What is ESRD?

End-stage renal disease (ESRD) — also called kidney failure or Stage 5 CKD — means your kidneys are functioning at less than 15% of normal capacity and can no longer sustain your body on their own. At this point, you need either dialysis or a kidney transplant to survive.

ESRD is the final stage of chronic kidney disease. Most people reach it gradually over years — which is why managing CKD in earlier stages is so important.

Over 800,000 Americans are living with ESRD today — and many live full, active lives with dialysis or after transplant. Reaching ESRD is not the end, but it does require a significant change in how you manage your health.

Symptoms of ESRD

By Stage 5, waste products build up to levels that cause significant symptoms:

  • Extreme fatigue and weakness
  • Nausea, vomiting, and complete loss of appetite
  • Metallic or ammonia taste in the mouth
  • Severe swelling throughout the body
  • Very little or no urine output
  • Shortness of breath from fluid in the lungs
  • Severe itching from waste products in the skin
  • Confusion, difficulty concentrating
  • Muscle cramps and restless legs

Your treatment options

Hemodialysis

A machine cleans your blood 3 times per week at a dialysis center (or at home). Each session takes 3–4 hours. It's the most common treatment for ESRD in the US.

Peritoneal dialysis

Uses the lining of your abdomen as a filter. Done at home — often automatically overnight while you sleep. Gives more flexibility and independence than in-center hemodialysis.

Kidney transplant

A healthy kidney from a donor is surgically placed in your body. The best long-term option for people who are healthy enough — it restores near-normal kidney function and eliminates the need for dialysis.

Conservative management (palliative care)

For some people — particularly older adults with multiple serious health conditions — the burdens of dialysis may outweigh the benefits. Conservative management focuses on maximizing quality of life, managing symptoms, and planning for end-of-life care without dialysis. This is a valid, dignified choice that your care team can support fully.

The best time to discuss your ESRD treatment options is in Stage 4 — before you reach kidney failure. Planning ahead gives you more choices and better outcomes. If you haven't had this conversation yet, ask your nephrologist at your next visit.

Medicare coverage for ESRD

ESRD is one of the few conditions that qualifies for Medicare coverage regardless of your age. Once you begin dialysis or receive a kidney transplant, you are eligible for Medicare — even if you are under 65. Coverage generally begins on the fourth month of dialysis, or immediately with a living donor transplant.

Your nephrologist's office can connect you with a social worker who specializes in helping kidney patients navigate insurance, financial assistance programs, and the Medicare enrollment process.