What Is Dialysis and When Do I Start?

What Is Dialysis?

Dialysis is a treatment that removes wastes and excess fluid from your blood.

If I Have Kidney Disease, Will I Need Dialysis?

In the early stages of chronic kidney disease (CKD), you do not need dialysis. The stages of chronic kidney disease can last for many years. But if your kidneys fail (stage 5 of CKD), you will need dialysis or a kidney transplant to keep you alive.

When Should I Start Dialysis?

The Deutsche Gesellschaft für Nephrologie (DGfN) guidelines recommend you start dialysis when your kidney function drops to 15 percent or less and/or if you have severe symptoms caused by your kidney disease, such as shortness of breath, fatigue, muscle cramps, nausea or vomiting. Your doctor will help you decide when to start dialysis, based on your symptoms and the results of lab tests that measure how much function you have left in your kidneys.

Since kidney failure often happens slowly, sometimes people do not realize how bad they’ve been feeling until they start dialysis and begin to feel much better.

It is important to start getting ready for dialysis or a transplant well in advance—that is, when your kidney disease reaches stage 4 (severe, with glomerular filtration rate, or GFR, less than 30 mL/min). Learning about the types of dialysis and transplant options will help you make the choice that is best for you. Any type of dialysis will require surgery to allow access for your treatments, and the surgery should be done well in advance to allow time for healing before dialysis begins.

Once I Am on Dialysis, Will My Kidneys Get Better?

The chances that your kidneys will get better depend on what caused your kidney failure. Kidney failure is divided into two general categories, acute and chronic. Acute (or sudden) kidney failure is often temporary and kidney function may recover. But when the damage to your kidneys has been continuous and progressive over a number of years, as it is in chronic kidney disease (CKD), then the kidneys usually do not resume normal function. When CKD has progressed to the end stage, it is considered irreversible.

Typical Causes of Acute (Sudden) Kidney Failure

  • Insufficient blood supply to the kidneys
  • Obstructed urine flow
  • Reactions to allergens, toxic substances or an acute autoimmune attack on the kidneys

Typical Causes of Chronic (Gradual) Kidney Disease1

  • Type I and type II diabetes
  • High blood pressure
  • Glomerulonephritis (inflammation of the glomeruli, the tiny clusters of blood vessels that filter your blood)
  • Polycystic kidney disease
  • Long-term autoimmune attack on the kidneys
  • Prolonged urinary tract obstruction

If your chronic kidney disease was not diagnosed until you were at the point of needing dialysis or a transplant, then it may seem sudden to you. However, the gradual injuries to your kidneys that occurred over a number of years caused permanent damage.

If you have acute kidney failure, you may need dialysis for only a few days or weeks while your kidneys recover. If your kidneys are too badly damaged to recover their function, then you will need long-term dialysis or a kidney transplant.

If it seems that your kidneys are recovering, talk to your doctor to learn whether it could be true. Tests can determine whether your kidney function has improved.

1. [National Kidney Foundation, www.kidney.org]

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