End-stage renal disease means the kidneys have lost nearly all function — an eGFR under 15 — and can no longer sustain life on their own.
The name is worse than the reality. People live for decades after reaching it. What determines how those decades go is a conversation that usually happens too late, or never.
The referral that came too late
Most patients meet a nephrologist for the first time when kidney failure is already close. Sometimes in an emergency room.
By then the options have quietly closed. A hemodialysis fistula takes three to six months to mature. Transplant evaluation takes months. A peritoneal catheter needs two weeks to heal, plus training.
None of that can be compressed. Someone arriving in fluid overload with an eGFR of 6 starts dialysis that afternoon through a catheter in the neck — the worst access, highest rates of infection and clotting, carried for months while a fistula is finally built.
That outcome was decided years earlier, by a referral that did not happen.
And nobody mentioned transplant
A transplant can be performed before dialysis ever starts. It is called preemptive transplant, and it produces better outcomes than a transplant after dialysis — better graft survival, better patient survival, and years of your life not spent in a chair three days a week.
Evaluation should begin at an eGFR of 20, while you still have time. It takes months to complete. A living donor, if you have one, can be worked up in parallel.
Most patients are never told this. They learn about transplant after they are already on dialysis, when the best version of the option has passed.
If your eGFR is under 30 and you have not seen a nephrologist — or if it is under 20 and nobody has raised transplant — that is the appointment.
Board-certified nephrology at Remix Medical in Houston. Call (713) 597-5131 or book online.
What happens now
Three paths. All real choices, and the right one depends on your health, your priorities, and what kind of life you want.
Transplant. For most candidates, the most years and the best ones. You can be evaluated and listed before dialysis ever starts.
Dialysis. Hemodialysis at a center or at home. Peritoneal dialysis at home, overnight or across the day.
Conservative management. Comprehensive medical care without dialysis, focused on symptoms and quality of life. A legitimate choice, particularly for older patients with serious other illness. It should be discussed honestly rather than treated as giving up.
| Option | What it involves | Where |
|---|---|---|
| Hemodialysis | Blood filtered by a machine, ~3–4 hours, three times a week | Center — or trained to do it at home |
| Peritoneal dialysis | Uses your abdomen's own lining to filter, done daily | At home, often overnight |
| Kidney transplant | A donor kidney takes over full function | Surgery, then lifelong medication |
| Conservative care | Symptom-focused care without dialysis | At home, with a supportive team |
Why the timing of that conversation matters more than almost anything
A hemodialysis fistula takes three to six months to mature. Transplant evaluation takes months. Peritoneal dialysis needs a catheter placed two weeks ahead and one to two weeks of training.
None of that can be compressed. When someone arrives in an emergency room in fluid overload with an eGFR of 6, none of it has happened, and they start dialysis that afternoon through a catheter in the neck — the worst access, with the highest rates of infection and clotting, carried for months while a fistula is built.
This is why we begin planning at an eGFR of 30 and start transplant evaluation at 20. Not because it is imminent. Because there is no way to make up the time later.
Living with it
Dialysis replaces filtration. It does not replace the hormonal work of the kidney, so anemia, bone and mineral disease, and blood pressure all still need treatment.
Diet requires real attention — potassium, phosphorus, fluid. Cardiovascular disease is the leading cause of death, not kidney failure itself, which is why blood pressure and cholesterol remain central.
Many patients continue working. Many travel; dialysis units arrange treatment at partner centers. Home therapies preserve schedule flexibility that in-center hemodialysis cannot.
What we do
We manage the transition, not just the endpoint. That means building the vascular access on time, running the transplant evaluation before dialysis is needed, choosing the modality with you rather than for you, and treating the anemia, bone disease, and cardiovascular risk that determine how these years actually go.
Kidney failure is visible years before it arrives. Everything that improves how it goes has to be started before it does.
Call (713) 597-5131 or book online.