Dialysis

Overview

Dialysis is a treatment that does some of the work your kidneys normally do. Your kidneys clean your blood, remove extra water, and keep the balance of minerals in your body steady. When kidneys stop working well enough, dialysis takes over these jobs. It filters your blood, removes extra fluid and waste, and helps keep you safe. Dialysis is not a cure for kidney disease, but it can help you live a longer, more active life. There are two main types: haemodialysis (done through a machine, usually at a clinic) and peritoneal dialysis (done at home using the lining of your belly).

Yes. Kidney failure is common around the world, and millions of people are living on dialysis. Because diabetes and high blood pressure are on the rise, more people need dialysis each year.

Dialysis can be needed at any age, from young children to older adults. It is most often needed by people whose kidneys have slowly stopped working over many years, usually because of diabetes or high blood pressure. Some people need dialysis suddenly after an injury, severe infection, or other short-term problem.

Symptoms

Common symptoms

• Feeling very tired, weak, or short of breath, even with rest
• Swelling in the legs, ankles, feet, or around the eyes
• Peeing much less than usual, or not at all
• Feeling sick, throwing up, or not wanting to eat
• Metal taste in the mouth or bad breath
• Itchy skin, muscle cramps, or restless legs
• Trouble sleeping or feeling foggy and confused
• During dialysis itself: low blood pressure, dizziness, cramps, headache, or feeling cold

Symptoms in children

• Slow growth or not gaining weight as expected
• Wetting the bed again after being dry, or needing to pee a lot at night
• Tiredness, poor appetite, or trouble concentrating at school
• Swelling around the eyes, hands, or feet
• Children often need dialysis at a specialist children's kidney centre, and parents or carers are trained to help

Symptoms in older adults

• Confusion, memory problems, or feeling more frail than usual
• Falls, dizziness, or trouble walking
• Breathlessness and swelling from extra fluid
• Poor appetite and weight loss
• Older adults may also choose treatment that focuses on comfort rather than dialysis, and this is a valid choice to discuss with the kidney team

Causes

Main causes

• Diabetes that has damaged the kidneys over time (the most common cause)
• High blood pressure that harms the small blood vessels in the kidneys
• Glomerulonephritis (say: glom-er-you-lo-nef-ry-tis), which means swelling and damage to the kidney's filtering units
• Polycystic kidney disease, an inherited condition that causes fluid-filled sacs to grow in the kidneys
• Long-term harm from certain medicines, such as some pain relievers, or from other illnesses
• Blocked urine flow, repeated kidney infections, or damage from a sudden kidney injury

Risk factors

• Having diabetes or high blood pressure for many years
• A family history of kidney disease
• Heart and blood vessel disease
• Smoking
• Being overweight
• Certain ethnic backgrounds, such as people of Black African, Black Caribbean, or South Asian heritage, who are at higher risk of kidney disease
• Long-term use of some pain medicines, or a past serious kidney injury

When to see a doctor

See a doctor urgently if:

• You can't keep fluids down or are peeing very little
• New or worse breathlessness, swelling, or weight gain
• Fever or a sore, red, swollen access site
• You feel very weak, confused, or your heartbeat feels odd
• You missed a dialysis session or your dialysis machine or tube has a problem

Book a routine appointment if:

• You feel more tired than usual, or your appetite has dropped
• You have itching, cramps, or trouble sleeping
• You have questions about your schedule, diet, or fluid limits
• You feel low, worried, or overwhelmed about your treatment
• You are planning travel or a change in your care

Diagnosis

Your doctor works out how well your kidneys are working using simple blood and urine tests. If kidney function drops very low, or if you have symptoms that can't be managed in other ways, your team will talk with you about dialysis. This decision is made together with you, your family, and the kidney team, and it includes a check of your general health and goals.

Tests that may be done

• Blood tests to measure waste products and give an estimate of kidney function (often called eGFR)
• Blood tests for minerals such as potassium, phosphate, and calcium
• A full blood count to check for anaemia (low red blood cells)
• Urine tests to look for protein or blood
• An ultrasound scan to look at the size and shape of your kidneys
• Sometimes a small sample of kidney tissue (a biopsy) to find the cause
• Before starting dialysis, a check of your veins and blood vessels, or a planning scan for home-based treatment

What to expect at your appointment

You will usually have time to learn about the options before dialysis starts. Your team may show you the dialysis unit, explain how each type works, and help you decide what fits your life best. If dialysis is needed suddenly, the team will explain what is happening and support you through each step.

Treatment

There are two main types of dialysis. Haemodialysis (say: hee-mo-dye-al-iss-is) uses a machine to clean your blood, usually three times a week at a clinic, with each session lasting a few hours. Some people learn to do it at home. Peritoneal dialysis (say: per-ih-toe-nee-al) uses the lining inside your belly; fluid is put in through a soft tube and drained out later, often several times a day or overnight while you sleep. A kidney transplant is another treatment for kidney failure and can be the best option for some people. Your team will help you choose what suits your health, home, and daily life.

Self-care at home

• Look after your dialysis access every day: keep it clean, check it works, and tell your team about any redness, swelling, or pain
• Follow your fluid limit, if you have one, and sip slowly through the day
• Weigh yourself at the same time each day and write it down
• Take your medicines exactly as your team advises, and ask before starting anything new, including herbal remedies and over-the-counter pain relievers
• Follow the eating plan your kidney dietitian gives you, and keep salty and processed foods low
• Keep all your appointments and blood tests
• Get some gentle activity most days, such as walking, if you feel able

Medical treatments

Dialysis itself is the main treatment, and your team will fine-tune how often and how long it runs to keep you feeling well. Alongside it, you may be given medicines to keep your blood pressure in a safe range, to help your body make enough red blood cells, to keep phosphate and potassium at safe levels, and to protect your bones and heart. Your team will also treat any infections quickly and adjust your medicines as your kidneys change. Your dietitian will help you plan meals that work with your treatment.

When is surgery considered?

Small procedures are often needed to get you ready for dialysis. For haemodialysis, a surgeon may join an artery and vein in your arm to make a strong blood vessel, called a fistula (say: fiss-chew-la), or place a soft tube in a large vein in your neck or chest. For peritoneal dialysis, a thin tube is placed into your belly. These are usually short operations done under local or general anaesthetic. A kidney transplant is a bigger operation, and your team can talk with you about whether it is an option.

Living with this condition

Dialysis becomes part of your weekly rhythm, but it does not have to take over your whole life. Many people work, study, care for family, and travel. Plan ahead for sessions, keep a bag ready with medicines, snacks, and something to pass the time, and let your team know early if you want to travel so they can help arrange dialysis elsewhere.

Lifestyle tips

• Keep to a steady routine for sleep, meals, and sessions
• Stay up to date with vaccinations your team recommends
• Avoid smoking and limit alcohol
• Ask your team before using saunas, hot tubs, or swimming with a dialysis tube or healing access site
• Keep your access arm safe: no tight sleeves, blood pressure cuffs, or heavy lifting on that side
• Carry a card or wear a medical alert item that says you are on dialysis

Diet and exercise

Your dietitian will help you build a plan that fits your treatment. Many people need to watch salt, potassium, phosphate, and how much fluid they drink. You may need more protein than before. Gentle, regular movement, such as walking, chair exercises, or light weights, helps your heart, your strength, and your mood. Start slowly and ask your team what is safe for you.

Mental health and emotional wellbeing

It is very common to feel sad, anxious, angry, or worn out when you are on dialysis. Your body and your daily routine have changed, and that is a lot to carry. These feelings are not a sign of weakness. Talk with your team if you feel low for more than a couple of weeks, lose interest in things you enjoy, or feel hopeless. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support line in your country right away, or tell someone nearby and ask them to stay with you.

Prevention

Many cases of kidney failure can be prevented or slowed, but not all. Keeping blood sugar and blood pressure in a healthy range, not smoking, staying active, and treating kidney problems early make the biggest difference. If you already have advanced kidney disease, the goal shifts to protecting the kidney function you have and planning ahead.

Vaccines

Your care team may recommend vaccinations, such as flu, hepatitis B, and pneumonia vaccines, because dialysis and kidney disease can make infections more serious. Ask your team which ones are right for you.

Screening programmes

If you have diabetes, high blood pressure, heart disease, or a family history of kidney disease, regular blood and urine tests can catch kidney problems early, when treatment works best. Ask your doctor whether you should be checked.

Complications

If left untreated

• A dangerous build-up of waste products and fluid in the body
• Very high potassium, which can cause an irregular heartbeat and be life-threatening
• Fluid in the lungs, causing severe breathlessness
• Weak bones and heart problems over time
• Serious infections, especially around dialysis access points

Long-term outlook

Many people live for many years on dialysis and continue to do the things that matter to them. Some go on to have a kidney transplant. Your outlook depends on your age, other health conditions, and how well your treatment plan fits your life. Your team will keep checking how you are doing and adjust your care as needed. It is always fair to ask questions, share worries, and talk about what you want from treatment.

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