Dialysis: What to expect from this life-changing — and lifesaving — treatment

If your kidneys are unable to do their job because of illness or injury, dialysis can be a lifesaving treatment. Dialysis removes waste and excess fluids from your body that would otherwise build up and cause serious health problems.

If you or a loved one needs dialysis, you're likely to have questions. This article will explain what dialysis is, who needs it, how it works, and what to expect during treatment.

What is dialysis?

The kidneys are essential organs that filter waste products and excess fluid from the blood and produce urine. When the kidneys can't do this anymore, waste builds up in the body, which can be very harmful.

Dialysis is a treatment that helps people with kidney failure keep the body's balance of fluids, electrolytes (such as sodium and potassium), and blood pressure under control. This is essential for staying healthy when your kidneys are no longer able to function properly.

Who needs dialysis?

Dialysis is typically recommended when kidney function is too poor to keep the body healthy on its own. This can happen suddenly due to kidney injury, or over time (this is called chronic kidney disease, or CKD).

Eventually, CKD can progress into end-stage renal disease (ESRD). ESRD is the final stage of CKD, and describes kidneys that have lost about 90% or more of their function. (ESRD is increasingly being called end-stage kidney disease, or ESKD, by the medical community.)

Dialysis can be a temporary or long-term solution. Some people may only need it for a short period while their kidneys heal from an injury. However, most people with ESKD will need it for the rest of their lives unless they receive a kidney transplant. Without dialysis or a kidney transplant, people with ESKD cannot survive.

How does dialysis work?

Dialysis takes over the kidney's job of filtering the blood. It removes extra water, waste, and toxins from the body.

Types of dialysis

There are two main types of dialysis: hemodialysis and peritoneal dialysis. Both treatments help remove waste and excess fluid from your body, but they work in different ways. You and your doctor will decide together which option is best for your needs.

Hemodialysis

Hemodialysis is the most common type of dialysis. It uses a machine to filter your blood outside of your body.

Here's how it works:

• Blood is drawn from your body and passed through a filter called a dialyzer, which acts as an artificial kidney.
• Blood flows into tiny hollow fibers in the filter, while a special fluid called dialysis solution moves in the opposite direction outside the fibers.
• Waste from the blood passes into the solution, which exits the body. The cleaned blood returns to your body.

The dialysis machine carefully monitors your blood pressure during this process and regulates blood flow.

Each dialysis session takes about four hours and is usually done three times a week, at a dialysis center or sometimes at home. Some centers offer nighttime treatments, which take longer but happen while you sleep.

Peritoneal dialysis

Peritoneal dialysis is another option for people with kidney failure. Instead of using a machine to filter your blood, this method uses the lining of your abdomen, called the peritoneum, as a natural filter.

Here's how it works:

• A few weeks before starting peritoneal dialysis, a surgeon inserts a soft tube (catheter) into your abdomen.
• During treatment, dialysis solution is introduced into your abdomen through this tube. The peritoneum filters waste from the blood, and the waste is absorbed by the dialysis solution.
• After a few hours, the fluid containing waste, along with excess fluid, is drained. It is replaced with fresh fluid to continue the filtering process. This process is repeated several times per day, depending upon the person's needs.

There are two main types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD), which is done by hand several times a day, and automated peritoneal dialysis (APD), which uses a machine to perform the exchanges, often while you sleep. You can perform peritoneal dialysis in any clean, private place including at home, work, or while traveling.

What to expect during hemodialysis

Hemodialysis is a structured process that happens at regularly scheduled intervals. Before starting, you will have a minor surgery to create an access point (called an arteriovenous fistula) for the machine to connect to your bloodstream. This is often done in your arm. For patients who cannot have a fistula created, a catheter may be placed in a vein in the neck to allow the dialysis machine to connect with the bloodstream.

At the beginning of a hemodialysis session, a nurse or technician inserts two needles into your access point. These needles are connected to soft tubes that link to the dialysis machine.

Each hemodialysis session lasts about four hours, and most people go to a dialysis center three times a week. While the machine does its job, you'll be seated and can read, watch TV, or sleep. The process can be tiring, and it's common to feel a little tired afterward. Some people also experience low blood pressure, cramps, or headaches, but your care team will monitor you closely to help manage any discomfort.

Lifestyle and other changes your doctor may recommend

Living with dialysis often requires making some changes, but with time and support, many people adapt well. Here are some changes your doctor may recommend.

• Dietary adjustments: Your kidneys are no longer able to filter out certain nutrients, so your doctor may recommend limiting foods high in sodium, potassium, and phosphorus. You'll also need to manage your fluid intake to avoid fluid overload. Additionally, dialysis removes protein from the body, so you will need to pay special attention to increasing protein intake.
• Medications: Many medicines are processed by the kidneys. When you start dialysis, some medicines may not work the same or could be harmful, so your doctor might need to adjust them. You may also need to take medications to help manage your blood pressure, protect your bones, or prevent anemia.
• Regular check-ups: Your health care team will monitor your condition regularly to make sure the dialysis is working and that your body is adjusting well. Blood tests and other assessments are part of this routine.
• Time management: Dialysis can take up to several hours each week, so planning around your treatment schedule is essential. It may feel overwhelming at first, but many people find ways to balance their treatments with work, family, and personal time.

Dialysis can be life-changing, but it doesn't have to stop you from living your life. With the right support and care, many people continue to work, travel, and enjoy time with family and friends. Your health care team will help you manage your treatment and maintain your quality of life.