors and angiotensin II receptor blockers (ARBs) are often used to control hypertension and reduce proteinuria. Glycemic control is essential in diabetic patients, with a target HbA1c of less than 7%.
As kidney function continues to decline, patients require dialysis or kidney transplantation to replace the lost renal function. Hemodialysis and peritoneal dialysis are common modalities used to filter waste and manage fluid and electrolyte imbalances. Dialysis may be initiated when patients experience uremic symptoms, hyperkalemia, severe acidosis, or intractable volume overload. Kidney transplantation is the preferred treatment option for ESRD, as it provides better long-term outcomes compared to dialysis, improving survival rates and quality of life.
