The incidence of terminal renal failure is rising at an alarming rate, in spite of impressive advances in the management of ESRD. An estimated one lakh people develop ESRD every year.

This is in addition to a pre-existing pool of about 20 lakh sufferers. More than three-fourths of the people suffering from ESRD do not get treated at all.

Further, the burden of renal disease is growing rapidly in India. Particularly distressing is the number of older patients who need renal replacement therapy.

In fact, more than 50 per cent of patients undergoing renal dialysis or transplantation for ESRD are age 65 or older.
It is vital for kidneys to function to sustain human life.

Kidneys act like blood purifiers as they filter out toxic products and excess fluid from our system. They also maintain the chemical balance of important electrolytes such as sodium and potassium within our bodies.

End-stage kidney disease occurs when the kidneys are no longer able to function at a level that is necessary for day-to-day life.

It usually occurs as chronic renal failure worsens to the point where kidney function is less than 10 per cent of normal.

At this point, the kidney function is so low that without dialysis or kidney transplant, complications are multiple and severe, and death will occur from accumulation of fluids and waste products in the body.

Chronic renal failure usually occurs over a number of years as the internal structures of the kidney are slowly damaged. In the early stages, there may be no symptoms.

In fact, progression may be so gradual that symptoms do not occur until kidney function is less than one-tenth of normal.

This is usually in response to a chronic (ongoing, long-term) disease such as diabetes or high blood pressure. In some cases this kidney disease is hereditary.

People with the following conditions are at greater-than-normal risk of developing kidney failure and end-stage renal disease: Diabetes (type 1 or type 2), high blood pressure, glomerular diseases, hemolytic uremic syndrome, sickle cell anemia, severe injury or burns and liver disease or liver failure, Inherited kidney diseases such as polycystic kidney disease, congenital obstructive uropathy, cystinosis and prune belly syndrome also put people at risk of ESRD.

Taking antibiotics, cyclosporin, heroin, and chemotherapy is also a factor as it can lead to damage to the kidney structure and functions.

Preventive care is possible and early kidney damage is manageable. However, ESRD cannot be treated with conventional medical treatments such as drugs.

Treatment depends on the degree of kidney function that remains. And may include medications (to help with growth, prevent bone density loss, and/or to treat anaemia diuretic therapy or medications (to increase urine output)), specific diet restrictions, dialysis and kidney transplant.

Dialysis is a well-accepted therapy option, since there is a shortage of kidney donors for conducting transplants. There are two types of dialysis options available - Hemo Dialysis (HD) and Peritoneal Dialysis (PD).

People with ESRD are now living longer than ever. Today, both mortality among dialysis patients and the rate at which ESRD has been increasing over the past decade are declining.

Dialysis treatments (both hemodialysis and peritoneal dialysis) will help a person feel better and live longer. Obviously, the primary goal should be prevention of ESRD.

Aggressive treatment of hypertension and hyperglycemia is likely to reduce the incidence of ESRD. Screening for diabetes and hypertension may be a fruitful approach to reduction in ESRD rates.

Today, with the availability of adequate information, knowledge and resources it is possible to deal with the spread of unwanted complications from ESRD.

Symptoms of renal failure?
The main external symptoms are general feeling of sickness, tiredness, swelling around the feet/ankles/eyes, loss of appetite, and nausea.

Blood tests will show up a very high concentration of a toxic substance called urea, creatinine, which the body is not able to excrete.

Urine tests will normally show abnormally high protein content, as the kidneys are not able to reabsorb the protein before urine is passed out. Also gradually many patients tend to lose their daily urine output.