Chronic kidney disease is often progressive. If the disease gets worse, your symptoms, such as fatigue, nausea, and loss of appetite, may occur more frequently or become more severe. Work with your doctor to develop a treatment plan to help control these symptoms. An eating plan that limits the amount of protein, fluids, and salt in your diet is usually needed to help slow the progression of kidney failure.

Uremic syndrome (uremia) is a serious complication of chronic kidney disease. It occurs when waste products build up in the body because the kidneys are not able to eliminate them. These substances can become poisonous (toxic) to the body if they reach high levels. Uremic syndrome can affect many body systems, including the intestines, nerves, and heart. If it develops, the mechanical removal of wastes and fluids (dialysis) or replacement with a donor kidney (kidney transplant) will be needed.

When the kidneys do not produce enough of the protein that the body needs to produce new red blood cells (erythropoietin), anemia develops. This type of anemia is treated with a medicine called human recombinant erythropoietin (rhEPO) that helps your body

If you are not able to control chronic kidney disease, your kidney function will continue to get worse. When kidney function falls below a certain point, it is called kidney failure. Kidney failure has harmful effects throughout your body. It can cause serious heart, bone, and brain problems and make you feel very ill.

Once you develop kidney failure, either you will need to have dialysis or you will need a new kidney. Both choices have risks and benefits. Talk with your doctor to decide which would be best for you.

Dialysis is a process that performs the work of healthy kidneys by clearing wastes and extra fluid from the body and restoring the proper balance of chemicals (electrolytes) in the blood. You may use dialysis for many years, or it may be a short-term measure while you are waiting for a kidney transplant.

• Hemodialysis uses a man-made membrane called a dialyzer to clean your blood. You are connected to the dialyzer by tubes attached to your blood vessels. Before hemodialysis treatments can begin, your doctor creates a site where blood can flow in and out of your body. This is called the dialysis access. Usually the doctor creates the access by joining an artery and a vein in the forearm or by using a small tube to connect an artery and a vein. An access may be created on a short-term basis by putting a small tube into a vein in your neck, upper chest, or groin.
• Peritoneal dialysis uses the lining of your belly, which is called the peritoneal membrane, to filter your blood. Before you can begin peritoneal dialysis, your doctor will need to place a catheter in your belly to be the dialysis access.

Kidney transplant is often a better treatment option for kidney failure because it may allow you to live a fairly normal life. But there are some drawbacks:

• If no one you know can donate a kidney, the wait for a transplant may be long. You will probably need to have dialysis while you wait for a kidney.
• It may be difficult to find a good match for your blood and tissue types. Sometimes, even when the match is good, the body rejects the new kidney.
• You will have to take medicine to suppress your immune system (immunosuppressants) for the rest of your life. These medicines help prevent your body from attacking your new kidney (rejection). Not taking the medicines properly is a common cause of rejection.
• Immunosuppressant medicines work by lowering your body's disease-fighting ability, so they increase your risk of getting infections or cancer.
• In some cases, kidney transplant is not successful. If this is the case, transplant can be tried again.

As your disease gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have diseases that do not go away and often get worse over time. It is different than care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life-not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.

Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a long-term disease, make future plans around your medical care, or help your family better understand your disease and how to support you.

Chronic kidney disease progresses to kidney failure when damage to the kidneys is so severe that dialysis or a kidney transplant is needed to control symptoms and prevent complications and death. Many people have successful kidney transplants or live for years using dialysis. But at this point you may wish to talk with your family and doctor about health care and other legal issues that arise near the end of life.

If you have severe chronic kidney disease but have not yet developed kidney failure, discuss with your doctor which type of dialysis is best for you. The type of dialysis you have may sometimes depend on how quickly you need to begin dialysis.

Learning about dialysis (predialysis education) is an important step in preparing for dialysis. Most dialysis clinics offer predialysis services to help you better understand your choices.

Dialysis can be expensive. But Medicare or insurance may cover most or all of the costs. The dialysis center or hospital can help you find the best way to pay for your treatment.