ICD-10: N18.6

End-stage renal disease (ESRD), classified under ICD-10 code N18.6, represents the final stage of chronic kidney disease (CKD) where the kidneys can no longer maintain the body's balance of fluids, electrolytes, and waste products. This condition necessitates renal replacement therapy, such as dialysis or kidney transplantation, to sustain life. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with ESRD is crucial for effective diagnosis and management.

Clinical Presentation

Definition and Diagnosis

End-stage renal disease is characterized by a significant decline in kidney function, typically defined as a glomerular filtration rate (GFR) of less than 15 mL/min. This stage is often the result of prolonged chronic kidney disease, which can stem from various underlying conditions, including diabetes mellitus, hypertension, and glomerulonephritis[1][2].

Patient Characteristics

Patients with ESRD often present with a range of demographic and clinical characteristics:
- Age: ESRD is more prevalent in older adults, particularly those over 65 years[3].
- Comorbidities: Common comorbid conditions include diabetes, hypertension, cardiovascular diseases, and obesity, which significantly contribute to the progression of kidney disease[4].
- Ethnicity: Certain ethnic groups, including African Americans and Hispanics, are at a higher risk for developing ESRD due to genetic and socioeconomic factors[5].

Signs and Symptoms

Common Symptoms

Patients with ESRD may exhibit a variety of symptoms, which can significantly impact their quality of life. These include:

• Fatigue and Weakness: Due to anemia and the accumulation of toxins in the bloodstream, patients often report extreme fatigue and a general sense of weakness[6].
• Edema: Fluid retention leads to swelling, particularly in the legs, ankles, and around the eyes, as the kidneys fail to excrete excess fluid[7].
• Shortness of Breath: Pulmonary edema can occur due to fluid overload, causing difficulty in breathing[8].
• Nausea and Vomiting: Accumulation of waste products can lead to gastrointestinal symptoms, including nausea and vomiting[9].
• Changes in Urination: Patients may experience decreased urine output or changes in urine color and consistency[10].
• Itching (Pruritus): Accumulation of waste products can cause severe itching, which can be distressing for patients[11].

Physical Examination Findings

During a physical examination, healthcare providers may observe:
- Hypertension: Elevated blood pressure is common due to fluid overload and increased vascular resistance[12].
- Signs of Anemia: Pallor and signs of fatigue may indicate anemia, a common complication of ESRD[13].
- Cardiovascular Abnormalities: Patients may exhibit signs of heart failure or other cardiovascular issues due to fluid overload and electrolyte imbalances[14].

Conclusion

End-stage renal disease is a complex condition that requires comprehensive management strategies tailored to the individual patient's needs. Recognizing the clinical presentation, signs, symptoms, and patient characteristics associated with ESRD is essential for healthcare providers to deliver effective care. Early identification and intervention can help manage symptoms and improve the quality of life for patients facing this challenging diagnosis. Regular monitoring and a multidisciplinary approach involving nephrologists, dietitians, and other healthcare professionals are vital in managing the complications associated with ESRD and optimizing patient outcomes.

References

1. ICD-10-CM Code for End stage renal disease N18.6.
2. Chronic kidney disease, risk of readmission, and ...
3. Patient Characteristics and Outcomes of Hospitalized ...
4. Association of chronic kidney disease and end-stage renal ...
5. Chronic Kidney Disease - CKD - HIA Code.
6. End-stage renal disease - Symptoms and causes - Mayo Clinic.
7. How to Document and Code for Hypertensive Diseases ...
8. ICD-10-CM Official Guidelines for Coding and Reporting.
9. ICD-10-CM Diagnosis Code N18.6 - End stage renal disease - ICD List.
10. ICD-10-CM Code for Chronic kidney disease (CKD) N18.
11. Chronic kidney disease (CKD) - Humana.
12. 2025 ICD-10-CM Diagnosis Code N18.6: End stage renal disease.
13. ICD-10-CM Code N18.6 End stage renal disease - ICD.Codes.
14. Scheme based on ICD-10 diagnoses and drug prescriptions to ...

End-stage renal disease (ESRD), classified under ICD-10 code N18.6, is a critical condition characterized by the irreversible decline in kidney function, necessitating dialysis or kidney transplantation for survival. Understanding the alternative names and related terms for this diagnosis can enhance clarity in medical documentation, billing, and patient communication. Below are some of the key alternative names and related terms associated with N18.6.

Alternative Names for End-Stage Renal Disease

1. Chronic Kidney Disease Stage 5 (CKD Stage 5): This term is often used interchangeably with end-stage renal disease, as it represents the final stage of chronic kidney disease where kidney function is severely impaired[1].

2. Kidney Failure: This is a broader term that encompasses both acute and chronic forms of renal failure, but it is frequently used to refer specifically to end-stage renal disease when the kidneys can no longer maintain homeostasis[2].

3. Terminal Renal Failure: This term emphasizes the irreversible nature of the condition and the need for renal replacement therapy, such as dialysis or transplantation[3].

4. Uremia: While technically referring to the clinical syndrome resulting from kidney failure, uremia is often associated with end-stage renal disease due to the accumulation of waste products in the blood[4].

5. Dialysis-Dependent Kidney Disease: This term highlights the necessity for dialysis treatment in patients with end-stage renal disease, indicating that their kidneys can no longer function adequately[5].

Related Terms

1. Renal Replacement Therapy (RRT): This encompasses treatments such as dialysis and kidney transplantation that are required for patients with end-stage renal disease[6].

2. Chronic Kidney Disease (CKD): While CKD refers to a spectrum of kidney disease stages, it is essential to note that N18.6 specifically pertains to the most advanced stage of this condition[7].

3. Acute Kidney Injury (AKI): Although distinct from ESRD, AKI can lead to chronic kidney disease and potentially progress to end-stage renal disease if not managed appropriately[8].

4. Nephropathy: This term refers to kidney disease in general and can include various forms of kidney damage, including those that may progress to end-stage renal disease[9].

5. Kidney Transplantation: This is a treatment option for patients with end-stage renal disease, representing a potential cure for the condition when a suitable donor is available[10].

Conclusion

Understanding the various alternative names and related terms for ICD-10 code N18.6 is crucial for healthcare professionals involved in the management and documentation of end-stage renal disease. These terms not only facilitate clearer communication among medical staff but also enhance patient understanding of their condition and treatment options. As the medical field continues to evolve, maintaining familiarity with these terms will aid in effective patient care and accurate coding practices.

The ICD-10 code N18.6 refers to End Stage Renal Disease (ESRD), which is a critical condition characterized by the complete or near-complete failure of the kidneys to function. This diagnosis is essential for proper coding and billing in healthcare settings, particularly for patients requiring dialysis or kidney transplantation. Below are the key criteria and considerations used for diagnosing ESRD under this code.

Diagnostic Criteria for End Stage Renal Disease (N18.6)

1. Clinical Presentation

• Symptoms: Patients may present with symptoms such as fatigue, weakness, nausea, vomiting, and changes in urine output. These symptoms often indicate significant kidney dysfunction.
• Physical Examination: Signs may include edema, hypertension, and alterations in mental status due to uremia (the accumulation of waste products in the blood).

2. Laboratory Tests

• Serum Creatinine Levels: A serum creatinine level greater than 6.0 mg/dL is often indicative of ESRD. This level reflects a significant decline in kidney function.
• Glomerular Filtration Rate (GFR): A GFR of less than 15 mL/min is a critical criterion for diagnosing ESRD. This measurement assesses how well the kidneys are filtering waste from the blood.
• Blood Urea Nitrogen (BUN): Elevated BUN levels can also support the diagnosis of ESRD, particularly when combined with other findings.

3. Urinalysis

• Proteinuria: The presence of significant protein in the urine (often measured as a protein-to-creatinine ratio) can indicate kidney damage and is commonly seen in chronic kidney disease leading to ESRD.
• Hematuria: Blood in the urine may also be present, depending on the underlying cause of kidney failure.

4. Imaging Studies

• Ultrasound or CT Scan: Imaging studies may be performed to assess kidney size and structure. In ESRD, kidneys may be small and shrunken due to chronic damage.

5. History of Kidney Disease

• Chronic Kidney Disease (CKD): A documented history of CKD, particularly stages 1 through 5, is crucial. ESRD is typically the final stage of CKD, where the kidneys can no longer maintain homeostasis.
• Underlying Conditions: Conditions such as diabetes mellitus, hypertension, or glomerulonephritis that contribute to kidney damage should be documented.

6. Dialysis Requirement

• Initiation of Dialysis: Patients who require dialysis (either hemodialysis or peritoneal dialysis) due to kidney failure are classified under N18.6. The need for dialysis is a definitive indicator of ESRD.

7. Transplantation Consideration

• Kidney Transplant Evaluation: Patients diagnosed with ESRD may be evaluated for kidney transplantation, which further solidifies the diagnosis.

Conclusion

The diagnosis of End Stage Renal Disease (ICD-10 code N18.6) is based on a combination of clinical symptoms, laboratory findings, and the patient's medical history. Accurate documentation and coding are essential for effective patient management and reimbursement processes in healthcare settings. Understanding these criteria helps healthcare providers ensure that patients receive appropriate care and interventions tailored to their condition.

End-stage renal disease (ESRD), classified under ICD-10 code N18.6, represents the final stage of chronic kidney disease (CKD) where the kidneys can no longer maintain the body's balance of fluids, electrolytes, and waste products. This condition necessitates comprehensive treatment strategies to manage symptoms, prevent complications, and improve the quality of life for patients. Below, we explore the standard treatment approaches for ESRD.

Treatment Modalities for End-Stage Renal Disease

1. Dialysis

Dialysis is a critical treatment for patients with ESRD, serving as a substitute for the normal function of the kidneys. There are two primary types of dialysis:

• Hemodialysis: This method involves diverting blood from the body to a machine that filters out waste products and excess fluids before returning the cleaned blood to the body. Hemodialysis is typically performed three times a week in a dialysis center, although home hemodialysis options are also available.

• Peritoneal Dialysis: In this approach, a special fluid is introduced into the abdominal cavity through a catheter. The peritoneum (the lining of the abdominal cavity) acts as a filter, allowing waste products and excess fluids to pass from the blood into the dialysis fluid, which is then drained away. This method can be performed at home and offers more flexibility in scheduling.

2. Kidney Transplantation

For many patients with ESRD, a kidney transplant is the preferred treatment option, as it can restore kidney function and improve quality of life. Candidates for transplantation must undergo a thorough evaluation to determine their suitability, which includes assessing their overall health, the presence of other medical conditions, and compatibility with potential donors.

• Living Donor Transplant: This involves receiving a kidney from a living person, often a relative or friend, which can lead to better outcomes and shorter waiting times.

• Deceased Donor Transplant: This involves receiving a kidney from a deceased donor, which is subject to availability and waiting lists.

3. Conservative Management

In some cases, particularly for patients who are not candidates for dialysis or transplantation, conservative management may be appropriate. This approach focuses on:

• Symptom Management: Addressing symptoms such as pain, nausea, and fatigue through medications and supportive care.

• Nutritional Support: Implementing dietary modifications to manage fluid intake, protein consumption, and electrolyte balance, which can help alleviate some symptoms and improve overall well-being.

• Palliative Care: Providing comprehensive support that focuses on improving the quality of life for patients with advanced kidney disease, including emotional and psychological support for both patients and their families.

4. Pharmacological Interventions

Patients with ESRD often require medications to manage complications associated with kidney failure, including:

• Erythropoiesis-Stimulating Agents (ESAs): These medications help stimulate red blood cell production to combat anemia, a common issue in ESRD patients.

• Phosphate Binders: To manage elevated phosphate levels, which can lead to bone disease and cardiovascular issues.

• Antihypertensives: To control blood pressure, which is crucial for patients with kidney disease.

• Vitamin D Supplements: To help manage calcium and phosphate balance and support bone health.

Conclusion

The management of end-stage renal disease (ICD-10 code N18.6) involves a multifaceted approach tailored to the individual needs of patients. Dialysis and kidney transplantation are the primary treatment modalities, while conservative management and pharmacological interventions play essential roles in symptom control and overall health maintenance. Ongoing monitoring and support from healthcare professionals are vital to ensure optimal outcomes and enhance the quality of life for those living with ESRD.

End-stage renal disease (ESRD), classified under ICD-10 code N18.6, represents the final stage of chronic kidney disease (CKD), where the kidneys have lost nearly all their ability to function effectively. This condition necessitates either dialysis or kidney transplantation for survival. Below is a detailed overview of the clinical description, diagnostic criteria, and implications associated with this diagnosis.

Clinical Description of End-Stage Renal Disease (ESRD)

Definition and Pathophysiology

End-stage renal disease is characterized by a significant decline in kidney function, typically defined as a glomerular filtration rate (GFR) of less than 15 mL/min. At this stage, the kidneys are unable to maintain the body's balance of fluids, electrolytes, and waste products, leading to a range of systemic complications. The primary causes of ESRD include diabetes mellitus, hypertension, and glomerulonephritis, among others[1][2].

Symptoms and Complications

Patients with ESRD may experience a variety of symptoms, including:
- Fatigue and weakness: Due to anemia and the accumulation of toxins in the blood.
- Fluid retention: Leading to swelling in the legs, ankles, and around the eyes.
- Shortness of breath: Resulting from fluid overload or pulmonary edema.
- Nausea and vomiting: Often due to uremia, a buildup of waste products in the blood.
- Changes in urination: Such as decreased urine output or changes in urine color.

Complications of ESRD can include cardiovascular disease, bone disease, and electrolyte imbalances, which can further complicate the patient's health status[3][4].

Diagnostic Criteria

Laboratory Tests

Diagnosis of ESRD typically involves a combination of clinical evaluation and laboratory tests, including:
- Serum creatinine and blood urea nitrogen (BUN): Elevated levels indicate impaired kidney function.
- GFR estimation: Calculated using serum creatinine levels, age, sex, and race.
- Urinalysis: To assess for proteinuria, hematuria, or other abnormalities.

Imaging Studies

Imaging studies, such as ultrasound or CT scans, may be performed to evaluate kidney size and structure, as well as to rule out obstructive causes of renal failure[5][6].

Treatment Options

Dialysis

Patients with ESRD typically require dialysis, which can be either:
- Hemodialysis: Blood is filtered through a machine to remove waste products and excess fluid.
- Peritoneal dialysis: A solution is introduced into the abdominal cavity to absorb waste products, which are then drained out.

Kidney Transplantation

For eligible patients, kidney transplantation is the preferred treatment option, offering a potential cure for ESRD and improved quality of life. However, this option is contingent upon the availability of donor organs and the patient's overall health status[7][8].

Documentation and Coding Considerations

ICD-10-CM Guidelines

When documenting ESRD under ICD-10 code N18.6, it is essential to include:
- The patient's history of chronic kidney disease.
- Any relevant comorbidities, such as diabetes or hypertension.
- Details regarding the type of renal replacement therapy being utilized (dialysis or transplantation) if applicable.

Accurate coding is crucial for appropriate reimbursement and to ensure that the patient's medical history is comprehensively recorded[9][10].

Conclusion

End-stage renal disease is a critical health condition requiring comprehensive management and intervention. Understanding the clinical implications, diagnostic criteria, and treatment options associated with ICD-10 code N18.6 is essential for healthcare providers to deliver effective care and improve patient outcomes. Regular monitoring and timely intervention can significantly impact the quality of life for patients suffering from this debilitating disease.