When Do I Need Dialysis?

Medically Reviewed by Minesh Khatri, MD on December 07, 2022

Your kidneys are two bean-shaped organs that lie 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.

What’s Dialysis?

It’s a treatment that takes over your kidney functions if those organs stop doing their job. There are two 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.

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.

Who Needs Dialysis?

If your kidney disease becomes very severe and crosses a point where there’s not enough function to maintain the body, then you need either a transplant or dialysis.

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.

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

How Does Hemodialysis Work?

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

Fistula (also known as arteriovenous fistula or A-V fistula): An artery and 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 (arteriovenous graft or A-V graft): A plastic tube is used to join an artery and 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 to 5 hours, and you’ll likely only need them three times a week. If you have hemodialysis at home, you’ll need treatments 6 or 7 days for 2 to 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.

How Does Peritoneal Dialysis (PD) Work?

It uses the lining of your belly to filter your blood. A few weeks before you start treatment, a catheter is placed near your navel. Once the area heals, you’ll be trained on how to do PD since you’ll be doing it yourself.

You’ll use the catheter to transfer dialysis solution from a bag into your belly. This special fluid contains water with salt and other additives. It soaks up waste and extra fluids inside your body. After a few hours, you’ll drain it out into a separate bag. This process is called an “exchange.”

There are two kinds of PD:

Continuous cycling peritoneal dialysis (CCPD): This uses a machine to do your exchanges.

Continuous ambulatory peritoneal dialysis (CAPD): You’ll do your exchanges by hand.

You’ll likely do four to six exchanges each day. Your doctor can help you decide which type fits your lifestyle. Some people do both.

What Can I Expect When I Go Through Dialysis?

It shouldn’t hurt. If you have pain during or after treatment, tell your doctor right away. You may have side effects, though. Low blood pressure is common. You could also have nausea, vomiting, dry or itchy skin, muscle cramps, or feel very tired.

You can lessen side effects by being careful about what you eat and drink. Your doctor can advise how much fluid, protein, and salt you should have. 

Hemodialysis patients are also at an increased risk for infections. 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.

What If I Want to Stop Dialysis?

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 to 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 is not for everyone, particularly for the very elderly and those with very severe medical conditions.

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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