Which of the following is NOT typically associated with end-stage renal disease?

• A. Elevated energy and appetite
• B. Metabolic acidosis
• C. Electrolyte imbalance
• D. Weight loss

Answer: (A)

End-stage renal disease disrupts multiple body systems, leading to fatigue, reduced appetite, and several metabolic disturbances. Because the kidneys can no longer maintain acid–base balance or properly filter and regulate electrolytes, patients commonly experience metabolic acidosis, electrolyte imbalances, and weight loss from poor intake and a catabolic state. Elevated energy and appetite, on the other hand, are not typical findings in ESRD; most patients feel fatigued and have decreased appetite. Metabolic acidosis arises from decreased acid excretion and bicarbonate production, electrolyte imbalance (such as potassium, phosphate, and calcium shifts) from impaired renal handling, and weight loss from reduced intake and uremic symptoms. So the statement describing increased energy and appetite does not fit the usual ESRD presentation.