Which combination of symptoms is associated with end-stage renal disease?

• A. Metabolic acidosis, electrolyte imbalance, progressive weakness, fatigue, weight loss
• B. Shortness of breath only
• C. Frequent headaches
• D. Vision changes

Answer: (A)

End-stage renal disease leads to a systemic failure to excrete acid and waste, regulate electrolytes, and maintain overall metabolic balance. As kidney function declines, hydrogen ions and other acids accumulate, causing metabolic acidosis. At the same time, the kidneys’ ability to manage electrolytes—such as potassium, calcium, phosphate, and sodium—becomes impaired, leading to electrolyte imbalances. The accumulation of toxins and the catabolic state, along with reduced appetite, contribute to progressive weakness, fatigue, and weight loss. This combination—metabolic acidosis, electrolyte disturbances, and symptoms like weakness, fatigue, and weight loss—best reflects the multiorgan impact of end-stage renal disease.

Shortness of breath can occur with fluid overload but isn’t as emblematic of ESRD on its own, and headaches or vision changes aren’t typical core features of ESRD without another primary cause.