Introduction
The terms end stage kidney disease and kidney failure are often used when kidney function has declined severely. At this stage, the kidneys may no longer be able to adequately remove waste, control fluid balance, regulate electrolytes, or perform other essential functions.
End stage kidney disease is generally associated with Stage 5 Chronic Kidney Disease (CKD), typically when eGFR is below 15 mL/min/1.73 m² and the abnormality is persistent. However, kidney failure is not diagnosed from one laboratory value alone. Symptoms, complications, kidney function trends, and the overall clinical condition are also important.
Treatment may include careful medical management, dialysis, kidney transplantation, or conservative kidney management depending on the patient's health, symptoms, kidney function, preferences, and eligibility for different treatments.
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, provides comprehensive evaluation and long-term management for patients with advanced CKD and kidney failure.
What Is End Stage Kidney Disease?
End stage kidney disease (ESKD) refers to advanced, usually irreversible kidney disease in which kidney function has become severely reduced.
At this stage, the kidneys may struggle to:
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Remove waste products
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Maintain fluid balance
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Control electrolyte levels
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Regulate acid-base balance
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Help control blood pressure
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Support red blood cell production
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Maintain normal mineral and bone metabolism
Some patients can remain medically stable for a period with intensive medical management, while others develop complications requiring kidney replacement therapy.
Is End Stage Kidney Disease the Same as Kidney Failure?
The terms are closely related but are not always identical.
Kidney failure describes a level of kidney dysfunction in which the kidneys can no longer adequately meet the body's needs.
End stage kidney disease generally refers to advanced irreversible CKD, often requiring dialysis or transplantation to sustain life when kidney replacement therapy becomes necessary.
Kidney failure can also occur suddenly because of acute kidney injury (AKI). Some cases of severe AKI can improve substantially with appropriate treatment.
Therefore, severe kidney dysfunction does not automatically mean that recovery is impossible.
Stages Leading to Kidney Failure
Chronic kidney disease is commonly classified according to eGFR.
| CKD Stage | eGFR |
|---|---|
| Stage 1 | 90 or higher, with evidence of kidney damage |
| Stage 2 | 60–89, with evidence of kidney damage |
| Stage 3a | 45–59 |
| Stage 3b | 30–44 |
| Stage 4 | 15–29 |
| Stage 5 | Below 15 |
For Stage 1 and Stage 2, reduced eGFR alone does not establish CKD. Evidence of kidney damage and persistence for at least three months are important.
Stage 5 represents severe loss of kidney function, but dialysis is not automatically required simply because eGFR falls below 15.
The decision to start dialysis depends on the patient's clinical condition and complications.
Common Causes of End Stage Kidney Disease
Several diseases can progressively damage the kidneys.
Diabetes
Long-standing or poorly controlled diabetes can damage the kidney's filtering units and contribute to progressive CKD.
High Blood Pressure
Persistent hypertension can damage blood vessels within the kidneys and accelerate kidney disease.
Glomerular Diseases
Diseases affecting the kidney's filtering structures can cause protein leakage, inflammation, and progressive loss of kidney function.
Polycystic Kidney Disease
This inherited condition causes multiple kidney cysts that can progressively impair kidney function.
Autoimmune Kidney Diseases
Conditions such as lupus nephritis can cause ongoing inflammation and kidney damage.
Recurrent or Severe Kidney Problems
Repeated kidney injuries, obstruction, infections, or other structural problems may contribute to chronic loss of kidney function.
Symptoms of End Stage Kidney Failure
Symptoms vary between individuals and may develop gradually.
Possible symptoms include:
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Severe fatigue
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Weakness
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Swelling of the feet, ankles, legs, or face
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Reduced urine output
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Changes in urination
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Loss of appetite
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Nausea or vomiting
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Persistent itching
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Muscle cramps
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Shortness of breath
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Difficulty concentrating
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Sleep disturbances
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Metallic taste in the mouth
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Weight changes
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High blood pressure
Some symptoms may also be caused by other medical conditions, so laboratory evaluation is essential.
Why Does Kidney Failure Cause These Symptoms?
As kidney function declines, several changes occur.
Waste Product Accumulation
When filtration decreases, waste products can accumulate in the blood and contribute to nausea, fatigue, poor appetite, itching, and difficulty concentrating.
Fluid Retention
Reduced ability to eliminate sodium and water can cause swelling, weight gain, and breathlessness.
Anemia
Advanced CKD can reduce erythropoietin production and contribute to anemia, resulting in fatigue and weakness.
Electrolyte and Acid-Base Changes
Abnormal potassium, sodium, bicarbonate, and other levels can occur as kidney function declines.
Mineral and Bone Disorders
Changes in phosphorus, calcium, vitamin D metabolism, and parathyroid hormone can affect bones and blood vessels.
How Is End Stage Kidney Failure Diagnosed?
A nephrologist evaluates more than just creatinine.
Blood Tests
Testing may include:
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Serum creatinine
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eGFR
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Blood urea nitrogen
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Potassium
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Sodium
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Bicarbonate
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Calcium
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Phosphorus
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Hemoglobin
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Albumin
Additional tests may be recommended depending on the underlying cause.
Urine Tests
Urine testing may assess:
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Albumin
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Protein
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Blood
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Infection
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Other markers of kidney damage
Blood Pressure
Blood pressure monitoring is important because hypertension can both result from and worsen kidney disease.
Imaging
Kidney ultrasound or other imaging may be recommended to assess kidney size, obstruction, cysts, or structural abnormalities.
Does Everyone With Stage 5 CKD Need Dialysis?
No.
Dialysis is not started solely because of a particular creatinine or eGFR number.
Doctors consider factors such as:
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Persistent symptoms caused by kidney failure
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Fluid overload that cannot be controlled medically
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Difficult-to-manage high potassium
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Severe metabolic acidosis
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Accumulation of waste products causing significant symptoms
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Progressive nutritional deterioration
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Other complications that cannot be adequately managed without kidney replacement therapy
The timing of dialysis should therefore be individualized.
Treatment Options for End Stage Kidney Disease
Treatment aims to manage complications, maintain quality of life, and provide kidney replacement therapy when appropriate.
Medical Management
Even advanced kidney disease requires ongoing medical care.
Treatment may address:
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Blood pressure
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Diabetes
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Anemia
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Mineral and bone abnormalities
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Electrolyte disturbances
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Fluid retention
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Cardiovascular risk
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Symptoms such as itching or nausea
Hemodialysis
Hemodialysis uses a dialysis machine and filter to remove waste products and excess fluid from the blood.
It may be performed at a dialysis center or, for selected patients, at home.
Peritoneal Dialysis
Peritoneal dialysis uses the lining of the abdomen, called the peritoneum, as a natural filtering membrane.
It can be performed at home after appropriate training.
Kidney Transplantation
For eligible patients, kidney transplantation may provide functioning replacement kidney tissue and can offer improved long-term outcomes compared with remaining on dialysis.
However, transplantation requires comprehensive medical evaluation and lifelong follow-up.
Conservative Kidney Management
Some patients may choose or require a treatment approach focused on symptom control and quality of life without dialysis or transplantation.
This is known as conservative kidney management.
The decision should involve the patient, family, nephrologist, and other relevant healthcare professionals.
Preparing for Dialysis
When kidney function is progressively declining and dialysis may become necessary, advance planning can be beneficial.
Depending on the selected dialysis type, preparation may include:
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Education about dialysis options
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Vascular access planning for hemodialysis
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Peritoneal dialysis catheter planning
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Dietary and medication review
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Assessment of home support
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Evaluation for kidney transplantation
Early nephrology care allows patients more time to understand their choices and prepare appropriately.
Kidney Transplant as a Treatment for Kidney Failure
A kidney transplant can replace the filtering function of failed kidneys with a functioning donor kidney.
Potential sources include:
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Living donors
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Deceased donors
Not every patient is suitable for transplantation.
Evaluation may consider:
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Heart and lung health
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Infections
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Cancer screening
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Other medical conditions
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Kidney disease history
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Surgical risk
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Ability to take lifelong immunosuppressive medicines
After transplantation, patients require lifelong monitoring and medication.
Can Kidney Function Improve in Severe Kidney Failure?
The answer depends on whether the problem is acute or chronic.
Severe acute kidney injury can sometimes improve substantially when the underlying cause is treated.
Established advanced CKD, particularly irreversible Stage 5 disease, generally does not return to normal kidney function.
However, kidney function can sometimes remain stable for a significant period with appropriate treatment.
A nephrologist can determine whether reduced kidney function appears acute, chronic, or a combination of both.
Diet During End Stage Kidney Disease
Dietary requirements vary considerably between patients.
Depending on kidney function and treatment, doctors may recommend adjustments to:
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Sodium
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Protein
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Potassium
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Phosphorus
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Fluid intake
Patients on dialysis may have different nutritional requirements from patients who are not yet receiving dialysis.
Therefore, there is no single end stage kidney disease diet that is appropriate for everyone.
A personalized plan from a nephrologist or renal dietitian is preferable to following restrictive internet diets.
Lifestyle and Daily Care
Patients with advanced kidney disease can support their health by:
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Taking prescribed medicines consistently
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Monitoring blood pressure
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Following individualized dietary advice
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Attending regular blood tests
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Maintaining appropriate physical activity
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Avoiding smoking
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Avoiding unnecessary NSAID painkillers
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Reporting new symptoms promptly
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Keeping dialysis appointments when dialysis is prescribed
Patients should not independently change fluid intake or medications without discussing the change with their healthcare team.
Possible Complications of End Stage Kidney Disease
Advanced kidney disease can lead to:
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Severe fluid overload
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High potassium
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Metabolic acidosis
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Anemia
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Bone and mineral disorders
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Cardiovascular disease
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Malnutrition
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Persistent itching
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Uremic symptoms
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Increased infection risk
Regular nephrology care helps detect and manage these complications.
When Is End Stage Kidney Failure an Emergency?
Seek urgent medical attention for:
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Severe difficulty breathing
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Chest pain
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Severe confusion
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Seizures
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Fainting
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Very low or absent urine output
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Severe weakness
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Persistent vomiting
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Rapidly worsening swelling
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Severe symptoms associated with high potassium or fluid overload
These symptoms can indicate serious complications requiring immediate assessment.
Why Choose Prabhakar Bhurke Clinic?
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, provides comprehensive care for patients with advanced CKD and kidney failure.
The clinic focuses on:
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Detailed kidney-function assessment
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Management of advanced chronic kidney disease
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Blood pressure and diabetes-related kidney care
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Anemia and electrolyte management
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Fluid-overload assessment
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Dialysis planning and follow-up
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Hemodialysis and peritoneal dialysis guidance
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Kidney transplant evaluation and guidance
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Conservative kidney management when appropriate
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Long-term kidney health monitoring
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Personalized dietary and lifestyle recommendations
The goal is to provide individualized treatment while maintaining kidney function, managing complications, and supporting quality of life.
Frequently Asked Questions
What is end stage kidney failure?
End stage kidney disease generally refers to advanced irreversible CKD, usually Stage 5, where kidney function is severely reduced and kidney replacement therapy may eventually be required.
Is Stage 5 CKD the same as kidney failure?
Stage 5 CKD represents very severe kidney-function loss. Some patients may be described as having kidney failure when the kidneys can no longer adequately meet the body's needs, but dialysis is not automatically required solely because eGFR is below 15.
How long can someone live with end stage kidney disease?
There is no single life expectancy for end stage kidney disease. Prognosis varies according to age, underlying disease, cardiovascular health, nutrition, complications, treatment, dialysis status, and kidney transplantation.
Does everyone with end stage kidney disease need dialysis?
No. Dialysis is recommended when kidney function is insufficient to maintain health and complications or symptoms cannot be adequately controlled through medical treatment.
Can Stage 5 kidney disease be reversed?
Established advanced CKD is generally not reversible. However, acute kidney injury can sometimes recover, and appropriate treatment may stabilize chronic kidney disease and slow further deterioration.
Is kidney transplantation better than dialysis?
For appropriately selected patients, kidney transplantation can offer better long-term survival and quality of life than long-term dialysis. However, transplantation is not suitable for everyone and requires careful evaluation.
What should a person with end stage kidney disease eat?
Diet should be individualized. Sodium, potassium, phosphorus, protein, and fluid requirements depend on kidney function, laboratory results, medications, dialysis status, and other medical conditions.
Can kidney failure cause swelling and breathlessness?
Yes. Severe reduction in kidney function can cause fluid retention, which may contribute to swelling and breathlessness. Heart and lung conditions can also cause similar symptoms and should be evaluated.
Conclusion
End stage kidney failure represents a serious stage of kidney disease in which kidney function has become severely impaired. However, the diagnosis does not automatically mean that dialysis must begin immediately. Treatment decisions depend on symptoms, complications, kidney-function trends, overall health, and the patient's treatment goals.
Management may include advanced medical treatment, dialysis, kidney transplantation, or conservative kidney care. Early preparation and regular nephrology follow-up can help patients understand their options, manage complications, and maintain the best possible quality of life.
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, provides personalized care for patients with advanced CKD and kidney failure, including kidney-function monitoring, dialysis planning, transplant evaluation, complication management, and long-term nephrology support.
Book an Appointment Today
If you or a loved one has Stage 5 CKD, end stage kidney disease, kidney failure, very low eGFR, high creatinine, persistent swelling, reduced urine output, severe fatigue, nausea, or other symptoms of advanced kidney disease, schedule a consultation at Prabhakar Bhurke Clinic.
Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, can evaluate kidney function, assess complications, discuss treatment options, and develop an individualized kidney-care plan.
Medical Disclaimer
This article is intended for general educational purposes only and does not replace professional medical advice, diagnosis, or treatment. End stage kidney disease and kidney failure require individualized assessment. Dialysis should not be started or stopped based solely on an eGFR or creatinine value. Treatment decisions depend on symptoms, complications, kidney function, overall health, and patient preferences. Severe breathlessness, chest pain, confusion, seizures, fainting, very low or absent urine output, or rapidly worsening symptoms require urgent medical attention.
