Kidney Failure: What to 

Expect 

U.S. Department of Health 

and Human Services 

NATIONAL INSTITUTES OF HEALTH 

National Kidney and Urologic Diseases 

Information Clearinghouse

How does kidney failure affect a 

person’s health? 

Kidney failure can affect a person’s 

health in several ways. Some 

people experience fatigue, some 

lose their appetite, and some have leg 

cramps. These problems are caused by 

waste products that build up in the blood, 

a condition known as uremia. Healthy 

kidneys remove waste products from the 

blood. When the kidneys stop working, 

uremia occurs. 

The kidneys also make hormones and 

balance the minerals in the blood. When 

the kidneys stop working, most people 

develop conditions that affect the blood, 

bones, nerves, and skin. In addition to 

fatigue, loss of appetite, and leg cramps, 

some of the more common problems 

caused by kidney failure are itching, sleep 

problems, restless legs, weak bones, joint 

problems, and depression. 

When is uremia likely to occur? 

Uremia is likely to occur when a person 

reaches the final stages of chronic kidney 

disease (CKD). People with CKD often 

feel no symptoms until the kidneys are 

severely damaged. Usually when people 

develop symptoms, their kidney failure 

has progressed to the point where they 

must have regular blood-filtering treatments called dialysis or receive a kidney 

transplant to stay alive. Kidney failure 

treated by dialysis or transplant is called 

end-stage renal disease (ESRD). The 

word “renal” refers to the kidneys. Even 

people who have dialysis treatments 

may experience some of the problems of 

uremia if they skip treatments or eat foods 

not recommended for people on dialysis. 

Can uremia be avoided? 

People with kidney failure can avoid 

most of the problems of uremia by having 

regular dialysis treatments and limiting 

foods that contain sodium, potassium, 

and phosphorus. People who have CKD 

should see a kidney specialist—called a 

nephrologist—regularly to track the progression of the disease so they can begin 

appropriate treatment before uremia 

occurs. 

Even though health care providers can 

treat most of the complications of CKD 

and ESRD, people with these conditions 

should know what to expect when their 

kidneys fail. 

What problems can occur during 

hemodialysis? 

During the first few weeks of 

hemodialysis—a type of dialysis that uses 

a machine to circulate blood through a 

filter outside of the body—many people 

find that rapid changes in the body’s 

water and mineral balance can cause problems. Muscle cramps and hypotension—a 

sudden drop in blood pressure—are two 

common side effects. Hypotension can 

make people feel weak, dizzy, or sick to 

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Many people need a few months to adjust to 

hemodialysis. Side effects can often be treated 

quickly and easily, so people should always report 

problems to their health care provider and dialysis 

staff. Many side effects of hemodialysis treatments 

can be avoided by following a diet tailored for 

hemodialysis patients, limiting liquid intake, and 

taking medications as directed. 

How does kidney failure affect the 

blood? 

In addition to uremia, kidney failure can also cause 

anemia, a condition in which the red blood cells 

are fewer or smaller than normal, which means 

less oxygen is carried to the body’s cells. Anemia 

can cause extreme fatigue and can worsen existing 

heart problems. 

Anemia is common in people with CKD, as well 

as those on dialysis, because the damaged kidneys 

slow the production of the hormone erythropoietin (EPO), which helps the bone marrow make red 

blood cells. Less EPO means the body has fewer 

red blood cells, resulting in anemia. A synthetic 

form of EPO is commonly prescribed for people 

on dialysis. 

How does kidney failure affect the 

heart and blood vessels? 

People with kidney failure, particularly dialysis 

patients, have far higher rates of heart and blood 

vessel problems than people without kidney 

problems. Heart attacks are the leading cause of 

hospitalization and death among dialysis patients. 

Kidney failure also raises the risk of other cardiovascular problems such as blockage of blood to the 

heart and congestive heart failure. People who 

have kidney failure need to monitor their cardiovascular health, take all prescribed medications, 

and follow their health care provider’s instructions 

for diet and exercise. 

How does kidney failure affect the 

appetite? 

People who have uremia often lose their appetite. Some people find that food tastes different. 

Some no longer like foods they once craved. In 

fact, many people feel sick to their stomach at the 

thought of eating. But getting enough protein and 

calories is important for staying healthy. People 

with kidney failure should talk with the renal dietitian at their dialysis clinic or transplant center to 

find foods that are appealing and provide needed 

nutrients. 

How does kidney failure affect the skin? 

Many people treated with hemodialysis complain 

of itchy skin, usually on the back, chest, head, or 

limbs. The itching is often worse during or just 

after dialysis treatment due to the waste products that are not removed from the blood during 

dialysis. 

The problem can also be due to the damaged kidneys’ inability to balance the levels of the minerals 

calcium and phosphorus in the blood. The resulting low levels of blood calcium trigger four peasized glands in the neck, called the parathyroid 

glands, to release parathyroid hormone, which 

draws calcium from the bones back into the blood. 

The high levels of parathyroid hormone can cause 

itching. Some people feel much better after having 

most of their four parathyroid glands removed. 

As long as one parathyroid gland remains, it can 

regulate the calcium and phosphorus balance in 

the blood. 

Damaged kidneys cause phosphorus to build up 

in the blood, which can also cause itching. Often, 

medications called phosphate binders—such 

as calcium carbonate (Tums), calcium acetate 

(PhosLo), sevelamer hydrochloride (Renagel), or 

lanthanum carbonate (Fosrenol)—are prescribed 

with meals and snacks to bind phosphorus in the 

bowel, decreasing its absorption into the blood. 

The resulting lower blood phosphorus levels seem 

to ease the itching for some people. Reducing the 

dietary intake of phosphorus can also help. 

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Other people find relief after exposure to ultraviolet light. Ultraviolet light can be absorbed simply 

by spending time in sunlight or near a light box, 

a therapeutic device that uses several fluorescent 

lights. Still others improve with EPO shots. A few 

antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax, Vistaril), have been 

found to help. People should consult their health 

care provider before starting any therapy that 

includes over-the-counter medications. 

A cure for itching that works for everyone has 

not been found. In some situations, a health care 

provider may refer people to a dermatologist, a 

doctor who treats people with skin problems. 

How does kidney failure affect the 

bones? 

Kidney failure weakens the bones due to a condition called chronic kidney disease-mineral and 

bone disorder. As discussed in the previous section, kidney failure can throw off the balance of 

calcium and phosphorus in the blood, causing the 

parathyroid glands to produce too much parathyroid hormone. The high level of parathyroid 

hormone draws calcium from the bones into the 

blood, leaving the bones without enough calcium. Chronic kidney disease-mineral and bone 

disorder describes the imbalance of calcium and 

phosphorus and how this imbalance weakens the 

bones. The condition 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 disorder. Controlling 

parathyroid hormone levels prevents damage to 

bones. Usually, overactive parathyroid glands are 

controllable with an adjustment in dialysis treatment, medications, or changes in diet. In some 

cases, removal of most of the parathyroid glands 

may be useful. Reducing dietary intake of phosphorus can also help prevent bone disease. 

How does kidney failure affect the 

joints? 

Kidney failure can cause pain, stiffness, and fluid 

in the joints, the points where two or more bones 

come together. These symptoms result from amyloidosis, a condition in which an abnormal protein 

in the blood called amyloid is deposited in tissues 

and organs, including the joints and tendons—the 

tough bands of tissue that connect muscles to 

bones. Healthy kidneys filter amyloid protein out 

of the blood, but dialysis filters are not as efficient 

as the kidneys in removing amyloid. Dialysisrelated amyloidosis is common in people who 

have been on dialysis for more than 5 years. No 

treatment to reverse amyloidosis has been found, 

although a successful kidney transplant may stop 

the disease from progressing. Health care providers can advise people on the best ways to relieve 

their pain. 

How does kidney failure affect sleep? 

People who have kidney failure often have 

insomnia—trouble getting to sleep and staying 

asleep. Insomnia and other sleep disorders can 

worsen a person’s quality of life. People with 

kidney failure should discuss these problems with 

their health care provider. 

Some people suffer from sleep apnea syndrome, 

which may be related to the effects of advanced 

kidney failure on breathing. 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 

condition can cause headaches, depression, and 

fatigue. Some treatments may work with people 

who have sleep apnea, whether they have kidney 

failure or not. These treatments include losing 

weight, changing sleeping position, and wearing 

a mask connected to a small machine that gently 

pumps air continuously through a hose into the 

nostrils—nasal continuous positive airway pressure, commonly known as CPAP. 

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Many people on dialysis have trouble sleeping at 

night because of aching, uncomfortable, jittery, or 

restless legs. They may feel a strong impulse to 

kick or thrash their legs. Kicking may disturb a 

bed partner throughout the night. Theories about 

the causes of this syndrome include nerve damage 

and mineral imbalances. 

Moderate exercise during the day may help, but 

exercising a few hours before bedtime can make 

restless legs worse. People with restless legs syndrome should reduce or avoid caffeine, alcohol, 

and tobacco. Some people also find relief through 

massages or warm baths. Health care providers may prescribe medications called benzodiazepines, often used to treat insomnia or anxiety, for 

relief of restless legs syndrome. Benzodiazepines 

include clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium), and triazolam 

(Halcion). A newer and sometimes more effective 

medication therapy is levodopa (Sinemet), which is 

also used to treat Parkinson’s disease. 

How does kidney failure affect mental 

health? 

Many people feel depressed when starting dialysis, 

or after several months of treatment. Adjusting 

to the effects of kidney failure and the time spent 

on dialysis can be difficult. People on dialysis also 

have less energy. They need to make changes in 

their work or home life, giving up some activities 

and responsibilities. Keeping to a schedule can 

be difficult when kidneys fail. Accepting this new 

situation can be hard. A mental health counselor 

or renal social worker can help people who are 

approaching total kidney failure and those starting dialysis. People who have kidney failure and 

depression should not keep their depression to 

themselves or assume they can handle their problems on their own. They should tell their health 

care provider because depression can often be 

treated with adjustments to the diet and dialysis dose, medications, and counseling. Scientists 

are also studying the use of cognitive behavioral 

therapy—a way of correcting harmful thought and 

behavior patterns—to treat depression in people 

with total kidney failure. 

Eating, Diet, and Nutrition 

For people who are on dialysis or approaching 

total kidney failure, adequate nutrition is important for maintaining energy, strength, healthy 

sleep patterns, bone health, heart health, and good 

mental health. A person’s treatment will dictate 

the type of diet that should be followed: 

n	 People on hemodialysis must watch how much 

fluid they drink and avoid eating foods with too 

much sodium, potassium, and phosphorus. 

n	 In contrast, people on peritoneal dialysis— 

a type of dialysis that uses the lining of the 

abdomen, or belly, to filter the blood inside 

the body—may be able to eat more potassiumrich foods because peritoneal dialysis removes 

potassium from the body more efficiently than 

hemodialysis. 

n	 Both hemodialysis and peritoneal dialysis can 

remove proteins from the body, so anyone on 

either form of dialysis should eat protein-rich 

foods such as meat, fish, and eggs. 

All dialysis centers and transplant clinics have a 

renal dietitian who specializes in helping people 

with kidney failure. People who are on dialysis 

or have a kidney transplant should talk with their 

clinic’s renal dietitian to develop a meal plan that 

will enhance the effectiveness of their treatment. 

For more information about nutrition for people 

with advanced CKD or who are on dialysis, see 

Nutrition for Advanced Chronic Kidney Disease 

in Adults or Eat Right to Feel Right on Hemodialysis from the National Kidney and Urologic Diseases Information Clearinghouse at 

www.kidney.niddk.nih.gov. 

Points to Remember 

n	 Kidney failure can affect a person’s health in 

several ways. 

n	 When the kidneys stop working, waste products 

build up in the blood, a condition known as 

uremia. 

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n	 People with kidney failure can avoid most of the 

problems of uremia by having regular dialysis 

treatments and limiting foods that contain sodium, potassium, and phosphorus. 

n	 Anemia is common in people with chronic kidney disease (CKD), as well as those on dialysis, 

because the damaged kidneys slow the production of the hormone erythropoietin (EPO), 

which helps the bone marrow make red blood 

cells. 

n	 People with kidney failure, particularly dialysis patients, have far higher rates of heart and 

blood vessel problems than people without kidney problems. 

n	 People who have uremia often lose their 

appetite. 

n	 Many people treated with hemodialysis complain of itchy skin. 

n	 Kidney failure weakens the bones due to a condition called chronic kidney disease-mineral and 

bone disorder. 

n	 Kidney failure can cause pain, stiffness, and 

fluid in the joints. These symptoms result from 

amyloidosis, a condition in which an abnormal 

protein in the blood called amyloid is deposited 

in tissues and organs, including the joints and 

tendons. 

n	 People on dialysis often have insomnia, sleep 

apnea syndrome, and restless legs syndrome. 

n	 People who have kidney failure and depression 

should tell their health care provider because 

depression can often be treated with adjustments to the diet and dialysis dose, medications, 

counseling, and cognitive behavioral therapy. 

n	 For people who are on dialysis or approaching 

total kidney failure, adequate nutrition is important for maintaining energy, strength, healthy 

sleep patterns, bone health, heart health, and 

good mental health. 

n	 All dialysis centers and transplant clinics have a 

renal dietitian who specializes in helping people 

with kidney failure. People who are on dialysis 

or have a kidney transplant should talk with their 

clinic’s renal dietitian to develop a meal plan that 

will enhance the effectiveness of their treatment. 

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. The program 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. 

Participants in clinical trials can play a more active 

role in their own health care, gain access to new 

research treatments before they are widely available, and help others by contributing to medical 

research. For information about current studies, 

visit www.ClinicalTrials.gov. 

For More Information 

American Association of Kidney Patients 

3505 East Frontage Road, Suite 315 

Tampa, FL 33607 

Phone: 1–800–749–2257 

Fax: 813–636–8122 

Email: info@aakp.org 

Internet: www.aakp.org 

American Kidney Fund 

6110 Executive Boulevard, Suite 1010 

Rockville, MD 20852 

Phone: 1–800–638–8299 

Fax: 301–881–0898 

Email: helpline@kidneyfund.org 

Internet: www.kidneyfund.org 

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National Kidney Foundation 

30 East 33rd Street 

New York, NY 10016 

Phone: 1–800–622–9010 or 

212–889–2210 

Fax: 212–689–9261 

Internet: www.kidney.org 

Acknowledgments 

Publications produced by the Clearinghouse are carefully reviewed by both 

NIDDK scientists and outside experts. 

This fact sheet was originally reviewed 

by Keith Norris, M.D., Charles R. Drew 

University of Medicine and Science, Los 

Angeles. 

National Kidney Disease 

Education Program 

3 Kidney Information Way 

Bethesda, MD 20892 

Phone: 1–866–4–KIDNEY 

(1–866–454–3639) 

TTY: 1–866–569–1162 

Fax: 301–402–8182 

Email: nkdep@info.niddk.nih.gov 

Internet: www.nkdep.nih.gov 

The National Kidney Disease Education Program (NKDEP) is an initiative 

of the National Institute of Diabetes and 

Digestive and Kidney Diseases, National 

Institutes of Health, U.S. Department 

of Health and Human Services. The 

NKDEP aims to raise awareness of the 

seriousness of kidney disease, the importance of testing those at high risk, and 

the availability of treatment to prevent or 

slow kidney disease. 

You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov. 

This publication may contain information about 

medications. When prepared, this publication 

included the most current information available. 

For updates or for questions about any medications, 

contact the U.S. Food and Drug Administration 

toll-free at 1–888–INFO–FDA (1–888–463–6332) or 

visit www.fda.gov. Consult your health care provider 

for more information. 

National Kidney and Urologic 

Diseases Information Clearinghouse 

3 Information Way 

Bethesda, MD 20892–3580 

Phone: 1–800–891–5390 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: nkudic@info.niddk.nih.gov 

Internet: 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 of 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. 

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired. 

This publication is available at 

www.kidney.niddk.nih.gov. 

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. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 12–6059 

December 2011 

The NIDDK prints on recycled paper with bio-based ink.