When Do I Need Dialysis?

Medically Reviewed by Zilpah Sheikh, MD on September 20, 2023
7 min read

Dialysis is a treatment that takes over your kidney functions if those organs stop doing their job.

What are kidneys?

Your kidneys are part of your urinary system. They're two bean-shaped organs just below your rib cage, on each side of your spine. They remove waste and fluid from your body, level out your blood pressure, and keep your bones strong. They also ensure that you have the right amount of minerals, like potassium and sodium (salt), in your blood. Finally, they make the hormone that causes your body to create red blood cells.

If your kidney disease becomes very severe and crosses a point where there's not enough function to maintain your body, you may need dialysis or a kidney transplant. Injuries or health conditions like lupus, high blood pressure, or diabetes can lead to kidney disease. You can also develop kidney disease for no known reason.

You typically start dialysis when you have symptoms or your lab tests show toxic levels of waste in your blood. Symptoms of kidney failure include nausea, fatigue, swelling, and throwing up.

When you should start dialysis depends on your age, energy level, overall health, lab test results, and how willing you are to commit to a treatment plan. Although it can make you feel better and live longer, it involves a lot of your time.

There are five stages of kidney disease. In stage V, you're considered to be in end-stage renal disease or kidney failure. This is when your kidneys have 10%-15% of their normal function. You may need dialysis or a kidney transplant to stay alive. You might have dialysis while waiting for a transplant.

Your doctor will let you know when you should start treatment. They'll also explain which type might work best for you.

There are two main types of dialysis:

Hemodialysis: Your blood is put through a filter outside your body, cleaned, and then returned to you. This is done either at a dialysis facility or at home.

Potential risks of this type of dialysis include infection, poor blood flow, blockage from scar tissue, blood clots, anemia, and sudden heart attack.

Peritoneal dialysis: Your blood is cleaned inside your body. A special fluid is put into your abdomen to absorb waste from the blood that passes through small vessels in your abdominal cavity. The fluid is then drained away. This type of dialysis is typically done at home.

Potential risks of this type of dialysis include skin infections around the catheter, as well as an infection called peritonitis that can happen when bacteria gets inside your abdomen through the catheter. The abdominal catheter, and pumping your belly full of fluid, can weaken your abdominal muscles and may lead to a hernia. This type of dialysis can also lead to weight gain.

Continuous renal replacement therapy is also a type of dialysis that's done as a life-saving measure for unstable patients in the ICU who can't tolerate regular dialysis. It's done 24 hours a day to slowly and continuously clean out waste products and fluid.

In hemodialysis, a machine removes blood from your body. It then filters your blood through a dialyzer (artificial kidney) and returns the cleaned blood to your body. This procedure lasts 3-5 hours. You get it in a hospital or a dialysis center three times a week.

You can have hemodialysis at home, also. Home hemodialysis allows you to have dialysis for a longer period or more frequently—usually three to seven times a week. You might do this at night so you can sleep while it's happening.

First, you'll need a minor surgery to create direct access to your bloodstream. This can be done in a few ways:

Fistula (also known as arteriovenous [A-V] fistula): An artery and a vein are joined together under the skin in your arm. Most of the time, this is done in the one you don't write with. An A-V fistula needs 6 weeks or longer to heal before it can be used for hemodialysis. Then, it can be used for many years.

Graft (A-V graft): A plastic tube is used to join an artery and a vein under your skin. This heals in only 2 weeks, so you can start hemodialysis faster. This won't last as long as a fistula. You'll likely need another graft after a few years.

The risk of infection is greater with a graft. You'll also have to see your doctor more often so they can make sure the graft stays open.

Catheter (central venous catheter): This method is an option if you need to start hemodialysis very quickly. A flexible tube (catheter) is put into a vein in your neck, below your collarbone, or next to your groin. It's only meant to be used for a short time.

During hemodialysis, you'll sit or lie back in a chair. A tech will place two needles in your arm where the fistula or graft is located. A pump in the hemodialysis machine slowly draws out your blood, then sends it through another machine called a dialyzer. This works like a kidney and filters out extra salt, waste, and fluid. Your cleaned blood is sent back into your body through the second needle in your arm. Or if there's a catheter, blood comes out of one port and then is returned via a second port.

You can have hemodialysis in a hospital, a dialysis treatment center, or at home. If you have it in a center, the sessions last 3-5 hours, and you'll likely only need them three times a week. If you have hemodialysis at home, you'll need treatments for 6 or 7 days for 2-3 hours each time.

Some people read or watch TV during treatment. If you have hemodialysis at home, you may be able to do it at night while you sleep.

In peritoneal dialysis (PD), tiny blood vessels in your abdominal lining (peritoneum) filter your blood with the help of a dialysis solution. This solution (a type of cleansing liquid) contains water, salt, and other additives.

PD takes place at home. You may prefer it over hemodialysis because you don't have to make regular trips to a dialysis center or hospital. You also have fewer restrictions on what you can eat.

You'll have a minor surgical procedure about 3 weeks before you start PD. Your surgeon will place a soft, thin tube (catheter) through your belly and into your peritoneum. This catheter is permanent. A doctor will teach you how to do PD at home and prevent infections at your catheter site. The catheter transfers dialysis solution from a bag into your belly. This solution soaks up waste and extra fluids inside your body. After a few hours, you drain it into a separate bag. This process is called an "exchange."

You might prefer to do PD overnight, while you sleep.

There are two ways to do PD:

  • Automated peritoneal dialysis uses a machine to do your exchanges.
  • Continuous ambulatory peritoneal dialysis involves doing your exchanges by hand.

It shouldn't hurt. If you have pain during or after treatment, tell your doctor right away. You may have side effects, though. They can include:

  • Itchy skin
  • Low blood pressure (especially if you have diabetes)
  • Sleep problems
  • Fluid overload
  • Infections
  • Depression or mood swings
  • Nausea and vomiting
  • Muscle cramps
  • Fatigue

Try these tips to stay healthy:

  • Check your access site daily for redness, pus, and swelling. If you see any, call your doctor.
  • Keep the bandage that covers your catheter clean and dry.

Make sure anyone who helps with your treatment washes their hands before and after with soap and water.

Your fertility can also be affected when you have dialysis. It's not common to get pregnant while on dialysis. That's because dialysis only replaces a small percentage of your kidney function, and your body still has high amounts of waste products. This interferes with your egg production and menstrual cycle.

This treatment should maintain or improve your quality of life. But you can choose not to have it or stop at any time. If you do, make sure to talk to your doctor about other treatments that can help you. Changes in your diet or lifestyle may improve your quality of life.

If you want to stop dialysis because you feel depressed or ashamed, your doctor may urge you to speak to a counselor first. Sharing your feelings, taking antidepressants, or doing both of these things may help you make a more informed decision.

Dialysis isn't for everyone, such as those who are much older or have other severe medical conditions.

  • Dialysis is a treatment that takes over your kidney functions if those organs stop doing their job.
  • If your kidney disease becomes very severe and crosses a point where there's not enough function to maintain your body, then you may need dialysis.
  • Injuries or health conditions like lupus, high blood pressure, or diabetes can lead to kidney disease.
  • You can develop kidney disease for no known reason.
  • There are different types of dialysis, depending on your condition, as well as availability and cost.
  • Dialysis shouldn't hurt.
  • Dialysis can cause side effects, ranging from minor to severe.
  • Dialysis isn't for everyone, such as those who are much older or have other severe medical conditions.
  • What is the life expectancy on dialysis?

The average life expectancy on dialysis is 5-10 years. But some people on dialysis live 20 or 30 years.

  • How serious is having to be on dialysis?

Dialysis is very serious. The longer you're on dialysis, the more likely you are to have side effects. Some of those can be deadly.

  • Can kidneys start working again after dialysis?

Rarely. A small percentage of people on dialysis may recover healthy kidney function, even after a long time on dialysis.

Show Sources


National Institute of Diabetes and Digestive and Kidney Diseases: “Your Kidneys and How They Work,” “Dialysis,” “Choosing Not to Treat With Dialysis or Transplant,” “Treatment Methods for Kidney Failure: Hemodialysis.”

National Kidney Foundation: “Dialysis,” “Hemodialysis,” “Coping With the Top 5 Side Effects of Dialysis,” “Filtering Dialysis Myths From Facts,” “Dialysis: Deciding to Stop.”

Texas Heart Institute: “Vascular Access for Hemodialysis.”

Mayo Clinic: “Hemodialysis,” “Peritoneal Dialysis.”

University of Wisconsin Health: “Kidney Failure: When Should I Start Dialysis?”

American Kidney Fund: “Peritoneal Dialysis (PD).”

American Journal of Kidney Disease: “Fatigue in Patients Receiving Maintenance Dialysis: A Review of Definitions, Measures and Contributing Factors.”

CDC: “Dialysis Safety: Patient Overview.”

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