Dialysis does part of the work of failed kidneys: it removes waste, extra salt and extra water from your blood and helps keep your minerals and blood pressure in a safer range. The two main types are hemodialysis, done at a dialysis center or at home, and peritoneal dialysis, done at home. It is not a cure, but it can help you feel better and live longer.
Key Takeaways
- Dialysis filters waste and extra fluid from your blood, but it replaces only part of what healthy kidneys do.
- It is usually needed at kidney failure, when about 10% to 15% of kidney function remains, though symptoms and blood tests guide the timing.
- Hemodialysis filters your blood outside your body; peritoneal dialysis uses the lining of your belly as a filter inside your body.
- Both types need minor surgery beforehand, for a vascular access or a belly catheter, so plan early.
- A kidney transplant and conservative care without dialysis are other options, and you can change course later.
What Does Dialysis Do?
Healthy kidneys work 24 hours a day, 7 days a week. When they fail, waste and fluid build up. Dialysis takes over some of that work by:
- removing waste, extra salt and extra water
- keeping safer levels of minerals such as potassium, sodium, calcium and bicarbonate
- helping to control your blood pressure
Because dialysis cannot do everything healthy kidneys do, you will still need medicines, diet changes and regular care. After a sudden kidney injury, dialysis is sometimes needed only until the kidneys recover. With kidney failure, it is needed for life or until a kidney transplant.
When Is Dialysis Needed?
Dialysis is used for kidney failure, the last stage of chronic kidney disease. That often means your kidneys work at about 10% to 15% of normal, or a blood test called eGFR (estimated glomerular filtration rate) is below 15. The number is not the only guide: some people start because fluid, potassium or acid builds up in a way that medicines and diet can no longer manage safely.
The need usually comes on slowly. Losing your appetite and muscle can happen so gradually that you do not notice, and extra fluid can cause swelling or trouble breathing. Starting on time can help you regain your appetite and keep your strength, which is easier to keep than to rebuild. Most people still feel well when their doctor first raises dialysis.
What Are the Main Types of Dialysis?
Hemodialysis pumps your blood through a filter called a dialyzer and returns the cleaned blood to your body. Most people go to a dialysis center, usually 3 days a week, with each treatment often taking 3 to 5 hours. It can also be done at home after training, often as shorter treatments on more days or longer treatments while you sleep. Home treatment is more flexible but needs supplies, space and often a care partner.
Peritoneal dialysis (PD) uses the lining of your belly as a natural filter. A cleansing fluid flows in through a soft tube, soaks up waste and extra fluid, and is drained a few hours later, by hand during the day or by a machine at night. This post on training and preparing for peritoneal dialysis explains how people get started, and this comparison of in-center dialysis vs. at-home options weighs the settings.
How Do You Get Ready to Start Dialysis?
Hemodialysis needs a vascular access, a place where needles can reach a strong flow of blood. A fistula joins an artery to a vein, usually in your arm, and is the preferred long-term access when possible; a graft joins them with a soft tube; and a catheter in a large vein in the neck, chest or groin is often used when dialysis must start quickly. A fistula can take months to heal, so plan ahead, and ask that blood draws and IV lines use veins below your wrist to protect your arm veins. Read more about types of fistula and vascular access.
Peritoneal dialysis needs a soft tube, called a catheter, placed in your belly with minor surgery a few weeks before you start. For home dialysis of either type, you train first, often with a family member or friend who can help.
What Is a Dialysis Treatment Like?
At a center, staff weigh you, wash your access area and check your blood pressure, temperature, pulse and breathing. Two needles connect your access to the machine; they may be uncomfortable at first, and a numbing cream can help. During treatment you can read, nap, watch TV or chat while staff monitor your blood pressure and the machine. The treatment itself is painless.
Many people feel tired afterward. Early sessions can bring nausea, cramps, dizziness or headaches, which may ease with time; tell your team, who can often adjust your treatment.
What Is Daily Life Like on Dialysis?
With hemodialysis you will likely limit sodium, potassium, phosphorus and fluid while still getting enough protein and calories. Fluid limits may be looser with peritoneal dialysis, but sodium and phosphorus limits remain and protein needs are high. A kidney dietitian at your dialysis center can plan meals around your labs and the foods you like. Try never to miss or shorten a treatment: even one can let fluid, potassium, acid and waste build up to dangerous levels.
Most people keep their routine apart from treatment time, and many return to work once they adjust, though heavy physical labor may need changes. To travel, your center can help book treatments near your destination; plan several weeks ahead. Regular physical activity, tailored with your care team, helps your strength and heart. How long people live on dialysis varies with their other health conditions; this guide to how long you can live on dialysis covers that question.
How Do You Choose the Right Treatment for Kidney Failure?
Start learning early. The National Kidney Foundation notes that all types of dialysis are equally effective, but one may fit your health and preferences better. Think about your work and caregiving schedule, whether you want to do treatments yourself, whether you have space and help at home, and how far you live from a center. If a treatment does not suit you, you can ask about trying something else.
Dialysis is not the only option. A kidney transplant from a living or deceased donor filters better than dialysis, but it means surgery, anti-rejection medicines for as long as the kidney works, and often a wait for a donor. Conservative management means your team keeps caring for you without dialysis or a transplant, focusing on symptoms and quality of life. For some people with other serious illnesses, dialysis may feel like more burden than benefit. The choice is yours.
When Should You Call Your Care Team or Get Emergency Care?
If you are on dialysis, call 911 or go to the emergency room for chest pain, trouble breathing, fainting or bleeding from your access that will not stop. Call your dialysis center right away for fever or chills; severe pain, swelling, redness, warmth or drainage at your access; or a fistula or graft that stops buzzing or vibrating like usual. Untreated infections can lead to sepsis, a life-threatening condition.
Tell your care team soon if itching, trouble sleeping, or nausea and vomiting is severe or lasts more than 2 days. If you have kidney disease and are not on dialysis yet, make an appointment if you notice a poor appetite, muscle loss or new swelling.
Frequently Asked Questions
Does Dialysis Hurt?
The treatment itself is painless. Hemodialysis needles can be uncomfortable at first, but a numbing cream can help and most people get used to them.
Is Dialysis Permanent?
After a sudden kidney injury, dialysis may be needed only until the kidneys recover. With kidney failure, it is needed for life unless you get a kidney transplant.
What Happens If You Miss a Dialysis Treatment?
Waste, fluid and potassium can build up to dangerous levels. If you cannot make a session, call your dialysis center as soon as possible.
Can You Get a Kidney Transplant If You Are on Dialysis?
Yes. A transplant center can place you on the waiting list once you have permanent kidney damage and your kidney function is 20 or less, and some people start dialysis while they wait.
Who Pays for Dialysis?
Medicare covers kidney failure treatment at any age, and private insurance or state Medicaid programs may help with the rest. Your dialysis social worker can help with coverage questions.
Talk to ANC About Dialysis
If you are approaching dialysis or already on it, a nephrologist can help you plan. ANC sees patients approaching dialysis and on dialysis and provides outpatient dialysis; its dialysis sites are on the ANC locations page. Contact ANC or call 651-772-6251; in most cases you need a referral from your primary care doctor, depending on your insurance plan.
Sources
- National Kidney Foundation: Dialysis
- National Kidney Foundation: Hemodialysis
- NIDDK: Choosing a Treatment for Kidney Failure
- NIDDK: Hemodialysis
- MedlinePlus: Dialysis Centers, What to Expect
Medical Disclaimer
This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your specific care and treatment options.
