Kidney Health 10 min read·Updated 22 July 2026 Clinician-reviewed

Kidney Failure — Causes, Symptoms & Treatment

Kidney failure is the final stage of chronic kidney disease. A UK Consultant Nephrologist explains what it means, what it feels like, and the treatment options available on the NHS.

  • Clinically Reviewed
  • NHS & NICE Aligned
  • UK Evidence-Based
  • Last Reviewed 22 July 2026

Professor Mohammed Mahdi Althaf

Consultant Nephrologist & Acute Physician

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Professor Mohammed Mahdi Althaf

MD, MSc, PgDip (Clin Ed), FRCP, FHEA, FASN

Consultant Nephrologist & Acute Physician · GMC 7216325

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Direct answer

Kidney failure (stage 5 CKD, eGFR under 15) means the kidneys can no longer sustain life without support. Symptoms include severe fatigue, nausea, itch, breathlessness and swelling. Treatment options are haemodialysis, peritoneal dialysis, kidney transplant, or conservative (palliative) care. The best outcomes come from early planning and shared decision-making with your renal team.

Key recommendation: Kidney failure = stage 5 CKD (eGFR under 15).

Quick answer

✓ Best choices

  • Vegetables, lower-potassium fruit and whole grains
  • Sensible portions of fish, eggs, chicken or tofu
  • Olive oil and unsalted nuts in small amounts

✓ Foods to limit

  • Added salt and ultra-processed foods
  • Phosphate additives in processed meats and ready meals
  • Sugary and energy drinks

Key takeaway

Kidney failure (stage 5 CKD, eGFR under 15) means the kidneys can no longer sustain life without support. Symptoms include severe fatigue, nausea, itch, breathlessness and swelling. Treatment options are haemodialysis, peritoneal dialysis, kidney transplant, or conservative (palliative) care. The best outcomes come from early planning and shared decision-making with your renal team.

Who should be cautious

People on dialysis, post-transplant, pregnant or breastfeeding, or taking prescription medication — confirm with your renal team before changes.

Kidney Failure — Causes, Symptoms & Treatment

What kidney failure means

Kidney failure, also called end-stage kidney disease (ESKD) or stage 5 CKD, occurs when the kidneys have lost about 85–90% of their function. eGFR falls below 15 ml/min/1.73m². The kidneys can no longer remove waste products (urea, creatinine), balance fluids and salts, produce enough erythropoietin (causing anaemia), or activate vitamin D. Without treatment, kidney failure is fatal — but with dialysis or transplant, people can live for many years.

Symptoms of kidney failure

Uraemia — the build-up of waste products — causes a constellation of symptoms. Fatigue is often the most disabling. Nausea, vomiting and a metallic taste reduce appetite and cause weight loss. Severe pruritus (itch) affects sleep and quality of life. Fluid retention causes ankle swelling, pulmonary oedema (breathlessness), and raised blood pressure. Anaemia causes pallor, breathlessness and heart palpitations. High potassium can cause life-threatening heart rhythm disturbances.

Haemodialysis

In haemodialysis, blood is pumped through a dialysis machine containing an artificial kidney (dialyser) that removes waste and excess fluid. Standard NHS in-centre haemodialysis is three sessions per week, each lasting 3.5–5 hours. Home haemodialysis allows more frequent or longer sessions, which can improve blood pressure control, phosphate management and quality of life. A vascular access (fistula, graft or central line) is required. Dietary restrictions include limiting potassium, phosphate, sodium and fluid intake between sessions.

Food first. If you are choosing a daily multivitamin alongside a balanced diet, Kidney Vitality was developed by a UK Consultant Nephrologist using renal nutrition principles. See the formulation.

Peritoneal dialysis

Peritoneal dialysis uses the lining of the abdomen (peritoneum) as a natural filter. Dialysis fluid is infused into the abdomen through a catheter, left to dwell for several hours, then drained out — taking waste and fluid with it. Continuous Ambulatory Peritoneal Dialysis (CAPD) involves 3–4 manual exchanges during the day. Automated Peritoneal Dialysis (APD) uses a machine overnight. Peritoneal dialysis preserves residual kidney function longer and offers more flexibility, but requires good hand hygiene and abdominal space.

Kidney transplant

A kidney transplant from a living or deceased donor offers the best survival and quality of life for most people with kidney failure. One transplanted kidney is sufficient. Life expectancy with a transplant is roughly 10–15 years on average, though many grafts last 20+ years. Lifelong immunosuppressant medicines are essential to prevent rejection — these include tacrolimus, mycopurine (MMF), prednisolone, and sometimes belatacept or sirolimus. Transplant recipients need regular monitoring and are at higher risk of infections and some cancers.

Conservative (palliative) management

Not everyone with kidney failure chooses or is suitable for dialysis or transplant. Conservative management focuses on maximising quality of life through symptom control, medication, dietary support and psychological care, without dialysis. This is a valid, supported choice and does not mean 'giving up'. Many older adults with multiple health conditions live comfortably for months to years with conservative care. A dedicated palliative care team works alongside the renal team.

Preparing for kidney failure

When eGFR drops below 30, your renal team should begin 'shared decision-making' conversations about treatment options. This includes education about each modality, transplant assessment, access planning (fistula creation takes 6–12 weeks to mature), and psychosocial support. Early preparation reduces emergency dialysis starts — which carry higher risks and lower quality of life — and gives you time to make informed choices.

Stages of Kidney Disease Explained
Related reading: Stages of Kidney Disease Explained.

Key practical tips

Designed for quick scanning — what to order, what to avoid, sensible portions, common mistakes.

  • Cook from scratch when you can
  • Read sodium labels (≤ 0.3 g per 100 g is low)
  • Take any concerns to your GP or renal team early

Clinical guidance

TL;DR summary

Kidney failure (stage 5 CKD, eGFR under 15) means the kidneys can no longer sustain life without support. Symptoms include severe fatigue, nausea, itch, breathlessness and swelling. Treatment options are haemodialysis, peritoneal dialysis, kidney transplant, or conservative (palliative) care. The best outcomes come from early planning and shared decision-making with your renal team.

Key takeaways
  • Kidney failure = stage 5 CKD (eGFR under 15).
  • Symptoms: fatigue, nausea, itch, breathlessness, swelling.
  • Treatment: haemodialysis, peritoneal dialysis, transplant, or conservative care.
  • Diabetes and high blood pressure are the leading causes.
  • Early planning with your renal team improves outcomes.
Kidney Diet & Nutrition Considerations

Diet is one of the most powerful tools you have to look after your kidneys. UK renal guidance points to a Mediterranean-style, reduced-salt pattern: plenty of vegetables, lower-potassium fruit, whole grains, sensible protein, beans and pulses in moderation, oily fish and olive oil. Personal targets — for potassium, phosphate, protein and fluid — should be set by your renal team based on your bloods.

Foods to prioritise

  • Vegetables, lower-potassium fruit and whole grains
  • Sensible portions of fish, eggs, chicken or tofu
  • Olive oil and unsalted nuts in small amounts

Foods to limit

  • Added salt and ultra-processed foods
  • Phosphate additives in processed meats and ready meals
  • Sugary and energy drinks

Potassium, phosphate and protein needs vary between individuals — please confirm personal targets with your renal team or dietitian. Browse the Kidney Diet Hub for more guides in this cluster.

Frequently asked questions

What is kidney failure?

Kidney failure means the kidneys have lost most or all of their ability to filter waste, balance fluids and electrolytes, and produce essential hormones. It is also called end-stage kidney disease (ESKD) or stage 5 CKD. At this stage, eGFR is below 15 ml/min/1.73m². Waste products build up in the blood, causing uraemia. Dialysis or a kidney transplant is needed to sustain life.

What are the symptoms of kidney failure?

Symptoms include severe fatigue, nausea and vomiting, poor appetite and weight loss, metallic taste in the mouth, severe itch, restless legs, muscle cramps, breathlessness (fluid on the lungs), swelling of ankles, hands and face, confusion or reduced concentration, and very low urine output. Some people also develop anaemia-related pallor and heart complications from high potassium.

Is kidney failure the same as chronic kidney disease?

No. Chronic kidney disease (CKD) is a spectrum from mild (stage 1) to severe (stage 5). Kidney failure specifically means stage 5 CKD, where the kidneys can no longer sustain life without replacement therapy (dialysis or transplant). Acute kidney injury (AKI) is a sudden, often reversible drop in kidney function over hours to days — it is different from the gradual progression of CKD to failure.

What causes kidney failure?

The two most common causes are diabetes (diabetic nephropathy) and high blood pressure (hypertensive nephrosclerosis). Other causes include glomerulonephritis (inflammation of the kidney filters), polycystic kidney disease (PKD), recurrent kidney stones causing obstruction, reflux nephropathy, and autoimmune diseases such as lupus. In some cases, no specific cause is found.

What are the treatment options for kidney failure?

There are three main treatments. Haemodialysis: blood is filtered through a machine, usually three times a week at a hospital or dialysis unit, or more frequently at home. Peritoneal dialysis: the lining of the abdomen acts as a filter, with fluid exchanges done daily at home. Kidney transplant: a donated kidney is surgically placed. Transplant offers the best quality of life and survival but requires lifelong immunosuppressant medicines. Conservative (palliative) management without dialysis is a valid choice for some older or frail patients, focused on symptom control and quality of life.

What foods are good for kidney health?

A Mediterranean-style, mostly plant-based, reduced-salt diet is the most consistent evidence-based pattern for kidney health. Build meals around vegetables, lower-potassium fruit, whole grains, fish, eggs or tofu, beans and pulses in moderation, and olive oil.

Nutritional challenges in kidney disease

Many people living with kidney disease have to limit foods because of potassium, phosphate, diabetes, dialysis, appetite changes or simply the time it takes to cook from scratch every day. That can make it harder to keep daily nutrition balanced — particularly for vitamins and minerals that food alone may not fully cover.

Kidney Vitality is a UK-formulated daily nutritional support product designed by Consultant Nephrologist Professor Mohammed Mahdi Althaf with renal nutrition in mind from the start. It keeps doses moderate, leaves out added potassium, phosphate and magnesium, and avoids megadose vitamin A — sitting alongside a kidney-friendly diet, not replacing it.

Why Kidney Vitality fits this need

Aligned with UK renal replacement therapy guidance

Guidance follows NICE NG107 (renal replacement therapy), UK Renal Association standards, and NHS England Kidney Disease Treatment Pathways.

Designed by a UK Consultant Nephrologist

Formulated and reviewed by Professor Mohammed Mahdi Althaf (GMC 7216325), who manages dialysis and transplant patients in NHS practice.

Supports informed decision-making

Plain-English explanations of all treatment options, including conservative care, to support shared decision-making with your renal team.

Designed by a UK Consultant Nephrologist

Ready to support your kidney health?

If you have been researching kidney health, supplements, CKD nutrition or kidney-friendly living, Kidney Vitality was developed specifically around those principles by Professor Mohammed Mahdi Althaf (GMC 7216325). Nephrologist Developed Daily Multivitamin.

  • No Added Potassium
  • No Added Phosphorus
  • No Added Iron
  • UK Manufactured
  • One capsule daily
  • UK GMP — BRCGS, NSF GMP, Halal
Subscribe & Save — £20.39/monthCheck your current multivitamin

✓ Free UK tracked delivery  ·  ✓ Delivered every 30 days  ·  ✓ Pause or cancel anytime  ·  ✓ Never run out

ComparisonKidney VitalityTypical high-street multivitamin
Added potassiumNoneOften included
Added phosphateNoneOften included (E338–E452)
Vitamin A (retinol)No megadoseOften high-dose retinol
Kidney-focused formulationYesNo — general population
Consultant Nephrologist involvementYes (GMC 7216325)No
UK GMP manufacturedYes (BRCGS, NSF GMP)Varies

Food supplement. Not a medicine and not a treatment for kidney disease. Speak with your GP, pharmacist or renal team before starting any new supplement, especially in advanced CKD, on dialysis, post-transplant, pregnant or breastfeeding.

Clinical reviewer

Professor Mohammed Mahdi Althaf

Consultant Nephrologist

Acute Physician

GMC 7216325

View Full Biography

Professor Mohammed Mahdi Althaf is a UK Consultant Nephrologist and Acute Physician with a special interest in chronic kidney disease, AKI prevention and renal nutrition. He combines hospital practice with patient education and clinical guidance review.

View professional profile →
View Credentials
  • MD
  • MSc
  • PgDip (Clin Ed)
  • FRCP
  • FHEA
  • FASN

About this article

Written for UK patients and based on:

  • NICE guidance
  • NHS resources
  • British Dietetic Association guidance
  • Kidney Care UK resources
View methodology

Each article is researched against current UK clinical guidance (NICE NG203, NG118, NG136), NHS patient resources, KDIGO and KDOQI international guidelines, and the British Dietetic Association Renal Nutrition Group. Drafts are written by the Kidney Vitality editorial team and reviewed by a UK Consultant Nephrologist before publication. Content is reviewed on a rolling basis and updated when guidance changes.

Editorial standards

  • Clinically reviewed
  • NHS-aligned
  • NICE-aligned
  • Evidence-based
  • Reviewed before publication
View full editorial process

Every article is researched and written by the Kidney Vitality editorial team using current UK clinical guidance (NICE NG203, NG118, NG136), NHS patient resources, KDIGO/KDOQI international guidelines, and British Dietetic Association renal nutrition guidance. Drafts are reviewed for clinical accuracy by Professor Mohammed Mahdi Althaf, MD, MSc, PgDip (Clin Ed), FRCP, FHEA, FASN (Consultant Nephrologist & Acute Physician, GMC 7216325) before publication. Content is updated when UK guidance changes.

References (4)View Sources
  1. NICE NG203: Chronic kidney disease — assessment and management
  2. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD
  3. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update
  4. British Dietetic Association — Renal Nutrition Group

Medical disclaimer

This content is educational only and does not replace personalised medical advice.

Read full disclaimer

This page is general information, not personal medical advice. If you have chronic kidney disease, are on dialysis, have had a kidney transplant, are pregnant or breastfeeding, or take prescription medication, please confirm any supplement with your GP, pharmacist or renal team before starting.

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