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Cardiovascular Issues - Patients with kidney failure are 3.5 times more likely to die from cardiovascular disease then persons with normal kidney function. Premature atherosclerosis ("hardening of the arteries") is a major cause of morbidity and mortality in persons with end-stage renal disease. The risk of ischemic heart disease is increased 20-fold, while the risk of stroke is increased 10-fold when compared with persons with normal kidney function. Other complications include left ventricular hypertrophy, and a syndrome called uremic serositis which may consist of pericarditis, pleural effusion, and/or ascites. Hypertension not only causes kidney disease but kidney disease also causes hypertension.

Fluid and Electrolyte Imbalance - Hyperkalemia (elevated potassium level), hypocalcemia (decreased calcium level), hyperphosphatemia (elevated phosphorous level), hypomagnesemia (decreased magnesium level), and acidosis (a disturbance in the body's acid-base balance which causes excessive acidity of the blood) are manifestations of uremic syndrome and end-stage renal disease. Disorders of mineral metabolism (calcium, phosphorus, parathyroid hormone, and vitamin D) are thought to play an important role in the accelerated atherosclerosis unique to the dialysis population.

Musculoskeletal Issues - Uremic syndrome can result in muscle weakness, gout, bone pain and spontaneous bone fractures. This is due to three important changes: an imbalance between two minerals (calcium and phosphorus) leading to loss of calcium from the bones; over-activity of the parathyroid glands (hyperparathyroidism), which help to regulate calcium in your body; and insufficient conversion of vitamin D to the active form that can be used by the body.

Endocrine Issues - Hyperparathyroidism and increased insulin resistance may occur with uremic syndrome.

Neurological Issues - Uremic encephalopathy begins when the GFR falls below 10-15mL/min. Symptoms include difficulty concentrating, lethargy, confusion and can progress to coma if untreated. Neuropathy is present in 65% of patients on or nearing dialysis - symptoms include change in sensation, pain and restless legs.

Hematologic Issues - Anemia (low red blood cell count) is caused by the insufficient production of erythropoietin by the kidneys, but can also be due to deficiencies in vitamin B12 and iron, destruction of red blood cells (hemolysis), and suppressed bone marrow function. Anemia is a risk factor for the development of heart failure and mortality in renal failure. Decreased platelets can lead to increased bleeding and easy bruising.

Immunologic Issues - People with uremia tend to have a compromised immune system and are at increased risk of bacterial, fungal and viral infections.

Gastrointestinal Issues - Symptoms are often caused by the breakdown and retention of urea, metabolic acids, release of ammonia and other metabolic waste products. Symptoms include a metallic taste in the mouth, loss of appetite, nausea, vomiting, decreased appetite and weight loss.

Skin Issues - Uremia can cause itching and a yellowish discoloration of the skin.

Reproductive Issues - Women may experience decreased libido, sexual dysfunction, lack of menstruation (amenorrhea), heavy menstrual bleeding (menorrhagia), and infertility. Men may experience decreased libido, impotence, and infertility.