14618 Dialysis

Overview

Dialysis is a treatment that does part of the job your kidneys normally do. Your kidneys act like a filter: they remove waste and extra water from your blood, keep your body's salt and mineral levels balanced, and help make red blood cells. When kidneys stop working well enough to do this, dialysis can clean the blood and remove fluid for them. Dialysis is not a cure for kidney failure, and it does not heal the kidneys. It is a life-supporting treatment that keeps you safe and helps you feel better while your own kidneys recover (sometimes possible with sudden kidney damage) or while you wait for other options such as a kidney transplant. There are two main types: haemodialysis, where blood is cleaned by a machine, usually at a hospital or clinic several times a week, and peritoneal dialysis, where a cleaning fluid is put into your belly area through a small tube and drained out, often done at home.

Kidney failure needing dialysis is not rare. Millions of people worldwide are on dialysis, and numbers are rising because more people are living longer with diabetes and high blood pressure — the two biggest causes of kidney damage. In the UK, tens of thousands of people receive dialysis each year, and many more are cared for with earlier-stage kidney disease.

Dialysis can be needed at any age, from babies to older adults. It is most common in older adults, and in people who have had diabetes or high blood pressure for many years. It also affects people with inherited kidney conditions, certain immune conditions, or sudden severe kidney injury from infection, surgery or medicines. Some people need dialysis for a short time while their kidneys recover; others need it long term.

Symptoms

Common symptoms

• Feeling very tired, weak or short of breath during everyday activities
• Swelling in the ankles, legs, hands or face from extra fluid
• Feeling sick, being sick, or losing interest in food
• Itchy skin, a metallic taste in the mouth, or hiccups
• Passing much less urine than usual, or none at all
• Trouble sleeping, restless legs, or difficulty concentrating
• Feeling puffy or gaining weight quickly from fluid build-up

Symptoms in children

• Poor growth or slow weight gain
• Tiredness, irritability or poor school performance
• Wetting the bed again after being dry, or needing to pass urine very often
• Swollen eyes or ankles, especially in the morning
• Pale skin and frequent infections

Symptoms in older adults

• Confusion, drowsiness or memory changes that come on over days
• Falls or unsteadiness, partly from weakness or low blood pressure
• Loss of appetite and unplanned weight loss
• Breathlessness that is worse when lying flat
• Feeling generally 'not themselves' with no clear cause

Causes

Main causes

• Diabetes (high blood sugar) damaging the kidney filters over many years
• High blood pressure damaging the small blood vessels in the kidneys
• Glomerulonephritis — inflammation of the kidney's filtering units, often caused by the immune system
• Polycystic kidney disease and other inherited kidney conditions
• Blockages in the urinary system, repeated kidney infections, or long-standing kidney stones
• Sudden kidney injury from severe infection, major surgery, heavy bleeding, or medicines and toxins that harm the kidneys

Risk factors

• Having diabetes or high blood pressure, especially if poorly controlled
• A family history of kidney disease
• Being over 60 years old, as kidney function slowly falls with age
• Heart disease, stroke or circulation problems
• Being very overweight, smoking, or drinking a lot of alcohol
• Repeated use of painkillers that can harm the kidneys, such as some anti-inflammatory pain medicines
• Previous kidney damage, kidney stones or urinary problems
• Certain ethnic backgrounds where kidney disease is more common, such as people of African, Caribbean or South Asian heritage

When to see a doctor

See a doctor urgently if:

• You notice swelling, breathlessness, or a big drop in how much urine you pass
• You have a dialysis tube or access point that is red, painful, swollen or leaking
• You feel very tired, sick or confused and it is getting worse quickly
• You have a missed or shortened dialysis session
• Your blood pressure is very high or very low, or you feel faint

Book a routine appointment if:

• You have diabetes, high blood pressure, or a family history of kidney disease and want your kidney function checked
• Your urine is frothy, or you notice blood in your urine
• You have ongoing itching, poor appetite or weight loss
• You are starting dialysis and want to talk through options, timing and what to expect
• You feel low, anxious or overwhelmed about your treatment or your future

Diagnosis

Dialysis is not a diagnosis — it is a treatment. Doctors first work out how well your kidneys are working and why they are failing. That usually starts with a conversation about your health, a physical check-up, and blood and urine tests. Blood tests estimate your kidney function, often reported as eGFR (estimated glomerular filtration rate — a number that shows how much filtering your kidneys can do). A falling eGFR over months, together with symptoms and other results, tells the team whether dialysis is likely to be needed and when.

Tests that may be done

• Blood tests: creatinine and eGFR (measures of filtering), urea (a waste product), potassium and other minerals, and a full blood count to check for anaemia
• Urine tests: to look for protein or blood, which can show kidney damage
• Blood pressure checks, often over several visits
• Ultrasound scan of the kidneys to check size, shape and any blockage
• Blood tests for conditions that cause kidney damage, such as diabetes, and sometimes immune tests
• Occasionally a kidney biopsy — a small sample of kidney tissue is taken to look at under a microscope
• Lessons and planning with your kidney team: measuring your weight, blood pressure and fluid balance to choose the best type of dialysis and when to start

What to expect at your appointment

Your kidney team will explain the numbers in a way that makes sense to you, and will usually see you regularly over months as kidney function changes. When dialysis is being considered, you will meet a range of staff — kidney doctors, dialysis nurses, a dietitian and often a social worker — to talk about haemodialysis versus peritoneal dialysis, where treatment can happen, and how it fits your life. If you need access surgery (for example a fistula), it is usually planned in advance so the access is ready before you need it. You should feel free to ask questions, bring someone with you, and ask for information in writing.

Treatment

Dialysis is one part of a wider plan. The plan includes the dialysis itself, protecting your dialysis access, a kidney-friendly diet, medicines to manage blood pressure, phosphate, potassium and anaemia, and looking after your general health with activity, immunisations and emotional support. The two main options are haemodialysis (blood cleaned by a machine) and peritoneal dialysis (cleaning fluid used inside your belly). Some people are able to have a kidney transplant, which often offers the best long-term health and freedom. When dialysis should start is a joint decision — it is usually recommended when symptoms become hard to manage, when blood test results show advanced kidney failure, or when fluid and waste build-up is causing harm.

Self-care at home

• Follow your fluid advice — measure fluids, suck ice chips, and use small cups if you are thirsty
• Weigh yourself at the same time each day (or as your team advises) and write it down so changes are spotted early
• Keep the access point or tube very clean, and wash your hands before touching anything near it
• Take your prescribed medicines as directed, and ask your pharmacist before taking any new medicine — including over-the-counter painkillers, supplements and herbal products
• Attend every session and tell the team straight away if you cannot make one
• Check the access site daily for redness, swelling, heat or pain
• Keep moving: gentle daily activity helps circulation, mood and energy
• Keep a simple notebook of how you feel, your weight and your blood pressure to share at appointments

Medical treatments

Haemodialysis: a machine takes your blood out through a needle or tube, cleans it through a filter, and returns it to you. It is usually done in a hospital or clinic about three times a week, for around four hours each time, though some people have shorter or more frequent sessions, or train to do it at home. Peritoneal dialysis: a special cleaning fluid is put into your belly through a soft tube and left for a few hours, then drained out. This can be done at home, either in several exchanges during the day or by a machine overnight while you sleep. Your team helps you choose based on your health, your home, your work and your preferences. Alongside dialysis, your doctor will usually prescribe medicines to control blood pressure, keep phosphate and potassium in a healthy range, treat anaemia (low red blood cells), and support bone health, plus vitamins and vaccines. A dietitian will help you plan meals and fluid intake. If your kidneys may recover, dialysis might be temporary; your team will keep testing to see if that is happening.

When is surgery considered?

Surgery is sometimes part of dialysis care. To do haemodialysis well, you often need an 'access' — most commonly an arteriovenous fistula, where a vein in the arm is joined to a nearby artery so it becomes larger and stronger and can carry the blood flow needed; a small piece of tubing (a graft) or a central line in the neck or chest may also be used. These are usually created or placed in advance, so they are ready when needed. For peritoneal dialysis, a small soft tube is placed into your belly in a short operation. Surgery may also be needed to repair problems with access, such as narrowing or blockage. A kidney transplant is a bigger operation and is a separate decision; your team can explain whether it is an option for you and what it involves.

Living with this condition

Life on dialysis has a rhythm: treatment sessions, medicines, fluid limits and rest, but it also has room for work, family, hobbies and travel. Many people find the first few weeks the hardest as they learn the routines and get used to how treatment makes them feel. Over time, most people settle into a pattern, get to know their unit staff well, and find ways to fit dialysis around the rest of their life. Planning ahead helps: keeping a bag packed for sessions, arranging transport, and telling your employer or school what support you need. Ask your team about home dialysis and about planning dialysis while travelling — many units can arrange sessions in other towns or countries with notice.

Lifestyle tips

• Stay as active as feels comfortable — walking, swimming (ask about protecting your access), gardening or gentle classes all help
• If you smoke, ask for help to stop; it protects your heart and blood vessels
• Limit alcohol and check with your team what is safe for you
• Keep to your medicines and appointment schedule, and bring an up-to-date list of medicines to every visit
• Protect your access arm: avoid tight sleeves, blood pressure cuffs and blood tests on that arm unless your team says it is fine
• Have a plan for travel and holidays: ask your unit well in advance
• Ask your team about vaccines you need, and encourage close family to be vaccinated too

Diet and exercise

Diet is a big part of feeling well on dialysis. A kidney dietitian will help you find the right balance of salt, potassium, phosphate and protein for you — the advice differs depending on the type of dialysis and your blood results, so general internet advice may not suit you. Many people are advised to cut down on salt (which helps thirst, fluid and blood pressure), to be careful with high-potassium foods such as bananas, potatoes, tomatoes and some fruit juices, and to limit phosphate-heavy foods such as cola, processed meats, and some dairy. Protein needs are often higher on dialysis, so you may be encouraged to include protein at meals. Fluid limits are common, especially on haemodialysis; simple tricks like smaller cups, ice chips, sugar-free gum and avoiding salty foods make thirst easier to manage. Exercise helps strength, heart health and mood — start gently, build up, and ask your team or a physiotherapist for a plan that suits your access and energy levels.

Mental health and emotional wellbeing

It is very common to feel low, anxious, frustrated or worn down by kidney disease and dialysis. Treatment takes time and energy, and it can affect your body image, relationships, work and sense of independence. Fatigue and fluid swings can affect mood too. These feelings are not a sign of weakness, and they are not something you have to put up with alone. Talking to your team is worthwhile — depression and anxiety are treatable, and small changes to your care or support can make a big difference. If you ever feel you cannot cope, or have thoughts of harming yourself, contact your doctor or your local emergency number straight away, or reach out to a crisis support service in your area.

Prevention

Not all kidney failure can be prevented, but many people can protect their kidneys and slow kidney damage. The biggest steps are keeping blood sugar and blood pressure in a healthy range if you have diabetes or high blood pressure, taking medicines as prescribed, not smoking, staying active, and avoiding regular use of painkillers that can harm the kidneys (ask your pharmacist which ones are safer for you). If you have a condition that can affect the kidneys, regular check-ups help problems be caught early, when treatment works best.

Vaccines

Kidney disease and dialysis can make infections more serious, so vaccinations matter. Your team can advise on recommended vaccines in your area, which often include yearly flu vaccination, protection against pneumococcal infections, hepatitis B, and up-to-date COVID-19 vaccination where recommended. Live vaccines may not be suitable for some people with kidney disease, so always tell the vaccinator about your condition and treatment.

Screening programmes

Screening means testing for kidney problems before you notice symptoms. 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 kidney function and a urine test for protein. These tests are simple and can show early damage when there is still time to protect your kidneys.

Complications

If left untreated

• Dangerous build-up of waste products in the blood (uraemia), causing tiredness, confusion and eventually coma
• Dangerously high potassium, which can cause an irregular heartbeat and be life-threatening
• Fluid overload, leading to swelling, high blood pressure and fluid in the lungs
• Anaemia (low red blood cells), causing tiredness and breathlessness
• Bone and mineral problems, which can weaken bones and cause pain
• Poor appetite and malnutrition, leading to weight loss and weakness
• Higher risk of infections, including infections of the dialysis access
• Increased risk of heart and blood vessel disease over time

Long-term outlook

Dialysis is a well-established treatment that supports life for many years and helps people feel much better than they did before starting. How well someone does depends on their age, other health conditions, how well dialysis and diet are managed, and whether a transplant is possible. Many people on dialysis continue to work, care for family, travel and enjoy hobbies. Your team will review your care regularly and adjust it as your needs change. It is completely reasonable to ask about your options, including transplant, home dialysis and supportive care, so that your treatment fits the life you want to live.

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