Signs of advanced or end-stage renal disease include fluid around the heart or lung, confusion, seizures, persistent nausea and vomiting, and malnutrition. Fluid overload does not respond to diuretics, and high blood pressure does not respond well to medications. There may be several metabolic imbalances, too, including high potassium and phosphorus and low or high calcium. During this stage, urgent medical attention is required.

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