Table of ContentsView AllTable of ContentsSymptomsComplicationsTreatmentUremia and DialysisKidney TransplantsPrevention
Table of ContentsView All
View All
Table of Contents
Symptoms
Complications
Treatment
Uremia and Dialysis
Kidney Transplants
Prevention
Uremia, sometimes referred to as uremic syndrome, is a dangerous condition in which yourkidneysare unable to filter a waste product calledureafrom your blood.
Urea, a primary component of urine, is normally removed from the body when you pee (urinate). However, when the kidneys are no longer working—referred to askidney failure—urea can accumulate to toxic levels.
Uremia is most often due to kidney failure from advancedchronic kidney disease (CKD). Common symptoms include nausea, vomiting, weight loss, lower-stomach pain, and fatigue. Without treatment in the form ofdialysisor akidney transplant, uremia can get progressively worse, leading to seizures, coma, and death.
This article describes the symptoms and causes of uremia, including how this potentially deadly complication of kidney disease is diagnosed and treated.
Emergency Uremia Symptoms to Diagnose
Uremia is a consequence of kidney failure, the end stage of CKD (also known asend-stage renal disease or ESRD).It can also occur with anacute kidney injuryif the loss of kidney function is rapid and extreme.
The symptoms of uremia can be vague at first but become increasingly more pronounced as urea and other toxins accumulate in the bloodstream.
Stages of Kidney Disease and Treatment
Common Symptoms
Prior to the onset of symptoms, increases in blood urea may be entirelyasymptomatic(a state referred to asazotemia). With CKD, this can last for many years or decades, depending on how slowly or quickly kidney function is deteriorating. When symptoms of uremia do develop, they can often be nonspecific (very general) and easily attributed to other causes.
Common signs and symptoms of uremia include:
There is no consistent point at which azotemia becomes symptomatic uremia. In most people, uremic symptoms develop when a urine test called acreatinine clearance (CrCl)falls below 10 milliliters per minute (mL/min). CrCl levels this low are clear indications of kidney failure.
Uremic symptoms can occur at higher CrCl levels. Even so, uremia related to CKD only occurs with kidney failure and, as such, is always treated as a medical emergency.
Advanced Symptoms
Despite how general early symptoms are, uremia can rapidly progress, depending on how quickly toxins accumulate. As kidney function continues to deteriorate, the severity of symptoms will increase and theprognosis(likely outcome) will worsen.
Signs and symptoms of untreated uremia include:
Can Uremia Kill You?
In people with acute kidney injury, also known asacute renal failure, this can occur within hours or days if left untreated.
Effect of Uremia on Organ Systems
Urea itself is toxic to tissues, but that alone doesn’t account for uremia symptoms. Kidney failure also causes the accumulation of other waste products normally excreted from the body in urine when levels are extremely high, including:
Together, these toxins can disrupt the delicate balance of fluids,electrolytes, hormones, and acids that your body needs to function normally.Different organ systems are affected in different ways.
Blood Complications
The kidneys are responsible for producing a hormone callederythropoietin(EPO) that stimulates the production of red blood cells. Damaged kidneys produced far less EPO, resulting in fewer red blood cells and a type of anemia calledanemia of chronic disease.
Uremic toxins can also preventplatelets(the type of blood cell involved in clotting) from sticking together as they normally would. This can lead tocoagulopathyin which impaired blood clotting causes easy bleeding, including gastrointestinal bleeding.
Bone Complications
Anemia in Chronic Kidney Disease
Heart Complications
Uremia can causeuremic cardiomyopathy, a condition in which theleft ventricle of the heartstarts to thicken and become less flexible due to scarring. This reduces the heart’s ability to pump blood to the rest of the body, resulting incongestive heart failure.
Other complications of uremic cardiomyopathy include:
Brain Complications
Also contributing is a condition calledmetabolic acidosisin which uremic toxins damage parts of the kidney that regulate the acid-base balance in the body. High blood acid can disrupt normal brain function and lead to shock, coma, and death when excessively high.
Other Complications
Hyperkalemia(high potassium levels) is a major concern with end-stage kidney disease. When potassium levels are excessively high, life-threatening arrhythmias, muscle weakness, or paralysis can occur.
Taking certain drugs can worsen the situation, including:
Other possible complications of uremia include:
What Causes Kidney Failure?
Hospitalization and Treatment for Uremia
This can be accomplished in one of the following three ways:
People with symptomatic uremia should be treated with dialysis, without regard to the results of kidney function tests.
Those with acute kidney injury can often be treated with dialysis alone if the underlying cause is identified and properly treated. In such cases, normal kidney function may be restored.
The same is not true with uremia due to CKD. In such instances, damage to the kidneys is largely irreversible, and dialysis is often regarded as an interim measure until a donor kidney is available. For some, dialysis may be the only option if they are not candidates for a transplant.
What Are Kidney Function Tests?
Medications
No medications can directly treat uremia. With that said, certain medications may be prescribed to manage the symptoms or complications associated with uremia.
Examples include:
How Kidney Failure Is Treated
Uremia While on Dialysis
When uremia is due to end-stage kidney disease, dialysis can extend life and improve symptoms, but it may not erase all of the symptoms of uremia.
In 2020, researchers from Johns Hopkins University issued questionnaires to 1,954 adults on dialysis to evaluate the persistence of uremic symptoms while on life-extending treatment.
According to the findings published in the journalKidney360,more than 80% of the respondents reported three or more symptoms after starting dialysis, while over 50% reported five or more symptoms.
Even after one year, respondents on dialysis still reported significant rates of uremic symptoms, including:
Comparatively, people on peritoneal dialysis were more likely to experience nausea and vomiting but less likely to have loss of appetite than those on hemodialysis. No significant differences were observed for the other symptoms.
This further highlights the need to adhere to lifestyle recommendations if diagnosed with kidney failure, including the appropriate diet and exercise. Keeping as healthy as possible is arguably the best way to cope with the rigors of dialysis.
Uremia and Kidney Transplant
Even so, the benefits of a transplant can be enormous, normalizing kidney function and extending life for years and even decades.
How Long Can You Live After a Kidney Transplant?The prognosis following a kidney transplant is generally good. A 2020 analysis of 618 such transplants reported a five-year survival rate of 97%, meaning that 97 out of 100 recipients lived for at least five years. The 10- and 15-year survival rates were equally optimistic at 88% and 70%.
How Long Can You Live After a Kidney Transplant?
The prognosis following a kidney transplant is generally good. A 2020 analysis of 618 such transplants reported a five-year survival rate of 97%, meaning that 97 out of 100 recipients lived for at least five years. The 10- and 15-year survival rates were equally optimistic at 88% and 70%.
Is Uremia Preventable?
If you have chronic kidney disease, the best way to prevent uremia is to avoid disease progression. This means identifying your risk factors for CKD progression—including modifiable risk factors you can adjust (like diet and smoking) and non-modifiable ones you can’t (like age and family history).
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends the following lifestyle recommendations to avoid progression of CKD:
In addition, avoidnonsteroidal anti-inflammatory drugs (NSAIDs)like Advil and Motrin (ibuprofen) or Aleve (naproxen) that can harm your kidneys. Limiting your alcohol intake can also help.
Most importantly, see your healthcare provider regularly to monitor your kidney function with routine blood and urine tests andrenal ultrasound. With appropriate care, CKD—a disease that affects 15% of the U.S. population, or roughly 37 million people—may never progress to the point of failure.
How to Find SupportEducation and support can help you manage CKD over the long term. The National Kidney Foundation offers a helpline at 855-NKF-CARES (855-653-2273) to connect people with CKD and their families to the resources, referrals, and information they need. The helpline is available Monday through Friday from 9 a.m. to 7 p.m. Eastern time.
How to Find Support
Education and support can help you manage CKD over the long term. The National Kidney Foundation offers a helpline at 855-NKF-CARES (855-653-2273) to connect people with CKD and their families to the resources, referrals, and information they need. The helpline is available Monday through Friday from 9 a.m. to 7 p.m. Eastern time.
Do I Need a Nephrologist?
Summary
If left untreated, uremia can cause anemia, abnormal heart rhythms, bone disease, seizures, heart failure, and coma. Treatments include dialysis and kidney transplants. Without treatment, uremia is fatal.
20 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nigam SK, Bush KT.Uremic syndrome of chronic kidney disease: altered remote sensing and signaling.Nat Rev Nephrol.2019;15(5):301–316. doi:10.1038/s41581-019-0111-1Meyers TW, Hostetter TH.Approaches to uremia.J Am Soc Nephrol.2014;25(10):2151–2158. doi:10.1681/ASN.2013121264Dobre MA, Meyer TW, Hostetter TH.Chapter 14 - the uremic syndrome. In:Chronic Renal Disease (Second Edition).Cambridge, MA:Academic Press; 2020. doi:10.1016/B978-0-12-815876-0.00014-0Lara-Prado JI, Pazos-Perez F, Mendez-Landa CE, et al.Acute kidney injury and organ dysfunction: what is the role of uremic toxins?Toxins (Basel).2021;13(8):551. doi:10.3390/toxins13080551Lau WL, Vaziri ND.Urea, a true uremic toxin: the empire strikes back.Clin Sci (Lond). 2017;131(1):3-12. doi:10.1042/CS20160203National Kidney Foundation.Acute kidney injury (AKI).Hamza E, Metzinger L, Metzinger-Le Meuth V.Uremic toxins affect erythropoiesis during the course of chronic kidney disease: a review.Cells.2020;9(9):2039. doi:10.3390/cells9092039Baatan CCFMJ, Sternkopf M, Henning T, Marx N, Jankowski J, Noels H.Platelet function in CKD: a systematic review and meta-analysis.J Am Soc Nephrol.2021;32(7):1583–1598. doi:10.1681/ASN.2020101440Eknoyan G, Moe SM.Renal osteodystrophy: a historical review of its origins and conceptual evolution.Bone Rep.2022;17:101641. doi:10.1016/j.bonr.2022.101641Garikapti K, Goh D, Khanna S, Echampati K.Uraemic cardiomyopathy: a review of current literature.Clin Med Insights Cardiol.2021;15:1179546821998347. doi:10.1177/1179546821998347Rosner MH, Husain-Syad F, Reis T, Ronco C, Vanholder R.Uremic encephalopathy.Kidney Int.2022;101(2):227-241. doi:10.1016/j.kint.2021.09.025Wouk N.End-stage renal disease: medical management.Am Fam Physician.2021;104(5):493-499.Rivara MB, Mehrotra R.Timing of dialysis initiation - what has changed since IDEAL?Semin Nephrol. 2017;37(2):181–193. doi:10.1016/j.semnephrol.2016.12.008National Kidney Foundation.Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification.Metzger M, Abdel-Rahman EM, Boykin H, Song MK.A narrative review of management strategies for common symptoms in advanced CKD.Kidney Int Rep.2021;6(4):894–904. doi:10.1016/j.ekir.2021.01.038Moussavi K, Nguyen LT, Hua H, Fitter S.Comparison of IV insulin dosing strategies for hyperkalemia in the emergency department.Crit Care Explor. 2020;2(4):e0092. doi:10.1097/CCE.0000000000000092Rhee E, Gualiar E, Hwang S, et al.Prevalence and persistence of uremic symptoms in incident dialysis patients.Kidney360.2020;1(2):86–92. doi:10.34067/KID.0000072019Alimi R, Hami M, Afzalaghaee M, et al.Factors affecting the long-term survival of kidney transplantation in northeastern of Iran between 2000 and 2015.Iran J Public Health.2021;50(10):2076–2084. doi:10.18502/ijph.v50i10.7508National Institute of Diabetes and Digestive and Kidney Diseases.Preventing chronic kidney disease.Centers for Disease Control and Prevention.Chronic kidney disease basics.
20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nigam SK, Bush KT.Uremic syndrome of chronic kidney disease: altered remote sensing and signaling.Nat Rev Nephrol.2019;15(5):301–316. doi:10.1038/s41581-019-0111-1Meyers TW, Hostetter TH.Approaches to uremia.J Am Soc Nephrol.2014;25(10):2151–2158. doi:10.1681/ASN.2013121264Dobre MA, Meyer TW, Hostetter TH.Chapter 14 - the uremic syndrome. In:Chronic Renal Disease (Second Edition).Cambridge, MA:Academic Press; 2020. doi:10.1016/B978-0-12-815876-0.00014-0Lara-Prado JI, Pazos-Perez F, Mendez-Landa CE, et al.Acute kidney injury and organ dysfunction: what is the role of uremic toxins?Toxins (Basel).2021;13(8):551. doi:10.3390/toxins13080551Lau WL, Vaziri ND.Urea, a true uremic toxin: the empire strikes back.Clin Sci (Lond). 2017;131(1):3-12. doi:10.1042/CS20160203National Kidney Foundation.Acute kidney injury (AKI).Hamza E, Metzinger L, Metzinger-Le Meuth V.Uremic toxins affect erythropoiesis during the course of chronic kidney disease: a review.Cells.2020;9(9):2039. doi:10.3390/cells9092039Baatan CCFMJ, Sternkopf M, Henning T, Marx N, Jankowski J, Noels H.Platelet function in CKD: a systematic review and meta-analysis.J Am Soc Nephrol.2021;32(7):1583–1598. doi:10.1681/ASN.2020101440Eknoyan G, Moe SM.Renal osteodystrophy: a historical review of its origins and conceptual evolution.Bone Rep.2022;17:101641. doi:10.1016/j.bonr.2022.101641Garikapti K, Goh D, Khanna S, Echampati K.Uraemic cardiomyopathy: a review of current literature.Clin Med Insights Cardiol.2021;15:1179546821998347. doi:10.1177/1179546821998347Rosner MH, Husain-Syad F, Reis T, Ronco C, Vanholder R.Uremic encephalopathy.Kidney Int.2022;101(2):227-241. doi:10.1016/j.kint.2021.09.025Wouk N.End-stage renal disease: medical management.Am Fam Physician.2021;104(5):493-499.Rivara MB, Mehrotra R.Timing of dialysis initiation - what has changed since IDEAL?Semin Nephrol. 2017;37(2):181–193. doi:10.1016/j.semnephrol.2016.12.008National Kidney Foundation.Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification.Metzger M, Abdel-Rahman EM, Boykin H, Song MK.A narrative review of management strategies for common symptoms in advanced CKD.Kidney Int Rep.2021;6(4):894–904. doi:10.1016/j.ekir.2021.01.038Moussavi K, Nguyen LT, Hua H, Fitter S.Comparison of IV insulin dosing strategies for hyperkalemia in the emergency department.Crit Care Explor. 2020;2(4):e0092. doi:10.1097/CCE.0000000000000092Rhee E, Gualiar E, Hwang S, et al.Prevalence and persistence of uremic symptoms in incident dialysis patients.Kidney360.2020;1(2):86–92. doi:10.34067/KID.0000072019Alimi R, Hami M, Afzalaghaee M, et al.Factors affecting the long-term survival of kidney transplantation in northeastern of Iran between 2000 and 2015.Iran J Public Health.2021;50(10):2076–2084. doi:10.18502/ijph.v50i10.7508National Institute of Diabetes and Digestive and Kidney Diseases.Preventing chronic kidney disease.Centers for Disease Control and Prevention.Chronic kidney disease basics.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Nigam SK, Bush KT.Uremic syndrome of chronic kidney disease: altered remote sensing and signaling.Nat Rev Nephrol.2019;15(5):301–316. doi:10.1038/s41581-019-0111-1Meyers TW, Hostetter TH.Approaches to uremia.J Am Soc Nephrol.2014;25(10):2151–2158. doi:10.1681/ASN.2013121264Dobre MA, Meyer TW, Hostetter TH.Chapter 14 - the uremic syndrome. In:Chronic Renal Disease (Second Edition).Cambridge, MA:Academic Press; 2020. doi:10.1016/B978-0-12-815876-0.00014-0Lara-Prado JI, Pazos-Perez F, Mendez-Landa CE, et al.Acute kidney injury and organ dysfunction: what is the role of uremic toxins?Toxins (Basel).2021;13(8):551. doi:10.3390/toxins13080551Lau WL, Vaziri ND.Urea, a true uremic toxin: the empire strikes back.Clin Sci (Lond). 2017;131(1):3-12. doi:10.1042/CS20160203National Kidney Foundation.Acute kidney injury (AKI).Hamza E, Metzinger L, Metzinger-Le Meuth V.Uremic toxins affect erythropoiesis during the course of chronic kidney disease: a review.Cells.2020;9(9):2039. doi:10.3390/cells9092039Baatan CCFMJ, Sternkopf M, Henning T, Marx N, Jankowski J, Noels H.Platelet function in CKD: a systematic review and meta-analysis.J Am Soc Nephrol.2021;32(7):1583–1598. doi:10.1681/ASN.2020101440Eknoyan G, Moe SM.Renal osteodystrophy: a historical review of its origins and conceptual evolution.Bone Rep.2022;17:101641. doi:10.1016/j.bonr.2022.101641Garikapti K, Goh D, Khanna S, Echampati K.Uraemic cardiomyopathy: a review of current literature.Clin Med Insights Cardiol.2021;15:1179546821998347. doi:10.1177/1179546821998347Rosner MH, Husain-Syad F, Reis T, Ronco C, Vanholder R.Uremic encephalopathy.Kidney Int.2022;101(2):227-241. doi:10.1016/j.kint.2021.09.025Wouk N.End-stage renal disease: medical management.Am Fam Physician.2021;104(5):493-499.Rivara MB, Mehrotra R.Timing of dialysis initiation - what has changed since IDEAL?Semin Nephrol. 2017;37(2):181–193. doi:10.1016/j.semnephrol.2016.12.008National Kidney Foundation.Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification.Metzger M, Abdel-Rahman EM, Boykin H, Song MK.A narrative review of management strategies for common symptoms in advanced CKD.Kidney Int Rep.2021;6(4):894–904. doi:10.1016/j.ekir.2021.01.038Moussavi K, Nguyen LT, Hua H, Fitter S.Comparison of IV insulin dosing strategies for hyperkalemia in the emergency department.Crit Care Explor. 2020;2(4):e0092. doi:10.1097/CCE.0000000000000092Rhee E, Gualiar E, Hwang S, et al.Prevalence and persistence of uremic symptoms in incident dialysis patients.Kidney360.2020;1(2):86–92. doi:10.34067/KID.0000072019Alimi R, Hami M, Afzalaghaee M, et al.Factors affecting the long-term survival of kidney transplantation in northeastern of Iran between 2000 and 2015.Iran J Public Health.2021;50(10):2076–2084. doi:10.18502/ijph.v50i10.7508National Institute of Diabetes and Digestive and Kidney Diseases.Preventing chronic kidney disease.Centers for Disease Control and Prevention.Chronic kidney disease basics.
Nigam SK, Bush KT.Uremic syndrome of chronic kidney disease: altered remote sensing and signaling.Nat Rev Nephrol.2019;15(5):301–316. doi:10.1038/s41581-019-0111-1
Meyers TW, Hostetter TH.Approaches to uremia.J Am Soc Nephrol.2014;25(10):2151–2158. doi:10.1681/ASN.2013121264
Dobre MA, Meyer TW, Hostetter TH.Chapter 14 - the uremic syndrome. In:Chronic Renal Disease (Second Edition).Cambridge, MA:Academic Press; 2020. doi:10.1016/B978-0-12-815876-0.00014-0
Lara-Prado JI, Pazos-Perez F, Mendez-Landa CE, et al.Acute kidney injury and organ dysfunction: what is the role of uremic toxins?Toxins (Basel).2021;13(8):551. doi:10.3390/toxins13080551
Lau WL, Vaziri ND.Urea, a true uremic toxin: the empire strikes back.Clin Sci (Lond). 2017;131(1):3-12. doi:10.1042/CS20160203
National Kidney Foundation.Acute kidney injury (AKI).
Hamza E, Metzinger L, Metzinger-Le Meuth V.Uremic toxins affect erythropoiesis during the course of chronic kidney disease: a review.Cells.2020;9(9):2039. doi:10.3390/cells9092039
Baatan CCFMJ, Sternkopf M, Henning T, Marx N, Jankowski J, Noels H.Platelet function in CKD: a systematic review and meta-analysis.J Am Soc Nephrol.2021;32(7):1583–1598. doi:10.1681/ASN.2020101440
Eknoyan G, Moe SM.Renal osteodystrophy: a historical review of its origins and conceptual evolution.Bone Rep.2022;17:101641. doi:10.1016/j.bonr.2022.101641
Garikapti K, Goh D, Khanna S, Echampati K.Uraemic cardiomyopathy: a review of current literature.Clin Med Insights Cardiol.2021;15:1179546821998347. doi:10.1177/1179546821998347
Rosner MH, Husain-Syad F, Reis T, Ronco C, Vanholder R.Uremic encephalopathy.Kidney Int.2022;101(2):227-241. doi:10.1016/j.kint.2021.09.025
Wouk N.End-stage renal disease: medical management.Am Fam Physician.2021;104(5):493-499.
Rivara MB, Mehrotra R.Timing of dialysis initiation - what has changed since IDEAL?Semin Nephrol. 2017;37(2):181–193. doi:10.1016/j.semnephrol.2016.12.008
National Kidney Foundation.Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification.
Metzger M, Abdel-Rahman EM, Boykin H, Song MK.A narrative review of management strategies for common symptoms in advanced CKD.Kidney Int Rep.2021;6(4):894–904. doi:10.1016/j.ekir.2021.01.038
Moussavi K, Nguyen LT, Hua H, Fitter S.Comparison of IV insulin dosing strategies for hyperkalemia in the emergency department.Crit Care Explor. 2020;2(4):e0092. doi:10.1097/CCE.0000000000000092
Rhee E, Gualiar E, Hwang S, et al.Prevalence and persistence of uremic symptoms in incident dialysis patients.Kidney360.2020;1(2):86–92. doi:10.34067/KID.0000072019
Alimi R, Hami M, Afzalaghaee M, et al.Factors affecting the long-term survival of kidney transplantation in northeastern of Iran between 2000 and 2015.Iran J Public Health.2021;50(10):2076–2084. doi:10.18502/ijph.v50i10.7508
National Institute of Diabetes and Digestive and Kidney Diseases.Preventing chronic kidney disease.
Centers for Disease Control and Prevention.Chronic kidney disease basics.
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