The basics

Dialysis

Part of the series "All about chronic kidney disease"

If you have chronic kidney disease  that progresses to end stage renal disease, you will want to know all of the dialysis choices  that are available to you. Below are some frequently asked questions pertaining to dialysis, such as when it is necessary, how long you can be on it and how often you would need to dialyze.

If I have kidney disease, will I need dialysis?

In the early stages of chronic kidney disease, you do not need dialysis. These early stages can last for many years. But if your kidneys fail, you will need dialysis or a kidney transplant to keep you alive.

If I have kidney disease, how long will it be before I need to start dialysis?

Depending what stage your chronic kidney disease is and how quickly it progresses, you may never need dialysis — or you may need dialysis right away. Dialysis is usually recommended when your kidney function is about 10-15% of normal.

Can I take a tour of a dialysis center before I start dialysis?

Yes, that's a great idea. To arrange your tour at a DaVita dialysis center, please call DaVita Guest Services at 1-800-244-0680. (Operating hours: Pacific Time: 5:00 a.m. to 6:30 p.m. / Eastern Time: 8:00 a.m. to 9:30 p.m.)

My doctor said I will need to go on dialysis in six months to a year. What does this mean?

It is time for you to learn about all the treatment options for kidney failure: peritoneal dialysis, hemodialysis and kidney transplant. You have some choices to make. If you plan to do peritoneal dialysis, which is a home dialysis option, you will need to have a tube surgically placed in your abdomen. If you plan to do hemodialysis, whether in center or at home, you will need to have surgery soon to create a vascular access and allow it to heal. If you want a kidney transplant, you will need to talk with your nephrologist about how to get on the transplant list or ask a friend or family member to donate a kidney.

When should I start dialysis?

National Kidney Foundation guidelines recommend that you start dialysis when your kidney function drops to 15% or less — or if you have severe symptoms caused by your kidney disease, like shortness of breath, fatigue, muscle cramps or nausea and vomiting. Your doctor will help you decide, based on lab tests that measure how much kidney function you have left and on your symptoms.

How is dialysis paid for?

Private insurance generally covers treatment for kidney failure whenever your doctor says it is needed. If you don't have private insurance, you may be able to get coverage through federal or state funded healthcare programs, such as Medicare or Medicaid.

Most people (about 93% of those who apply) qualify for Medicare when they need dialysis or a transplant, even if they are under age 65. Medicare pays for 80% of treatment for kidney disease when kidney function has dropped to 10-15%, or when your doctor justifies it.

If you are not having symptoms, you may be able to wait a bit longer for dialysis. However, some doctors believe that starting dialysis as soon as Medicare or insurance covers it is wise, since it can take a long time to recover if you let yourself get very ill. Since chronic kidney disease often happens slowly, sometimes people do not even know how bad they feel until they start dialysis and begin to feel much better.

It is important to start getting ready for dialysis or a transplant well in advance — when your kidney disease reaches Stage 4 chronic kidney disease (with glomerular filtration rate (GFR), less than 30 mL/min). Any type of dialysis will require surgery — usually outpatient — to create an access for your treatments, and this should be done well in advance to allow time for healing.

Learning about the types of dialysis and transplant options will help you make a choice that is best for you. Check out the rest of this website for educational resources from DaVita.

I am in Stage 4 kidney disease and can't have a transplant. Can I do dialysis for the rest of my life?

The questions "How long can someone live?" and "How well can someone live?" are very common when you need to go on dialysis and you're scared. Yes, dialysis is something you can do for the rest of your life. And, most people on dialysis enjoy a good quality of life. Some people have been on dialysis for 30 years or more without getting a transplant. How long you can live on dialysis, and how well you do, will depend on a number of things, including:

• How healthy you are, other than kidney disease
• How positive your attitude is (optimists live longer, depression can be treated)
• Whether you receive good quality medical care and dialysis
• How much you learn about dialysis and take an active role in your care.

Nobody lives for 30 years or more on dialysis by accident — it takes a lot of knowledge and effort. You are doing the right thing by visiting this website. Sign up for kidney classes. You may also want to check into joining a kidney patient organization, like a chapter of the National Kidney Foundation at: http://www.kidney.org, or the American Association of Kidney Patients at: http://www.aakp.org or learn more about kidney disease by visiting Kidney School at: http://www.kidneyschool.org.

If I start hemodialysis, how often will I have to get treatments?

The usual schedule for in-center hemodialysis treatments is three times a week, either Mon/Wed/Fri or Tues/Thurs/Sat. You will have the same morning or afternoon time for each treatment. The length of your treatment depends on what your doctor prescribes for you. Three to four hours is common, plus time to travel to and from the center, and often some waiting time when you arrive. If you don't like the treatment schedule you get, you can ask to be on a waiting list for a different time, or switch to a different center.

If I start PD, how often will I have to get treatments?

Peritoneal dialysis (PD) is most commonly done on a nightly basis using an automated cycler machine while a person sleeps. A patient will typically be connected to the cycler for 8 to 10 hours each night and be free of dialysis during the day. Some people will choose to do manual PD, which usually means doing four to five exchanges per day. Each exchange takes 20 to 30 minutes, and they need to be spread out over the whole day to clean the blood well. A common manual PD schedule might be to do one exchange upon waking, one at lunchtime, one at dinner, and one at bedtime. A cycler can be used together with a manual exchange. The cycler can be used at night with only one exchange during the day.

Summary

When chronic kidney disease progresses to kidney failure, dialysis is a treatment that replaces kidney function to help people live a quality life. There are several dialysis treatment options available. Talk to your doctor about the types of dialysis and which one would be best for your health and lifestyle needs.

Related articles

• What is dialysis and when do I start?
• How to choose a dialysis center
• What are my dialysis choices?
• How dialysis is paid for