Dialysis is a process that filters the waste products and excess fluid from your blood. What does it entail and how does it help kidney failure? 

What is dialysis?

Doctor explaining what is dialysis to CKD patients

Dialysis is a process that filters the waste products and excess fluid from your blood. Dialysis is generally the most common treatment option for end-stage kidney disease (ESKD). 

ESKD is when kidney function drops to below 15%. It is also called kidney failure. 

Dialysis is typically recommended when you have symptoms that indicate end-stage kidney disease. At this stage, the kidney function declines so much that toxins start building up to high levels and fluid balance becomes a problem, resulting in fluid overload. 

Dialysis can help reduce the above symptoms and prevent a potentially fatal build-up of toxins and fluid in the body. 

Types of dialysis

There are two main types of dialysis: haemodialysis (HD) and peritoneal dialysis (PD).  

HD is a type of dialysis that filters your blood outside your body. A small amount of blood is outside the body at any point in time, being filtered through a dialyser. A dialyser is a manufactured filter that acts like an artificial kidney. A haemodialysis machine pumps the blood through the dialyser. HD usually takes around 3-5 hours and can be done at a dialysis centre or at home. It is typically performed at least 3 times per week.  

In PD, the blood is cleaned inside the body using the natural lining of your abdomen (peritoneal membrane) as a filter and dialysis fluid which flows into and out of your abdomen.. It is typically performed daily, either manually during the day in 3-4 sessions (continuous ambulatory peritoneal dialysis) or automatically using a machine called a cycler (automated peritoneal dialysis) once for the entire night while you sleep. 

When choosing the type of dialysis, it is important to consider multiple factors such as your living situation, lifestyle, and pre-existing health conditions. The decision will be made together by you and your healthcare team who will explain the options suited to you. The selected treatment type can usually be re-evaluated and changed later if required. 

Alternatives to dialysis

Though dialysis is the most common treatment for kidney failure, some alternatives can be explored based on your situation. 

The ideal scenario for many people is a kidney transplant, where you receive a healthy kidney from a donor. This usually removes the need for dialysis and can signal a return to largely normal life, possibly with certain limitations, including daily medication to prevent rejection of the donor’s kidney. There are many considerations associated with this treatment option, including your overall health. If you are an ideal candidate for a transplant, your healthcare team will discuss the details with you. 

Sometimes the possible complications associated with dialysis outweigh the benefits and chronic kidney disease (CKD) patients choose to continue their CKD treatment with conservative care, in which your symptoms are controlled with medication, and the focus is on your comfort and quality of life. It is important to note that this approach cannot replace kidney function or stop the progression of CKD in any way. This form of care requires appropriate medication, dietary planning, physiotherapy, and psychosocial support to manage physical and mental requirements. 

Healthcare team explaining dialysis treatment to CKD patients

Support from your healthcare team

Your healthcare team will provide you with all the necessary information that you need to know about the preparing for dialysis and what you will experience during dialysis treatment. You can address potential concerns and questions you might have. Your renal care team will always be able to answer questions as they arise throughout your treatment. 

Doctor explaining to CKD patient the surgical procedure to create access for dialysis

Creating access for dialysis

Before you start dialysis, whether PD or HD, a surgical procedure is performed to create and access for dialysis. This procedure creates access to the bloodstream for HD or the peritoneal cavity for PD. Your renal care team will manage the scheduling of this surgery. 

Dialysis patient receiving support from their loved ones

Preparing for your first dialysis session

Apart from the steps your healthcare team will take to prepare your body for treatment, it is vital that you prepare yourself mentally. Talk to your family and friends so that you have a support network if required. Plan your daily schedule in such a way that you set aside enough time for treatment. This time required may vary based on the type of dialysis. If you are undergoing HD, consider whether you want to plan some relaxing activities for the treatment duration – load up your playlist or keep a favourite book handy. 

Regardless of the type of dialysis, remember that the change in routine will take getting used to and that keeping a positive outlook is essential. 

Doctor Preparing Patient for Peritoneal Dialysis (PD)

Life expectancy on dialysis

Life expectancy on dialysis depends on many factors, including any other long-term conditions that you may have, whether you can undergo a kidney transplant, and how efficient dialysis is for you. Talk to your healthcare team to understand your specific condition and which type of dialysis to choose. It is also important that you keep to your treatment plan and dialysis schedule as well as follow the advice of your healthcare team.