Kidney Failure:

What to Expect

Kidney failure can hit you in

surprising ways. You may get

headaches and other pains. You

may be tired all the time and lose your

appetite. But what do the kidneys have

to do with these conditions?

Healthy kidneys remove waste products

from your blood. When your kidneys

stop working waste products build up in

your blood. These waste products are

called uremic toxins. This condition is

known as uremia. Your kidneys also

make hormones and balance chemicals

in your system. When your kidneys

stop working many problems can

happen. You may develop anemia

(low blood count) or conditions that

affect your bones, nerves, and skin.

Some of the more common conditions

caused by kidney failure are fatigue,

bone problems, joint problems, itching,

and “restless legs.”

Anemia and Fatigue

Anemia is a condition in which the red

blood cells in the body are low. Red

blood cells carry oxygen to the cells in

the body. Without oxygen, cells can’t

use the energy from food. Someone

with anemia may tire easily and look

pale. Anemia can also add to heart

problems.

Anemia is common in people with kidney disease because the kidneys produce

the hormone erythropoietin (EPO).

EPO helps the bone marrow to make

red blood cells. People with kidney disease often don’t make enough EPO.

Their bone marrow makes fewer red

blood cells so they get anemia. EPO

is available by prescription. EPO is

commonly given to patients who are

on dialysis.

Loss of Appetite and Nausea

Having uremia can change the way food

tastes to you. You may no longer like

foods you used to crave. In fact, sometimes you may feel sick to your stomach

at the thought of eating. But getting

enough protein and calories is important for staying healthy. Work with

your clinic’s dietitian to find meals that

appeal to you and provide the nutrients

you need.

Itching (Pruritus)

Many people treated with hemodialysis

complain of itchy skin. This is often

worse during or just after the dialysis

treatment. Itching is common even in

people who do not have kidney disease.

If you have kidney failure the itching

can be made worse by uremic toxins

that aren’t removed from the blood

during dialysis. The problem can also

be related to high levels of parathyroid

hormone (PTH). This is also common

in kidney failure. Some people feel

much better after having their parathyroid glands removed. But a cure for

National Institute of Diabetes and Digestive and Kidney Diseases

NATIONAL INSTITUTES OF HEALTH

U.S. Department of Health

and Human Services
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itching that works for everyone has not been

found. Phosphate binders seem to help some

people. Others find relief after exposure to

ultraviolet light. Still others improve with EPO

shots. A few antihistamines (Benadryl, Atarax,

Vistaril) have been found to help. Capsaicin

cream applied to the skin may relieve itching

by deadening nerve impulses. Whatever treatment you choose, taking care of dry skin is

important. Applying creams with lanolin or

camphor may help keep your skin moist.

Sleep Disorders

Patients on dialysis often have insomnia 

(trouble getting to sleep). Some people have

a special problem called the sleep apnea

syndrome. Episodes of apnea are breaks in

breathing during sleep. Over time, these sleep

disturbances can lead to “day-night reversal”

(insomnia at night, sleepiness during the day).

This can cause headaches, depression, and

decreased alertness. The apnea may be related

to the effects advanced kidney failure has on

the control of breathing. Some treatments

may work with people who have sleep apnea,

whether they have kidney failure or not. These

include losing weight, changing sleeping position, and wearing a mask that gently pumps air

continuously into the nose (nasal continuous

positive airway pressure, or CPAP).

Many people on dialysis have trouble sleeping

at night because of aching, uncomfortable,

jittery, or “restless” legs. You may feel a strong

impulse to kick or thrash your legs. Kicking

may occur during sleep and disturb a bed

partner throughout the night. Theories about

the causes of this syndrome include nerve

damage and chemical imbalances.

Moderate exercise during the day may help,

but exercising a few hours before bedtime can

make restless legs worse. People with restless

leg syndrome should reduce or avoid caffeine,

alcohol, and tobacco. Some people also find

relief through massages or warm baths. A class

of drugs called benzodiazepines may also help.

They are often used to treat insomnia or

anxiety. These prescription drugs include

Klonopin, Librium, Valium, and Halcion. A

newer and sometimes more effective therapy is

levodopa (Sinemet). This drug is also used to

treat Parkinson’s disease.

Sleep disorders may not seem important, but

they can make your quality of life worse.

Make sure to bring these problems up with

your nurse, doctor, or social worker.

Renal Osteodystrophy

The term “renal” describes things related to the

kidneys. Renal osteodystrophy means bone

disease of kidney failure. It affects 90 percent

of dialysis patients, both children and adults,

causing bones to become thin, weak, or malformed. Symptoms can be seen in growing

children with kidney disease even before they

start dialysis. Older patients and women who

have gone through menopause are at greater

risk for this disease.

Amyloidosis

Dialysis-related amyloidosis (DRA) is common

in people who have been on dialysis for more

than 5 years. DRA develops when proteins in

the blood deposit on joints and tendons. This

causes pain, stiffness, and fluid in the joints,

as is the case with arthritis. Working kidneys

filter out these proteins. With kidney disease

these proteins can build up. Dialysis filters are

not as good as the kidney. That is why DRA

can happen in dialysis patients.
Depression

Adjusting to the effects of kidney failure and

the time you spend on dialysis can be difficult.

Aside from the “lost time,” you may have less

energy. You may need to make changes in your

work or home life, giving up some activities

and responsibilities. Keeping the same schedule you kept when your kidneys were working

can be very difficult now that your kidneys

have failed. Accepting this new reality can be

very hard on you and your family. A counselor

or social worker can help you cope.

Many patients feel depressed when starting

dialysis, or after several months of treatment.

If you feel depressed, you should talk with

your social worker, nurse, or doctor. This is

a common problem that can often be treated

effectively.

Your treatment should do more than just keep

you alive. It should also give you the best

quality of life possible. Don’t assume that you

have to live with fatigue and pain. Talk with

your health care team so they can help you get

the most from your treatments.

Hope Through Research

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is devoted

to improving the lives of people with kidney

disease. Its Division of Kidney, Urologic, and

Hematologic Diseases supports several kidney

programs and studies. These focus on improving treatment for patients with kidney disease.

The End-Stage Renal Disease Program promotes research for patients on dialysis or with

a kidney transplant. The research is designed

to reduce medical problems in kidney failure.

These include bone, blood, nervous system,

intestinal, heart, and endocrine problems. It is

also designed to improve the effectiveness of

dialysis and transplantation. Current efforts

focus on home dialysis options and alternative

dialysis schedules. They include short daily

sessions or long nightly sessions.

About the Kidney Failure Series

The NIDDK’s Kidney Failure Series includes

six booklets and eight fact sheets that can

help you learn more about treatment methods

for kidney failure, complications of dialysis,

financial help for the treatment of kidney

failure, and eating right on hemodialysis.

For free single printed copies of this series,

please contact the National Kidney and

Urologic Diseases Information Clearinghouse.

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The U.S. Government does not endorse or

favor any specific commercial product or

company. Trade, proprietary, or company

names appearing in this document are used

only because they are considered necessary in

the context of the information provided. If a

product is not mentioned, the omission does

not mean or imply that the product is

unsatisfactory.
National Kidney and Urologic

Diseases Information Clearinghouse

3 Information Way

Bethesda, MD 20892–3580

Phone: 1–800–891–5390

Fax: 703–738–4929

Email: nkudic@info.niddk.nih.gov

Internet: www.kidney.niddk.nih.gov

U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES

National Institutes of Health

NIH Publication No. 06–6059

July 2006

This publication is not copyrighted.

The Clearinghouse encourages users

of this fact sheet to duplicate and

distribute as many copies as desired.

This fact sheet is also available at 

www.kidney.niddk.nih.gov.

The National Kidney and Urologic Diseases

Information Clearinghouse (NKUDIC) is a

service of the National Institute of Diabetes

and Digestive and Kidney Diseases

(NIDDK). The NIDDK is part of the

National Institutes of Health under the U.S.

Department of Health and Human Services.

Established in 1987, the Clearinghouse

provides information about diseases of the

kidneys and urologic system to people with

kidney and urologic disorders and to their

families, health care professionals, and the

public. The NKUDIC answers inquiries,

develops and distributes publications, and

works closely with professional and patient

organizations and Government agencies

to coordinate resources about kidney and

urologic diseases.

Publications produced by the Clearinghouse

are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet

was also reviewed by Keith Norris, M.D.,

Charles R. Drew University of Medicine

and Science, Los Angeles.