The kidneys are definitely ‘multi-taskers.’ of the body. We’ll use the mnemonic, WAVE—Waste, Acid/Base, Volume, Endocrine—to learn chronic kidney disease symptoms and what happens when the kidneys no longer function

W – Waste Accumulation

Failure to remove waste products from the body results in uremia, a general term for the condition in which the kidneys are unable to clear toxic waste products from the body. People with uremia may experience loss of appetite, nausea, vomiting, severe generalized itching (pruritus), sexual and reproductive dysfunction or bleeding due to decreased numbers of platelets in the blood.

What are the effects of long-term kidney failure (uremia)?

It is important to have good-quality overall health care while on dialysis in order to manage the effects of long-term kidney failure. Possible complications include the following systems:

  1. Neurologic (nervous) system
  2. Gastrointestinal (stomach, small intestine, colon) system
  3. Cardiovascular (heart and blood vessels) system
  4. Pulmonary (lungs) system
  5. Skeletal (bones) system

Let’s break these down one system at a time.

Neurologic System

When people with kidney failure have neurologic effects, these might include:

  1. Fatigue, lethargy (lack of energy and motivation to do anything)
  2. Restless legs; myoclonus (twitching)
  3. Muscle weakness
  4. Loss of sensation
  5. Confusion
  6. Seizures
  7. Decreased consciousness, coma

Gastrointestinal System

When people with kidney failure have gastrointestinal effects, these might include

  1. Anorexia (loss of appetite)
  2. Nausea
  3. Vomiting
  4. Malnutrition (low albumen levels in the blood {serum})

Cardiovascular System

When people with kidney failure have cardiovascular effects, these might include:

  1. Pericarditis—inflammation of the lining around the heart
  2. Chest pain
  3. Low blood pressure
  4. Heart failure
  5. Cardiac arrest (extremely irregular heartbeat that may result in death)

Pulmonary System

When people with kidney failure have pulmonary (lung) effects, these might include:

  1. Chest pain
  2. Pleural effusion (build up of fluid in layers of lung tissue)
  3. Shortness of breath
  4. Severe complications from inability to breathe properly including death

Skeletal System

Skeletal (bone) effects of long-term kidney failure is discussed below.

Ways to manage uremia

Once people start experiencing some of the severe side effects of uremia as listed above, it is time for replacement therapy–that is dialysis or kidney transplantation. The various types of dialysis treatments are described later in this chapter.

A – Acid/Base and Electrolyte Imbalances

When the kidneys don’t excrete hydrogen ions or acid and don’t generate bicarbonate, an acidosis (abnormally high acid levels in the body) develops which can interfere with protein metabolism, increase bone breakdown and lead to further kidney injury.

Normal kidneys also help to maintain proper levels of electrolytes including

Calcium/Phosphorus (work together)

These electrolytes affect acid/base balance. When the kidneys fail, the ability to naturally control the levels of these electrolytes also fails. If balance is not restored, it can hasten the progression of kidney failure.

We will consider each of these to learn what may happen when the kidneys are not functioning properly or at all.


When the kidneys fail, they are not able to get rid of excess potassium in the body. High blood levels of potassium can be very serious and can lead to:

  1. Muscle weakness
  2. Slow heart rate
  3. Serious, sometimes fatal heart arrhythmias (rhythm problems)

Ways to manage potassium abnormalities include:

  1. Avoid foods high in potassium
  2. Take a water pill (diuretic), which takes out potassium along with excess fluid
  3. Take medicine such as Polystyrene sulfonate (Kayexalate) to help eliminate potassium from the body
  4. Regulate dialysis treatments to help rid the body of excess potassium

People receiving hemodialysis treatments, generally three times per week, must monitor dietary potassium intake carefully. Those on peritoneal dialysis have fewer dietary restrictions because of having daily dialysis treatments. All people with CKD must have their blood levels of potassium carefully monitored by their medical team.

Calcium and Phosphate Abnormalities

Calcium and phosphorus work as a team in the body. Correct balance of these two electrolytes is important for maintaining good health. It is very common for people with CKD to have above-normal phosphorus levels and below-normal calcium levels. Abnormal levels of these electrolytes are associated with

  1. Increased secretion (release) of parathyroid hormone (PTH)
  2. Skeletal (bone) and muscle breakdown and weakness
  3. Decreased circulation to skin and other organs (calciphylaxis) caused by blood-vessel disease

Ways to manage calcium/phosphate abnormalities include:

  1. Avoid foods high in phosphate (this will be discussed in the nutrition chapter of this text)
  2. Supplements of sodium bicarbonate
  3. Take phosphate binders (such as calcium acetate or non-calcium binders)
  4. Take a Vitamin D supplement, which prevents calcium from being drawn out of the bones
  5. Take agents to control (decrease) parathyroid hormone (PTH) secretion such as Sinacalcet (a calciumimetic agent—one that increases sensitivity to calcium in the body, thus decreasing PTH secretion)31
  6. Add bicarbonate or lactate solutions to dialysis treatments

V – Volume Imbalances

The kidneys help to regulate the sodium (salt) and water volume in the body; thus serious salt/water imbalances occur when kidneys fail. Excess salt does not get filtered out, and the body retains water. Fluid retention (the holding of water) can happen in the body tissues as well as in the circulatory system—the heart and blood vessels. This can lead to:

  1. Hypertension (high blood pressure)—too much pressure against the walls of vessels
  2. Edema (swelling)—tissue fluid accumulating in the feet, legs, face, and hands, around the lungs (called pleural effusion), in the abdomen (called ascites), etc.
  3. Congestive heart failure—a build-up of fluid in the lungs due to fluid overload backing up in the heart

Ways to manage sodium (salt)/water abnormalities?

  1. Reduce salt and fluid in the diet;
  2. Take diuretic medication(s). These are medicines that help the kidney to filter out excess fluid.
  3. Begin dialysis treatments, regulating the dialysis prescription to allow good sodium/water balance.
  1. Hemodialysis: a specific prescription for dialysis treatments allows dialysis nurses or technicians to manage the amount of fluid removed during each treatment. (Hemodialysis mechanism described below.)
  2. Peritoneal dialysis: a specific prescription for dialysis-solution strength is based on how much excess fluid the patient has accumulated. (Peritoneal dialysis mechanism described below.)

E – Endocrine – Hormonal Abnormalities

The kidneys help to produce certain hormones. In diseased kidneys, the production of those hormones is reduced and ultimately stops.

  1. Vitamin D, activated by the kidneys, decreases.
    1. When Vitamin D levels are reduced, it may cause calcium to be drawn from the bones (hypocalcemia) and lead to bone deterioration
    2. In response, the parathyroid produces too much hormone (hyperparathyroidism)
    3. Ways to raise Vitamin D levels back to normal limits are to take Vitamin D supplements, either
      1. Intravenously (IV—into the vein) or
      2. Orally (by mouth)
  2. Erythropoietin, a hormone manufactured in the kidneys, decreases. Since erythropoietin is involved in the making of red blood cells that carry oxygen through the blood vessels  and into body tissue, decreased levels of this hormone cause
    1. Anemia
    2. Muscle weakness and fatigue

Management of anemia

Erythropoietin medication can be administered intravenously (IV), into the vein or subcutaneously (under the skin). Adequate iron levels in the blood are required for erythropoietin to be effective. Iron supplements can be administered either by mouth or intravenously.

Kidney Side Effects
Chronic Kidney Disease