The Management of End-Stage Renal Disease (ESRD)

End-stage renal disease (ESRD) may be defined as a state of renal insufficiency of such severity that the affected individual is unable to carry out his usual activities because of symptoms usually attributed to the uremic syndrome. This state has been reached, or is imminent, when the serum creatinine concentration rises above 10 mg/100 ml and/or the creatinine clearance falls below 5 to 10 ml/min and reversible causes of renal failure such as obstructive uropathy, bilateral renal vascular disease, severe accelerated hypertension, hypercalcemic nephropathy, uric acid nephropathy, and certain immunologic diseases such as Wegener granulomatosis have been excluded. Prospective analysis of a population of patients meeting these biochemical criteria has clearly shown that at least 80% will require dialysis within 1500 days and 40% will require this method of treatment within 60 day to sustain life. Thus when ESRD is reached, weighty decisions concerning the patient’s care must be made. It is the purpose of this paper to review the management of ESRD and to point out some of the problems which may complicate the several therapeutic modalities