Introduction: Chronic kidney disease is one of the main causes of end-stage renal disease (ESRD) and has a very high mortality rate worldwide. Early assessment of chronic kidney disease is of great significance to the treatment of the disease, and is also the key to protecting the life and health of patients. To explore the application value of real-time shear wave elastography (RT-SWE) in evaluating the efficacy and prognosis of patients with end-stage renal disease (ESRD). Materials and methods: One hundred and thirty-one patients with chronic kidney disease treated in Affiliated Hospital of Hebei University from October 2019 to February 2021 were collected, development of 67 patients with ESRD (observation group, OG), the other 64 cases of chronic kidney disease alone (control group, CG). The modulus of elasticity (MOE) was compared between the two groups, and the clinical significance of MOE and its relationship with the prognosis of patients were analyzed. Results: The MOE of the OG increased, and the MOE of the improvement group decreased (P<0.05). Higher 3-and 5-year survival in patients with low MOE values, compared with those with high MOE values (P<0.05). The MOE value has a good predictive value for ESRD and the prognostic survival of patients (P<0.05). Conclusion: RT-SWE effectively evaluates and predicts the treatment effect and prognosis of patients with ESRD, which may be a candidate application index.