One of the devastating complications of diabetes is kidney damage. Early kidney disease has no symptoms, and can progress to kidney failure with little or no warning if left undetected. Chronic kidney failure – so-called “end-stage renal disease” or ESRD -- occurs when the kidneys are no longer able to filter toxins from the blood. People with ESRD must receive either hemodialysis or a kidney transplant to survive. Diabetes is the number one cause of ESRD in the U.S.