Update History 2025-11-26 15:08:22
End-Stage Renal Disease (ESRD) majorpublished
End-stage renal disease is the irreversible final stage of chronic kidney damage, marked by severely reduced filtration, toxin accumulation, systemic inflammation, and profound metabolic disturbances closely linked with gut microbiome dysbiosis.
End-Stage Renal Disease (ESRD)
Researched by:
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Dr. Umar
ID
Dr. Umar
Read MoreClinical Pharmacist and Clinical Pharmacy Master’s candidate focused on antibiotic stewardship, AI-driven pharmacy practice, and research that strengthens safe and effective medication use. Experience spans digital health research with Bloomsbury Health (London), pharmacovigilance in patient support programs, and behavioral approaches to mental health care. Published work includes studies on antibiotic use and awareness, AI applications in medicine, postpartum depression management, and patient safety reporting. Developer of an AI-based clinical decision support system designed to enhance antimicrobial stewardship and optimize therapeutic outcomes.
End-stage renal disease is the irreversible final stage of chronic kidney damage, marked by severely reduced filtration, toxin accumulation, systemic inflammation, and profound metabolic disturbances closely linked with gut microbiome dysbiosis.
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Dr. Umar
Read More
Researched by:
-
Dr. Umar
ID
Dr. Umar
Read More
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Dr. Umar
Definition
End-stage renal disease, increasingly termed kidney failure, is the final stage of chronic kidney disease (CKD), in which glomerular filtration rate (GFR) falls below ~15 mL/min/1.73 m² and the kidneys can no longer maintain fluid, electrolyte, and toxin homeostasis. Patients usually require kidney replacement therapy (hemodialysis, peritoneal dialysis, or transplantation).
Epidemiology and Burden
ESRD affects millions worldwide and is strongly linked to diabetes and hypertension. Cardiovascular disease, infection, and wasting syndromes are the leading causes of death.
Etiology and Risk Factors
Major upstream drivers include diabetic kidney disease, hypertensive nephrosclerosis, glomerulonephritides, polycystic kidney disease, and recurrent acute kidney injury. Genetic susceptibility, aging, obesity, and environmental nephrotoxins further accelerate progression from early CKD to ESRD.
Pathophysiology
Chronic renal damage → nephron loss & glomerulosclerosis → ↓GFR (G4–G5) → sodium/water retention, metabolic acidosis, hyperkalemia → accumulation of uremic toxins (indoxyl sulfate, p-cresyl sulfate, TMAO) → oxidative stress, endothelial dysfunction, vascular calcification → systemic inflammation, immune dysfunction, multiorgan damage.
Microbiome and ESRD
CKD and ESRD are tightly intertwined with gut and fungal microbiome dysbiosis. Urea influx into the gut lumen, altered transit, dietary restriction, phosphate binders, and antibiotics favor proteolytic bacteria, increasing the generation of microbiota-derived uremic toxins such as indoxyl sulfate and p-cresyl sulfate.
These toxins cross the leaky intestinal barrier, bind to plasma proteins, and are poorly cleared by dialysis, promoting cardiovascular injury, sarcopenia, and mortality.
Recent work also shows altered gut mycobiome signatures in ESRD, with distinct fungal taxa linked to perturbed serum and fecal metabolites.
Clinical Features and Complications
Typical manifestations include fatigue, anorexia, pruritus, nausea, volume overload, dyspnea, cognitive changes, and peripheral neuropathy, driven by retained solutes and endocrine failure (erythropoietin, vitamin D).
Complications encompass refractory hypertension, anemia, mineral and bone disorder, accelerated atherosclerosis, arrhythmia, infection, and protein-energy wasting—key phenotypes in microbiome-outcome association studies.