End-Stage Renal Disease (ESRD)

What is end-stage renal disease?

End-stage renal disease is the final stage of chronic kidney disease, also called stage 5 CKD or simply kidney failure. It means the kidneys are working at less than about 15% of normal — an eGFR below 15 — too little to clear waste and fluid on their own. Without treatment to take over that work, waste and fluid build up in the body.

Reaching this stage is serious, but it is not the end of the road or of a good life. Many people live for years after starting treatment, continuing to work, travel, and spend time with the people they love. What matters most now is understanding your options and choosing the path that fits you.

What are the symptoms of kidney failure?

As the kidneys fail, symptoms grow more noticeable:

• Deep fatigue and drowsiness
• Swelling in the legs or around the eyes
• Shortness of breath
• Nausea and poor appetite
• Trouble sleeping or thinking clearly
• Muscle cramps and itching
• Producing little urine, or changes in how often you go

If you live with advanced chronic kidney disease and these worsen, tell your kidney team — it may be a sign to act on a plan you’ve already discussed. Importantly, when dialysis is needed isn’t decided by a single lab number; it’s based on how you’re feeling and how your body is keeping up, which is why an ongoing relationship with a kidney team matters.

Can end-stage renal disease be reversed?

This is one of the first questions people ask, and the honest answer matters. Once the kidneys have failed, that damage can’t be reversed — they won’t heal or restart on their own, and no medication or diet brings them back. What can be done is to replace the work they did, through dialysis or a transplant, or to manage the body without that filtering through conservative care.

There’s an important exception worth knowing. A sudden drop in kidney function — called acute kidney injury (AKI) — is different from end-stage renal disease. AKI comes on quickly, often from dehydration, infection, or a medication, and it can sometimes recover with treatment. Established, long-term kidney failure does not. Your nephrologist can tell you which picture fits your situation.

Your three options, explained

There are three main ways to treat kidney failure. None is automatically right; the goal is the one that fits your health and your life.

1. Hemodialysis

A machine filters your blood. It’s most often done at a dialysis center, usually three times a week for a few hours. Some people are trained to do hemodialysis at home, sometimes more frequently, which can be gentler and more flexible. At a center, you continue to see a kidney doctor regularly. See our dialysis care page for more on what to expect.

2. Peritoneal dialysis

This uses the lining of your own abdomen to filter your blood, with no needles. It’s done at home — often overnight while you sleep — and gives many people more freedom and control over their schedule. We offer a home dialysis education program to help you learn whether it’s right for you.

3. Kidney transplant

A healthy kidney from a living or deceased donor takes over the work of your failed kidneys. For people who qualify, it can offer the closest thing to normal kidney function and the most freedom. A transplant is a treatment, not a cure — the new kidney needs lifelong anti-rejection care — and not everyone is a candidate. The surgery happens at a transplant center; we support you through the process before and after, from evaluation and referral to long-term follow-up.

One transplant detail is often missed: evaluation can usually begin before dialysis is ever needed. A transplant with little or no time on dialysis — a preemptive transplant — is linked to better long-term outcomes.

A preemptive transplant means receiving a new kidney before starting dialysis. Listing generally becomes possible once your eGFR falls below 20, but the evaluation can start earlier — which is exactly why bringing it up early with your kidney doctor matters. Despite its advantages, preemptive transplant is still uncommon, often simply because the conversation starts too late.

A fourth path worth knowing: conservative care

Not every patient wants dialysis or a transplant — and that’s a valid, dignified choice. Conservative kidney management (also called comprehensive conservative care or supportive care) means treating kidney failure without dialysis or transplant, focusing on symptom relief and quality of life. It’s often chosen by people who are older or living with other serious illnesses, for whom dialysis may add burden without clearly adding good time.

The evidence here is nuanced and worth sharing plainly. For many people, dialysis extends life. But for those who are quite elderly or frail with multiple serious conditions, that survival advantage narrows — and conservative care is associated with fewer hospitalizations, more time at home, and quality of life that some people value above length alone. This option is frequently left out of the conversation, and it shouldn’t be. National guidance says people facing kidney failure should be offered conservative care alongside dialysis and transplant as a real choice.

What happens without dialysis?

People understandably want to know what choosing conservative care, or stopping dialysis later, actually involves. Without dialysis or a transplant, waste and fluid gradually accumulate, and over time that leads to symptoms like increasing fatigue and breathlessness. With conservative care, the focus shifts entirely to comfort — actively managing those symptoms so you can spend your time the way you choose, usually with the support of palliative care and, when the time comes, hospice.

Two things are worth saying clearly. First, death from kidney failure is usually peaceful, and symptoms such as pain, breathlessness, and restlessness can be managed well by a good care team. Second, how much time remains varies and depends partly on how much kidney function is left — some people with residual function live comfortably for many months. This is a deeply personal decision, and a team that knows you can help you and your family make it without pressure.

How do you decide?

There’s rarely one correct answer. The right choice depends on your overall health, your other conditions, and what you value most. A few questions that help:

Talk it through with the people you trust — your family, your doctor, and, if it helps, a counselor or your faith. A good kidney team won’t rush you. They’ll lay out the options honestly and support the decision that’s right for you.

What daily life looks like on each option

Numbers and definitions only go so far. What people really want to know is what the days feel like. In broad terms:

Conservative care looks different again: no dialysis schedule at all, with the focus on feeling as well as possible, managing symptoms, and time spent how you choose, with your team supporting you throughout. None of these is one-size-fits-all, and people’s experiences differ. The best way to picture your own daily life on a given path is to ask your care team what it would realistically look like for you.

Why planning ahead changes everything

Almost every advantage in kidney failure care comes from planning early rather than reacting in a crisis. Starting the conversation while there’s still time means a preemptive transplant stays on the table, a home option can be set up properly, and — if you choose in-center hemodialysis — your access (a fistula or graft in the arm) can be created and allowed to mature, which takes time. Starting in an emergency, by contrast, often means a temporary catheter and fewer choices.

The single most important thing you can do facing kidney failure is to start the conversation early — it’s the difference between choosing your path and having one chosen by circumstance.

This is also where continuity matters most. Because Georgia Nephrology physicians provide medical direction and care at more than 30 dialysis centers across metro Atlanta, the doctor who has managed your kidney disease can keep caring for you if dialysis becomes part of your life — so you keep a team that already knows your history, your goals, and you.

Myths and facts