When Kidneys Can’t Keep Up
When your kidneys can no longer remove enough waste and fluid from your body, dialysis becomes a vital treatment option. For many, the thought of starting dialysis can bring anxiety and questions. What is it? How does it work? What changes should I expect in daily life? This guide is designed to help you understand dialysis and feel better prepared.
What Is Dialysis?
Dialysis is a treatment that takes over part of the work of your kidneys. It helps remove waste products, extra fluid, and toxins from your blood when your kidneys cannot do so effectively.
Dialysis is usually considered when kidney function falls to about 10–15%. However, the decision to start is based not only on lab numbers but also on symptoms and complications such as fluid overload, high potassium, or severe fatigue. Your nephrologist will guide the timing that’s right for you.
The Two Main Types of Dialysis
1. Hemodialysis
Hemodialysis uses a machine and a special filter (called a dialyzer) to clean your blood.
Access: Blood is removed from your body through a vascular access point, usually in your arm. The preferred access is an arteriovenous (AV) fistula, which can take weeks or months to mature, so early planning is important.
Filtration: Your blood passes through the dialyzer, where waste and excess fluids are filtered out.
Return: Clean blood is returned to your body.
Schedule:
In a dialysis center: usually 3 times per week, about 3-4 hours per session.
At home (with training): often shorter, more frequent sessions, which can provide more flexibility and may be gentler for some patients.
2. Peritoneal Dialysis
Peritoneal dialysis (PD) uses the lining of your abdomen, called the peritoneum, as a natural filter.
A cleansing fluid (dialysate) is placed into your abdomen through a soft tube (peritoneal catheter).
Waste and extra fluid pass from your blood into the dialysate.
After several hours, the fluid is drained and replaced with fresh solution.
Types of PD:
Manual exchanges (CAPD): 3–5 fluid exchanges during the day.
Automated (APD): done overnight using a machine while you sleep.
Note: A common risk with PD is infection (peritonitis), which requires careful training and hygiene.
Choosing the Right Dialysis Type
Your care team will help determine which treatment best fits your needs, considering:
- Medical condition and kidney function
- Lifestyle and personal preferences
- Support system at home
- Age and activity level
- Other health conditions
Dialysis Access: Your Lifeline
A reliable access point is essential for dialysis.
1. AV Fistula: The first choice for hemodialysis; created by connecting an artery and vein in your arm.
2. AV Graft: A synthetic tube for patients whose veins aren’t suitable for a fistula.
3. Central Venous Catheter: A temporary option, usually placed in the neck or chest.
4. Peritoneal Catheter: Used for peritoneal dialysis, placed in the abdomen.
Planning access early can reduce delays and lower risks of complications.
What Is a Typical Dialysis Schedule?
1. In-center hemodialysis: 3 sessions per week (Mon/Wed/Fri or Tue/Thu/Sat).
2. Home hemodialysis: Often 5–6 days a week, shorter sessions.
3. Peritoneal dialysis: Daily, either daytime exchanges or overnight with a machine.
Your nephrologist will recommend the schedule best suited to your health and lifestyle.
Side Effects of Dialysis
Dialysis is life-saving but may cause side effects:
Hemodialysis:
-Low blood pressure
-Muscle cramps
-Fatigue
-Headaches or nausea
-Access site infection or clotting
Peritoneal Dialysis:
-Infection (peritonitis)
-Hernias
-Weight gain from glucose in the dialysate
-Long-term: possible membrane changes that reduce effectiveness
Your team will monitor you closely and adjust treatment to minimize these risks.
Life on Dialysis: What to Expect
Adjusting to dialysis takes time, but many people live full and meaningful lives while on treatment.
- Energy: You may feel tired after sessions but usually recover with rest.
- Diet & Fluid: Managing sodium, potassium, phosphorus, and fluid intake is important.
- Medications: Commonly prescribed for anemia, bone health, and blood pressure.
- Emotional Health: Depression and anxiety are common but treatable; support from family, counseling, and peer groups can help.
Dialysis Diet: Supporting Your Health
Nutrition plays a key role in dialysis care. A renal dietitian can guide you, but common advice includes:
- Limit sodium to control blood pressure and fluid.
- Control phosphorus to protect bones (may require phosphate binders).
- Monitor potassium — restrictions depend on your blood levels.
- Control fluid intake between treatments.
- Get enough high-quality protein to maintain strength.
Considering a Kidney Transplant
Dialysis replaces kidney function but does not cure kidney disease. A kidney transplant can restore function and allow dialysis-free living.
- Evaluation: Transplant evaluation often begins before dialysis starts, when possible.
- Eligibility: Not all patients are candidates, and waiting times vary.
- Benefits: Transplant offers the best long-term survival and quality of life for most patients.
Preparing Mentally and Emotionally
Starting dialysis is a major life change. Coping strategies include:
- Asking questions and learning about your treatment
- Talking with other patients or joining a support group
- Staying connected to activities and work, if possible
- Working with a team that understands your goals and priorities
Final Thoughts
Dialysis can feel overwhelming at first, but it helps restore balance, reduce symptoms, and give you more time and quality of life. With the right care, support, and planning, many patients live well on dialysis while exploring options such as transplant.
At National Kidney Partners, we are here to guide you every step of the way.
Frequently Asked Questions
The treatment itself is not usually painful, though some patients feel discomfort with needle placement, muscle cramps, or fatigue.
Yes. With advance planning, many dialysis centers across the country and abroad accept visiting patients.
Dialysis may be long-term unless you receive a successful transplant or (in rare cases) kidney function improves.
Many patients continue working, especially with home dialysis or flexible schedules.
- Learn about your treatment, seek support groups, and stay engaged in activities you enjoy.