End-stage renal disease (ESRD) occurs when kidney function is inadequate without transplantation or dialysis. Early referral to nephrology is crucial. Kidney transplantation offers the best outcomes, but most patients undergo dialysis, which requires shared decision-making and vein preservation. Palliative care is an option for those with limited life expectancy. Patients with ESRD should be vaccinated against influenza, tetanus, hepatitis B, HPV, and pneumococcus, and routine cancer screening is discouraged. Blood pressure control, monitoring for protein-energy wasting, and using insulin for diabetes are essential.

The rise in ESRD cases is linked to increasing diabetes and hypertension rates. Early nephrology referral improves outcomes, but many patients lack adequate care before ESRD diagnosis. Kidney transplantation improves survival and quality of life more than dialysis. Shared decision-making is essential for dialysis due to its burdens. Home hemodialysis and peritoneal dialysis are alternatives to center-based hemodialysis. Indications for dialysis include persistent volume overload and refractory metabolic disorders. Conservative kidney management focuses on quality of life. Clinicians must manage ESRD-related complications like anemia, metabolic acidosis, hyperkalemia, and cardiovascular risk.

Reference: Wouk N. End-Stage Renal Disease: Medical Management. Am Fam Physician. 2021;104(5):493-499.