Kidney Failure: Should I Start Dialysis?

Having chronic kidney disease means that for some time your kidneys have not been working the way they should. Your kidneys have the important job of filtering your blood. They remove waste products and extra fluid and flush them from your body as urine. When your kidneys don't work right, wastes build up in your blood and make you sick. When kidney function falls below a certain point, it is called kidney failure.

Dialysis is a process that filters wastes from the blood when your kidneys can no longer do the job. It is not a cure for kidney disease, but it can help you live longer and feel better. It is a lifesaving treatment when you have kidney failure.

You have two types of dialysis to choose between: hemodialysis (say "HEE-moh-dy-AL-uh-sus") and peritoneal dialysis (say "pair-uh-tuh-NEE-uhl dy-AL-uh-sus").

Most people feel better within a week or two after starting dialysis. But it can sometimes take longer to see a change in your symptoms.

Hemodialysis

Hemodialysis uses a man-made membrane called a dialyzer to clean your blood. You are connected to the dialyzer by tubes attached to your blood vessels through a vascular access—a place where the blood can flow in and out of your body during your dialysis sessions. Your doctor will prepare the vascular access weeks to months before dialysis starts. The access is usually in an arm.

Dialysis is done mainly by trained health professionals who can watch for any problems. You will need dialysis on a regular basis, usually several times a week.

In some cases, hemodialysis can be done at home. You will need to be trained, and will need to make room for the dialysis machine. You may have choices for how often and how long you need dialysis.

Peritoneal dialysis

Peritoneal dialysis uses your body's own tissue (the peritoneal membrane) as a filter to clear wastes and extra fluid from your body and to return electrolyte levels to normal. Unlike with in-center hemodialysis, you don't need to travel to a dialysis center for your treatment. Peritoneal dialysis is done every day. It can often be done at night, while you sleep.

You will need to have a catheter (dialysis access) placed in your belly before you start dialysis.

If you don't have dialysis, your kidneys will continue to fail and you eventually will die. How long you could live depends on your overall health aside from your kidney disease and how much kidney function you have left.

As death nears, you will start to:

• Feel sleepy and weak. You may sleep more and need help to walk, bathe, and use the toilet.
• Be less hungry. You may eat and drink less than normal.
• Lose interest in daily life. You may lose interest in the outside world and the details of daily life, including the day or time.

If you don't have dialysis, health professionals who provide end-of-life care can help you have the highest quality of life possible. This may be done through hospice care. Hospice offers the chance to think about personal goals, relieve pain, and take care of your emotional and spiritual needs.

• Your doctor has told you that you need dialysis to live, and you want more time.

• You don't have other serious health problems that would end your life soon.
• You want more time to spend with loved ones or to complete other goals.

• You have other serious health problems that may shorten your life.
• You don't want to spend the time you have left on dialysis. You want to spend it how and where you want.
• Dialysis can cause side effects such as low blood pressure, muscle cramps, and infection.