What Kidney Failure Feels Like, Emotionally and Physically

Kidney failure, or end-stage kidney disease (ESKD), occurs when the kidneys are no longer able to filter waste and toxins from your bloodstream without the help of dialysis or a kidney transplant.

Kidney failure is the fifth and last stage of chronic kidney disease (CKD). Every case of kidney failure can feel a little different, and you may experience a variety of symptoms. 

With kidney failure, your kidneys function below 15% of their normal capacity, causing a buildup of toxins in the bloodstream that can affect many of your body's vital organs and systems. You may notice symptoms like overwhelming fatigue, nausea, itchy skin, leg or ankle swelling, and shortness of breath that make it difficult to perform everyday activities. 

Early Symptoms of Kidney Disease

More than 37 million adults in the United States are living with kidney disease, but only about 10% are aware of it. That's because chronic kidney disease is often "silent," progressing without causing symptoms until it reaches a more advanced stage—usually in stage 3 or 4 when there is already a significant loss of kidney function. 

The early symptoms of kidney failure can easily be mistaken for other conditions and may include: 

• Fatigue
• Itchy, dry skin 
• Loss of appetite
• Nausea and vomiting
• Unexplained weight loss 
• Urinating more or less often than usual 
• Swelling in your hands and feet 

Although these symptoms can be vague, seeking medical attention is crucial if you experience them. Kidney failure requires treatment. Without it, symptoms progressively worsen as the kidneys begin to lose function.

Advanced Symptoms

As kidney failure progresses and the kidneys sustain more damage, symptoms become more noticeable. These symptoms develop when there is severe loss of kidney function, and your kidneys are only capable of doing 15-29% of what they could previously do. At this stage, CKD is irreversible, but treatment can help manage symptoms and slow the progression of the disease.

As fluid accumulates and toxins build up in the bloodstream, you'll likely experience early symptoms of kidney failure alongside these advanced ones: 

• Muscle weakness
• Foaming, frothing, or bubbly urine
• Swelling in your arms and legs
• Lower back pain
• Muscle cramps
• Insomnia
• Bad breath that may smell fishy or urine-like 
• Shortness of breath 
• Difficulty concentrating

End-Stage Symptoms

During end-stage kidney disease (kidney failure), your kidneys function at less than 15% of their usual capacity or may not function at all. This stage can cause life-threatening complications, especially without proper intervention or treatment, like dialysis or a kidney transplant. 

With almost no kidney function remaining, waste products accumulate in your bloodstream, and fluid retention throughout the body worsens. You may experience early and advanced symptoms alongside end-stage symptoms, such as:

• Difficulty breathing 
• Severe fatigue 
• Headaches
• Loss of or change in taste
• Stiff, painful joints
• Memory problems
• Skin color changes 

How Does Kidney Failure Affect Mental Health?

Kidney failure takes a toll on your physical health, but it can also affect your emotional well-being. The stress of managing a chronic illness, going through dialysis, and feeling uncertain about the future can contribute to anxiety, depression, and a decline in overall mental health.

People with chronic kidney disease and kidney failure often experience: 

• Depression: Fatigue, sleep problems, loss of independence, and the ongoing demands of dialysis treatments can contribute to feelings of sadness, hopelessness, and isolation. Rates of depression in people with CKD range from 25-66%, and depression symptoms tend to worsen as CKD progresses. 
• Anxiety: People with CKD often worry about their health, treatment options and outcomes, and the impact of their disease on their loved ones, careers, and day-to-day life.
• Cognitive impairment: The buildup of toxins in the blood coupled with sleep problems and depression can impair cognitive functioning in people with CKD. Many experience confusion, memory problems, and difficulty focusing on tasks. This brain fog can make it challenging to complete everyday activities.
• Mood swings: A combination of waste products in blood and the physical and emotional stress of living with a chronic disease can lead to frustration, irritability, anger, or sudden emotional changes, affecting relationships and interactions with others in daily life.

How To Manage Kidney Failure

Living with kidney failure requires a proactive approach to managing your health. Here are some tips and suggestions to help you navigate the challenges and improve your quality of life:

• Follow your treatment plan: If you're undergoing dialysis and/or awaiting a kidney transplant, attending your dialysis sessions on time will help you feel better and live longer. It's also important to follow your healthcare provider's instructions for taking prescription medications for underlying conditions, such as high blood pressure, diabetes, or anemia.
• Adopt a kidney-friendly diet: Work with your healthcare provider or a registered dietitian (RD) to create a kidney-friendly diet plan you can follow. This will often involve reducing protein, sodium, potassium, phosphorus, and high-fat foods and eating more fruits, vegetables, lean meats, and low-fat or fat-free dairy products.
• Exercise regularly: Aim for at least 30 minutes of physical activity most days of the week. Exercise can help maintain a healthy body weight and manage stress. Even low-impact activities like walking, swimming, or cycling can help maintain physical strength and improve mental well-being.
• Avoid smoking: Smoking worsens kidney damage and increases the risk of heart disease, which is a common complication of kidney failure. If you'd like extra support, talk to your healthcare provider about smoking cessation programs. 
• Get enough sleep: Aim for 7-8 hours of sleep per night. Sleep problems, like insomnia, are common in people with kidney failure. Establishing a consistent bedtime routine, creating a calming sleep environment, and practicing relaxation techniques like meditation or deep breathing may help improve sleep.
• Monitor your mental health: Seek support for any emotional challenges by talking to a counselor, joining a support group, or discussing concerns with your healthcare team and loved ones.

When to Contact a Healthcare Provider

See a healthcare provider if you are experiencing symptoms of chronic kidney disease (CKD) or kidney failure, such as fatigue, itchiness, nausea, or sleep problems.

Although CKD is irreversible, early detection and treatment can help slow the progression of kidney disease, lower the risk of complications (e.g., heart disease), and protect the health and function of your kidneys.

If you have a diagnosis of CKD or kidney failure, you're likely already in regular contact with your healthcare team for routine monitoring and treatment. However, there are times when immediate contact with your provider is necessary.

Contact your healthcare provider or seek emergency medical care if you experience: 

• Sudden shortness of breath
• Severe swelling in the legs, ankles, or face
• Chest pain
• Noticeable changes in how often you urinate (pee) 
• Worsening nausea, vomiting, or diarrhea 
• Seizures
• Extreme fatigue 
• High fever
• Rapid heart rate
• Disorientation

A Quick Review

Kidney failure is the last stage of chronic kidney disease (CKD), and everyone experiences the condition a little differently. With kidney failure, your kidneys can no longer effectively filter waste products from the blood, leading to a harmful buildup of toxins in the bloodstream. 

Early symptoms, such as fatigue and nausea, can be subtle and vague. Advanced stages bring more noticeable and severe symptoms, like shortness of breath, cognitive changes, swelling, and little to no urination.

If you have kidney failure, dialysis or a kidney transplant can help you live longer. Following your treatment plan and making lifestyle changes like adopting a kidney-friendly diet and regular exercise can also help prevent worsening symptoms and improve your overall quality of life.