Understanding End-Stage Renal Disease (ESRD): A Guide for Nursing Home Staff

As the aging population continues to grow, nursing home staff are increasingly caring for residents living with End-Stage Renal Disease (ESRD). ESRD is not just a diagnosis—it’s a complex condition that profoundly affects a resident’s day-to-day life, health outcomes, and care needs. Having a strong foundational understanding of ESRD empowers staff to deliver safe, compassionate, and informed care.

What is End-Stage Renal Disease (ESRD)?

ESRD is the final stage of chronic kidney disease (CKD), where the kidneys have lost about 85-90% of their function and can no longer filter waste products, balance fluids, or regulate electrolytes effectively. At this stage, residents require renal replacement therapy—either dialysis or a kidney transplant—to survive.

Since transplants are rarely an option for frail, elderly, or medically complex residents in long-term care, dialysis becomes the primary life-sustaining treatment.

Recognizing ESRD in Nursing Home Residents

Nursing home staff are often the first to observe the subtle and progressive symptoms of ESRD, including:

• Persistent fatigue and general weakness
• Swelling in the lower legs, ankles, or feet (edema)
• Shortness of breath, especially with activity
• Nausea, vomiting, or changes in appetite
• Confusion or cognitive changes
• Itching, skin changes, or changes in urine output

Understanding these signs allows for early communication with medical providers, timely diagnostic evaluation, and proactive symptom management.

Dialysis: What It Means for Your Residents

Dialysis performs the critical functions that failing kidneys no longer can. There are two primary types:

Hemodialysis

• Most common among nursing home residents.
• Typically performed three times per week at an outpatient dialysis center.
• Blood is filtered through a machine and returned to the body.

Peritoneal Dialysis

• Less common in long-term care but possible.
• Involves infusing a cleansing fluid into the abdomen and draining it several times daily.
• Can be done by residents themselves or by trained staff.

Each type of dialysis comes with different care needs, schedules, and potential complications. Nursing staff should be trained to understand the treatment type each resident receives, their dialysis schedule, and possible signs of complications such as infection, bleeding from access sites, or severe fatigue post-treatment.

The Critical Role of Nursing Home Staff

Your role as nursing home staff is pivotal in ESRD care. Here’s how you can make a positive impact:

Monitoring and Reporting

• Keep track of vital signs, weight changes, fluid retention, and signs of infection.
• Be vigilant about signs of missed or ineffective dialysis, such as confusion, shortness of breath, or sudden swelling.

Medication Administration

• ESRD often involves complex medication regimens, including phosphate binders, blood pressure medications, and erythropoiesis-stimulating agents (ESAs).
• Monitor for side effects and ensure doses are given on time, especially around dialysis schedules.

Dietary Management

• Collaborate with registered dietitians to support low-sodium, low-potassium, and fluid-restricted diets.
• Educate dietary and kitchen staff on special meal requirements.

Emotional and Psychosocial Support

• Dialysis can be physically exhausting and emotionally draining.
• Residents may feel isolated, depressed, or anxious about their condition and treatment.
• Offer compassionate listening, involve social workers, and promote peer support when possible.