Kidneys Dialysis And Transplant

Overview

Your kidneys are two bean-shaped organs that sit at the back of your belly, one on each side. They act like a filter for your blood. Every day they clean your blood, take out extra water and waste, and turn it into urine. They also help control your blood pressure, keep your bones strong, and help make red blood cells. When the kidneys stop working properly, waste and extra fluid build up in the body. Doctors call this kidney failure, or end-stage kidney disease. When kidneys fail, treatment can do the kidneys' job. The two main options are dialysis (a machine or special fluid that cleans your blood for you) and a kidney transplant (an operation to give you a healthy kidney from a donor). Dialysis and transplant are treatments, not cures, but many people live full, active lives with either one.

Kidney disease is common around the world, and millions of people live on dialysis or with a transplanted kidney. Most people with early kidney damage never reach kidney failure, especially if it is found early and looked after.

Kidney failure can affect people of any age, including children, but it is much more common in older adults. It is also more common in people who have diabetes or high blood pressure, and in some families and communities where these conditions are more widespread.

Symptoms

Common symptoms

• Feeling very tired, weak or short of breath during normal activities
• Swelling in your ankles, feet, legs, hands or face, especially around the eyes
• Needing to pass urine more often, particularly at night, or passing less urine than usual
• Foamy or bubbly urine, or blood in your urine
• Feeling sick, being sick, or losing your appetite
• Itchy, dry skin
• Muscle cramps, especially at night, and restless legs
• Trouble concentrating or feeling foggy
• Feeling cold even when others are warm
• A metallic taste in your mouth, or food tasting different
• Losing weight without trying

Symptoms in children

• Growing more slowly than expected, or not putting on weight
• Wetting the bed again after being dry, or needing the toilet much more often
• Puffiness around the eyes, especially in the morning
• Swollen feet or ankles, or swelling in the belly
• Being very tired, irritable or pale
• Poor appetite, being sick, or not drinking much

Symptoms in older adults

• Feeling more tired or weak than usual, which can be mistaken for getting older
• Confusion, poor memory or difficulty concentrating
• Loss of appetite and unplanned weight loss
• Shortness of breath or swollen legs
• More falls or unsteadiness
• Feeling very thirsty, or passing a lot of urine at night

Causes

Main causes

• Diabetes (high blood sugar) — the most common cause of kidney failure in many countries
• High blood pressure, which damages the tiny blood vessels in the kidneys over time
• Glomerulonephritis — inflammation of the kidney's filtering units, sometimes caused by the body's immune system attacking itself
• Polycystic kidney disease and other inherited kidney conditions
• Long-term damage from repeated kidney infections, kidney stones, or a blockage such as an enlarged prostate
• Long-term use of certain medicines, such as some painkillers taken regularly over years
• Problems present from birth that affect how the kidneys are formed
• Other conditions such as lupus, heart failure, or serious illness that cuts blood flow to the kidneys

Risk factors

• Having diabetes or high blood pressure
• A family history of kidney disease or kidney failure
• Being older — kidney function naturally falls with age
• Smoking
• Being overweight or having obesity
• Heart disease or previous stroke
• A previous episode of sudden kidney injury, for example after major surgery or severe illness
• Regular use of some over-the-counter pain medicines over a long period
• Certain ethnic backgrounds, including people of South Asian, African or Caribbean heritage, where diabetes and high blood pressure are more common
• Untreated repeated urine infections or kidney stones

When to see a doctor

See a doctor urgently if:

• You pass very little or no urine, or your urine is bloody or very dark
• You have sudden severe swelling in your legs, face or hands, or you are breathless
• You are vomiting and cannot keep fluids down
• You have a high temperature with a dialysis tube or access point
• You feel very drowsy, confused or unusually weak
• You notice your dialysis access point has stopped buzzing or is bleeding

Book a routine appointment if:

• You feel tired all the time and it is not getting better
• You have swelling in your ankles or around your eyes that keeps coming back
• You are passing urine more often at night, or your urine is foamy
• You have itchy skin, cramps or a bad taste in your mouth that will not go away
• You have diabetes or high blood pressure and have not had a kidney check recently
• A close family member has kidney disease and you are wondering about your own risk

Diagnosis

Your doctor will ask about your health, your family and any medicines you take, then check your blood pressure and test your blood and urine. These tests show how well your kidneys are filtering and whether protein is leaking into your urine. If the results suggest a problem, you may have a scan of your kidneys or, rarely, a small sample taken to look at more closely. If your kidneys are already failing, you will be referred to a kidney specialist team who will talk with you about dialysis and transplant options well before you need them, so you have time to decide.

Tests that may be done

• A blood test for creatinine, which is used to work out your eGFR (estimated glomerular filtration rate — a number that shows how well your kidneys filter)
• A urine test for protein or albumin, which can be an early sign of kidney damage
• Blood pressure measurement
• Blood tests for salts and minerals such as potassium, phosphate and calcium, and for anaemia
• An ultrasound scan to look at the size and shape of your kidneys and check for blockages
• A kidney biopsy — a tiny sample of kidney tissue taken with a needle, using a local anaesthetic, to find the cause
• Tests to plan dialysis, such as checking your veins for a good access point

What to expect at your appointment

Most of the tests are simple blood and urine samples, and you can usually go home straight afterwards. Results may take a few days. If a biopsy is needed, you may be asked to lie still for a few hours afterwards and to avoid heavy lifting for a short while. Your kidney team will explain each result in plain words and talk through what it means for you — there is no such thing as a silly question, and you can ask for more time or a second conversation.

Treatment

Treatment has two aims. First, protect the kidney function you still have for as long as possible. Second, when the kidneys can no longer do their job, replace that job with dialysis or a transplant. Many people spend years in the first stage, with regular check-ups and medicines keeping things steady. When the time comes to choose dialysis or a transplant, your team will go through the pros and cons with you, and you can involve family or a friend in that decision.

Self-care at home

• Take your medicines as prescribed, even when you feel well — they are working quietly in the background
• Keep to the fluid and food advice your kidney team gives you; it is tailored to you and changes over time
• Check your blood pressure at home if your team asks you to, and keep a simple record
• Stay active — walking, swimming or gentle strength work all help your heart and your mood
• Stop smoking, and ask for help if you need it
• Avoid taking painkillers or supplements without checking with your pharmacist or kidney team first
• Keep a healthy weight and eat regular, balanced meals rather than skipping food
• Look after your dialysis access point carefully, keeping it clean and checking it daily
• Attend your appointments and blood tests, even when they feel like a chore

Medical treatments

Medicines are used to protect the kidneys and to treat the problems kidney failure causes. Your team may prescribe medicines to lower blood pressure, control blood sugar, reduce protein leaking into your urine, treat anaemia (low red blood cells), keep phosphate and calcium in balance, and reduce swelling. Some people also need vitamin D supplements or treatment for an overactive parathyroid gland. These are chosen and adjusted for you personally, so never start, stop or change a medicine on your own — always ask your doctor or pharmacist. When the kidneys can no longer cope, dialysis takes over part of their work. Haemodialysis cleans your blood by passing it through a machine, usually three times a week for a few hours. Peritoneal dialysis uses a special fluid inside your belly to draw out waste, and you can often do it at home, including overnight. A kidney transplant is an operation to place a healthy kidney from a donor into your body. It usually gives the best quality of life, but it needs lifelong medicines to stop your body rejecting the new kidney, and regular check-ups.

When is surgery considered?

Surgery is needed for a kidney transplant, and for creating dialysis access — for example, joining a vein and an artery in your arm to make a strong blood vessel for haemodialysis, or placing a small tube in your belly for peritoneal dialysis. Your team will only suggest these when they are right for you, and they will explain the risks, the recovery time and what to expect afterwards.

Living with this condition

Life with kidney failure settles into a routine. Dialysis sessions become part of your week, and many people work, study, travel and care for family alongside them. You will have regular appointments to check your treatment is working well. Some days will be harder than others — tiredness after dialysis is common, and it is fine to rest. Planning ahead helps: keep a small bag ready for sessions, tell your workplace or school what you need, and ask about travel dialysis if you want to go away.

Lifestyle tips

• Keep to your fluid allowance if you have one — sipping from a small cup, sucking ice chips or freezing drinks into cubes can help with thirst
• Eat regular meals and follow the advice from your kidney dietitian, especially about salt, potassium and phosphate
• Stay active within what feels comfortable; ask your team what is safe for you
• Protect your dialysis access arm — avoid tight sleeves, blood pressure cuffs or blood tests on that side
• Keep up to date with vaccinations your team recommends
• Avoid alcohol in excess, and check with your team about what is safe
• Get enough sleep, and tell your team if you are not sleeping well
• Carry a card or wear ID saying you have kidney disease, in case of an emergency

Diet and exercise

Food and movement are part of your treatment, not an extra. A kidney dietitian can help you plan meals that suit your blood results — often lower in salt, and sometimes adjusted for potassium, phosphate and protein. You may need extra protein if you are on dialysis. Fluid limits are common and can be tough, so ask for practical tips. Exercise helps your heart, your strength and your mood. Walking, cycling, swimming, chair-based exercise and light weights are all good options. Start gently, build up slowly, and check with your team before starting something new, especially if you have a dialysis access point or a new transplant.

Mental health and emotional wellbeing

It is very normal to feel scared, angry, low or worn out when you are living with kidney disease. Many people grieve for their old life, worry about the future, or feel guilty about needing help. Some people feel anxious before dialysis or before a transplant operation. These feelings are not a sign of weakness, and they can be treated. Talking to a counsellor, a kidney psychologist, your faith leader or a trusted friend can make a real difference. If you ever feel you cannot cope, or have thoughts of harming yourself, please reach out for crisis support straight away — contact your local emergency number or a crisis line in your country, or tell your kidney team. You do not have to manage alone.

Prevention

Many cases of kidney failure cannot be prevented completely, but a large number can be delayed or avoided. The biggest steps are looking after diabetes and high blood pressure, not smoking, keeping active, and having your kidneys checked if you are at higher risk. Protecting your kidneys early is far easier than treating kidney failure later.

Vaccines

People with kidney disease, and especially people on dialysis or with a transplant, are more likely to get seriously ill from infections. Ask your doctor or pharmacist which vaccinations are recommended for you — this often includes flu, COVID-19, pneumonia and hepatitis B. Live vaccines may not be safe for some people with weakened immune systems, so always check first.

Screening programmes

If you have diabetes, high blood pressure, heart disease or a family history of kidney disease, ask your doctor about regular kidney checks — usually a blood test for eGFR and a urine test for protein. In the UK, the NHS offers yearly kidney checks to people with these conditions, and a free NHS Health Check to adults in midlife. Finding kidney damage early gives you the best chance of keeping your kidneys working for longer.

Complications

If left untreated

• Build-up of waste and fluid in the body, which can be life-threatening
• Too much potassium in the blood, which can cause dangerous heart rhythms
• Anaemia — low red blood cells causing tiredness and breathlessness
• Weak bones and bone pain from changes in calcium and phosphate
• Fluid overload, leading to breathlessness and strain on the heart
• Heart and blood vessel disease, which is common in kidney disease
• Nerve damage causing numbness, tingling or restless legs
• Infections, especially around dialysis access points
• Poor appetite and malnutrition
• Infertility and changes in sex drive

Long-term outlook

The outlook for people with kidney failure is better now than ever before. Dialysis keeps many people well for years, and a transplant can offer a very good quality of life and often lasts for many years. Newer treatments and better care are steadily improving outcomes. Many people with kidney disease live long, full lives — working, travelling, and spending time with the people they love. Your kidney team is there to help you make the choices that suit your life, and it is always okay to ask for more information, a second opinion, or time to think.

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