End-Stage Renal Disease
Conditions We Treat
End-Stage Renal Disease
End-stage renal disease is not the end of the conversation. It is the beginning of a new one — about dialysis options, transplant evaluation, and how to live well with kidney failure.
What is end-stage renal disease?
End-stage renal disease (ESRD) is the final stage of chronic kidney disease, defined by a glomerular filtration rate below 15 mL/min/1.73m² — the point at which the kidneys can no longer sustain life without renal replacement therapy. In the United States, more than 800,000 people are living with ESRD, and approximately 130,000 new cases are diagnosed each year.
ESRD requires a decision: dialysis or kidney transplantation. Dialysis replaces the kidneys' filtering function artificially — either through hemodialysis (filtering blood through a machine) or peritoneal dialysis (using the lining of the abdomen as a filter). Transplantation replaces the failed kidney with a healthy one from a living or deceased donor.
The quality of life on dialysis varies enormously depending on the modality chosen, the quality of the dialysis unit, and the preparation that preceded it. Patients who begin dialysis with a functioning vascular access, a clear understanding of their options, and a nephrologist who knows them well have significantly better outcomes than those who arrive in the emergency department in crisis.
Renal Replacement Options
How we approach ESRD
Early dialysis education
We begin discussing dialysis options when eGFR falls below 20 — not when the patient arrives in crisis. Understanding the options early leads to better decisions and better outcomes.
Vascular access planning
An arteriovenous fistula — the preferred access for hemodialysis — takes months to mature. We refer for surgical creation well in advance, so patients start dialysis with a functioning access rather than a temporary catheter.
Modality selection
Hemodialysis and peritoneal dialysis each have advantages. We help patients understand both and choose the modality that fits their life, their anatomy, and their goals.
Transplant evaluation
Kidney transplantation offers the best long-term outcomes for eligible patients. We initiate transplant evaluation early and coordinate with transplant centers at Hoag and UCLA.
Frequently asked questions
What is end-stage renal disease?
End-stage renal disease (ESRD) is the final stage of chronic kidney disease, defined by a glomerular filtration rate below 15 mL/min/1.73m². At this level, the kidneys can no longer sustain life without renal replacement therapy — dialysis or transplantation.
What are my options when I reach ESRD?
The main options are hemodialysis (in-center or at home), peritoneal dialysis, and kidney transplantation. Each has advantages and limitations. The right choice depends on your medical situation, lifestyle, and personal preferences.
Is dialysis permanent?
For most patients with ESRD, dialysis is a long-term or permanent treatment. However, patients who receive a kidney transplant can discontinue dialysis. In rare cases — such as acute kidney injury that caused ESRD — kidney function may partially recover.
Should I be evaluated for a kidney transplant?
Most patients with ESRD who are otherwise healthy enough for surgery should be evaluated for transplantation. Transplant recipients live significantly longer than dialysis patients of comparable age and health. We initiate transplant evaluation and coordinate with transplant centers.
Related conditions
Facing ESRD? Let's talk through your options.
Our nephrologists guide patients through dialysis planning, modality selection, and transplant evaluation. Accepting new patients.