Patient presents with signs and symptoms consistent with uremia, a clinical manifestation of chronic kidney disease (CKD) and end-stage renal disease (ESRD).  The patient reports fatigue, nausea, vomiting, anorexia, and pruritus.  Physical examination reveals altered mental status, pericardial friction rub, and asterixis.  Laboratory findings indicate elevated blood urea nitrogen (BUN), creatinine, and potassium levels.  Glomerular filtration rate (GFR) is significantly reduced, confirming impaired renal function.  Diagnosis of uremia is based on the constellation of clinical findings, laboratory results, and decreased GFR.  Differential diagnoses considered include acute kidney injury (AKI), dehydration, and heart failure.  Treatment plan includes initiation of renal replacement therapy (RRT), such as hemodialysis or peritoneal dialysis, to manage fluid and electrolyte imbalances and remove uremic toxins.  Dietary modifications with protein restriction and potassium control are advised.  Patient education regarding medication adherence, dialysis access care, and potential complications of uremia is provided.  Follow-up appointments are scheduled to monitor renal function, electrolyte levels, and overall clinical status.  ICD-10 code N18.9, Chronic kidney disease, unspecified, is documented for medical billing and coding purposes.  The patient's prognosis is dependent on the initiation and effectiveness of RRT and management of underlying CKD.