Understanding Dialysis

Dialysis is typically recommended when you have symptoms that indicate end-stage kidney disease, also known as stage 5 chronic kidney disease (CKD). 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 is a medical process that removes toxins and waste from the body and helps maintain its fluid balance by filtering blood across a membrane, which mimics a healthy kidney. It is generally the most common treatment option for end-stage kidney failure.

Dialysis can help reduce stage 5 CKD symptoms and prevent a potentially fatal buildup of toxins and fluid in the body.

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

In HD, the blood is run through a dialyzer, often referred to as an artificial kidney, and returned to the body in a continuous process. The process usually takes around 3-5 hours and can be done at a dialysis center (in-center hemodialysis) or at home (home hemodialysis). 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 a special sterile dialysis fluid which flows into and out of your abdomen. PD is done at home and typically performed daily, either manually during the day in 3-4 short sessions (continuous ambulatory peritoneal dialysis) or automatically using a machine called a cycler (automated peritoneal dialysis) once for the entire night.

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 taken together by you and your healthcare team, who will explain the options suited to you. The selected treatment type can be re-evaluated and changed later if required.

Before you start PD or HD, a surgical procedure called dialysis access surgery is performed. This procedure creates access to the bloodstream for HD or the peritoneal cavity for PD.

For HD, you will have an arteriovenous fistula (AV fistula), an arteriovenous graft (AV graft) or a catheter to allow easier access to the bloodstream.

For PD, you will have a permanent catheter through your belly into the peritoneum for easy access to the peritoneal cavity.

Your healthcare team will provide you with all the necessary information that you need to know about the procedure before and during dialysis treatment. At this stage, it is important to address all potential concerns and questions you might have.

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 so that you set aside enough time for treatment. The 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 favorite book handy.
• Choosing PD means you will have to carry out dialysis independently. You will be trained by your healthcare team until you are comfortable and confident to perform dialysis on your own at home.

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

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.

The average life expectancy for patients on dialysis is more than ten years.

Talk to your healthcare team to understand your specific condition. It is also important that you keep to your treatment plan and dialysis schedule, as well as follow the advice of your healthcare team.