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end product

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The final material or substance left at the completion of a series of reactions, either chemical or physical.

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end-stage

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The final phase of a disease process.

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end-stage renal disease, end-stage kidney disease

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ABBR: ESRD. The stage of chronic kidney disease in which the clearance of creatinine has so much decreased that the patient will not survive without renal replacement therapies, e.g., dialysis or kidney transplantation.

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INCIDENCE: In the U.S., approximately 400,000 people are actively treated for ESRD with dialysis or kidney transplantation.

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CAUSES: End-stage renal disease may occur as a consequence of many other illnesses, including diabetes mellitus, hypertension, glomerulonephritis, recurrent or chronic renal infections, congenital kidney anomalies, vasculitis, multiple myeloma, analgesic overuse, or any of the causes of acute renal failure, e.g., shock, dehydration, post obstructive nephropathy; or exposure to nephrotoxins such as aminoglycosides or lead or to radiocontrast media.

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SYMPTOMS AND SIGNS: All body systems experience major changes as a result of chronic and end-stage renal failure. Patients may complain of fatigue (such as from anemia), difficulty concentrating, irritability, personality changes, increased sleepiness, muscle cramping and twitching, nausea, vomiting, anorexia, edema, breathlessness (if fluid retention results in pulmonary edema), or decreased urination. Some patients who become frankly uremic may develop uremic frost or become stuporous or comatose; others may develop uremic pericarditis.

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DIAGNOSIS: This stage of chronic kidney disease occurs when the creatinine clearance is about 10% of normal or when the glomerular filtration rate is 5 to 10 mL/min. The results of serum chemistries tests are used in equations like the Modification of Diet in Renal Disease (MDRD) or the Cockroft-Gault equation to estimate glomerular filtration. Patients with advanced kidney disease are typically also evaluated with urinalyses (to look for protein losses or the presence of red blood cells, white blood cells crystals or casts) and frequently with renal ultrasonography or other imaging studies.

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TREATMENT: Renal replacement therapies are required to prevent fatal fluid overload, hyperkalemia, and other uremic complications. These include hemodialysis, peritoneal dialysis, or kidney transplantation. Other therapies include the administration of water-soluble vitamins, phosphate-binding medications, erythropoietin, iron and folic acid (to treat anemia), and bicarbonate buffers (to prevent acidemia). The diet of patients with ESRD is restricted to limited quantities of fluids, and small concentrations of sodium, potassium, and protein, to prevent complications like fluid retention and hyperkalemia. Tight control of blood pressure and blood glucose levels in patients with hypertension or diabetes, respectively, will prolong kidney function and prevent deterioration.

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PATIENT CARE: Patients with ESRD should avoid medications that may damage the kidneys (such as nonsteroidal anti-inflammatory drugs) or drugs that may accumulate in toxic concentrations as a result of renal failure, i.e., drugs that are normally excreted ...

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