Preparing for dialysis and transplant
If kidney disease advances, dialysis or a kidney transplant may become necessary. Getting to know the options early gives you time to decide with a clearer mind. This page is educational only and covers the types of dialysis, transplant, care without dialysis and practical preparation.
This page is educational only and is written for adult kidney patients in general. Dialysis and transplant are carried out in specialist treatment centres; the aim here is to make you familiar with the options.
Why know about it early?
Most people with chronic kidney disease never need dialysis or a transplant. NHS says only around 2 in every 100 people with the condition reach kidney failure. This figure covers everyone with the disease, including mild stages, and each person’s risk depends on the stage, protein in the urine and the cause. But if the disease advances, NIDDK recommends talking with your doctor about the options before you need them, talking with people who have had dialysis or a transplant and consulting your family. This gives you a greater sense of control.
Kidney failure means the kidneys no longer have enough function. NIDDK names four options and stresses that none of them cures kidney failure.
The four options (NIDDK)
Hemodialysis. A machine passes the blood through a filter outside the body. It is usually done for about four hours, three times a week, at a dialysis centre, and treatment at home is also possible. To connect to the machine, a vascular access has to be made with a small operation:
- Fistula: a joining of an artery to a vein, usually in the arm. NIDDK considers it the best long-term option.
- Graft: an artificial tube between an artery and a vein.
- Catheter: a soft tube in a vein of the neck, chest or groin. A temporary option.
Peritoneal dialysis. It is done at home, with a tube in the abdomen, using the lining of the abdomen to filter the blood. The fluid is exchanged by hand several times a day or by a machine overnight. Dietary limits are usually fewer than with hemodialysis.
Kidney transplant. A healthy kidney from a living or deceased donor is placed in your body. NIDDK says a transplant generally works better than dialysis and gives freedom with food, but anti-rejection medicines must be taken for life, there are surgical risks and the wait may be long.
Conservative care. Treatment without dialysis or a transplant, focused on controlling symptoms and quality of life. It does not replace the work of the kidneys.
Who chooses which?
The choice is not only medical. NIDDK says to look at whether each option fits your work, family, daily routine and how you feel, and to ask your doctor and people who have had that treatment. Questions NIDDK suggests:
- Why is this option right for me?
- How does it affect my other conditions?
- Can I work and exercise?
- What training is needed and what does it cost?
- Whom do I call when there is a problem?
When dialysis should start and whether a transplant is suitable are decided by the doctor based on your situation, and the conditions and process for joining a transplant waiting list differ in each country.
Assessment for a transplant
NIDDK writes that a transplant is considered for people with kidney failure. Your doctor refers you to a transplant centre for assessment. The tests include blood tests, checks of the heart and other organs and an assessment of mental health, and may take several weeks to several months. Active illness, such as untreated cancer, or substance use can reduce the chance of success. NIDDK names two sources of a kidney:
- Deceased donor: with a shortage of donors, the wait becomes long.
- Living donor: no waiting list is needed and the operation is planned in advance. Rejection is seen less often in this case.
NHS Blood and Transplant also describes a kidney from a living or deceased donor as possible.
After a transplant
NIDDK says anti-rejection medicines must be taken every day, because they stop the immune system from attacking the new kidney. These medicines have side effects, including a higher risk of infection, and must be monitored with regular tests. Taking any medicine or supplement on your own is dangerous for a transplant recipient, so always discuss stopping or changing a medicine with the transplant team. NKF in particular warns that some herbal supplements interact with anti-rejection medicines.
What you can do
- Protect the veins in your arms ahead of time (NIDDK). Ask for blood tests and drips in the back of the hand or below the wrist.
- Now, while dialysis is not yet needed, review your meal plan and medicines with your doctor and dietitian.
- Look into money matters, treatment hours and family support early. NIDDK suggests talking with a social worker and writing down your treatment wishes.
- Look after your mental health. NIDDK says living with kidney failure can bring stress and depression, and asking for help is fine.
- Raise your views with your doctor. The decision is not final and can be changed.
When to get urgent help
If you have dialysis or a transplant:
- Dialysis access (fistula, graft or catheter). NIDDK says to check the site for signs of infection. Tell the dialysis centre the same day about warmth or redness, or if you can no longer feel the normal buzz of a fistula. Fever and chills with a dialysis access are urgent. If bleeding from the access does not stop with firm pressure, keep pressing and call 115.
- Peritoneal dialysis. Abdominal pain, fever, nausea or vomiting, redness or pain around the catheter, cloudy drained fluid, or pus or swelling at the catheter exit site. NIDDK says to get care right away.
- Transplant. Fever, pain or discharge at the surgical site, burning when passing urine, swelling and high blood pressure, and a cold or stubborn cough. NIDDK says anti-rejection medicines may hide the signs of infection, so contact the transplant centre quickly.
- Sudden swelling and shortness of breath, severe weakness or a sudden racing heart, or sharply reduced urine, at any stage of kidney disease.
In Iran, call 115, Iran’s emergency number. See the full list in the guide “When to get urgent help”.
Frequently asked questions
If I need dialysis, does that mean everything is over?
No. NIDDK writes that hemodialysis can help you feel better and live longer, although it does not cure kidney failure. NHS also reminds us that chronic kidney disease reaches kidney failure in only a minority of people with it.
How do I know whether dialysis or a transplant is better?
NIDDK says neither is a definite cure for kidney failure, and the choice depends on your lifestyle, general health and preference. A transplant usually works better than dialysis and gives more freedom with food, but it needs an operation, anti-rejection medicines for life and sometimes a long wait. Get the opinion of your nephrologist and the transplant team.
Can I change my mind later?
NIDDK says your choice is not final: you can change your mind and move from one treatment to another.
Is there treatment without dialysis?
Yes. NIDDK names conservative care, which continues without dialysis or a transplant and focuses on controlling symptoms and comfort. It does not replace the work of the kidneys: NIDDK says only dialysis or a transplant can filter wastes from the blood, and in kidney failure life is usually shorter without them. The patient and family make this decision with the care team.
Do I need to protect the veins in my arm from now on?
NIDDK tells patients who may reach dialysis to protect the veins in their arms: ask staff to take blood and place drips in veins below the wrist, such as the back of the hand, so the arm veins stay healthy for dialysis access. Your nephrologist can give details for your situation.