Content written on and updated on June 3, 2020 - Medically reviewed by Frances E. Ashe-Goins, RN, MPH, FAAN, Orlando Gutierrez, MD

What is dialysis?

Dialysis is a treatment to clean your blood when your kidneys are not able to. It helps your body remove waste and extra fluids in your blood. It does some of the work that your kidneys did when they were healthy. A healthy, working kidney can remove fluid and waste 24 hours a day. Dialysis can only do 10-15% of what a normal kidney does.

When is dialysis needed?

You will need dialysis when you have kidney failure, also called end stage renal disease (ESRD). Kidney failure means your own kidneys no longer take care of your body’s needs to remove waste or extra fluids from your blood. The waste and extra fluids can build up to make you feel sick.

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How is dialysis done?

There are 2 types of dialysis: hemodialysis and peritoneal dialysis (PD). As you think about your options with your loved ones, use this table to help you compare them:

In-center hemodialysis Home hemodialysis Peritoneal dialysis (PD)
What is it? A machine cleans your blood at a dialysis center several times a week A machine cleans your blood at home A fluid is put in your belly to clean your body and then removed several times a day and overnight
Where is it done? In a dialysis center At home Any place that is clean and dry. It is not done in a dialysis center.
How long does it take? Usually, each treatment lasts about 2-4 hours and is done 3 times a week Home hemodialysis treatments can be more frequent or longer than in-center. Sometimes, 2-3 hour treatments are done 4-6 times a week. It depends on the schedule you and your doctors choose. PD can be done in different ways, such as overnight while you sleep or several times during the day. Your overall health, health needs, and lifestyle will determine which method might be best for you.
Will I have to follow a special food and fluid plan? You will need to strictly limit potassium, sodium, phosphorus, protein, and fluids because there is more time between treatments for waste and fluid to build up in your body. If you do your treatments every day, you may be able to be less strict with your meal plan. You may follow a meal plan that limits phosphorus, potassium, sodium, and protein. This food plan may be less strict than the one for in-center hemodialysis because you have PD treatments more often. This means you may have a little more freedom in what you eat and drink.
Will I need to travel to receive treatment? You will travel to a dialysis center 3 times a week. You will not need to leave the house to get treatment. Common concerns like traffic, inclement weather, public transportation issues, or car problems will not stop you from starting dialysis. If you do PD, you will not need to travel to get treatment. Common concerns like traffic, inclement weather, public transportation issues, or car problems will not stop you from starting dialysis.
Do I need to make an appointment? You will have appointments scheduled 3 times a week. You do not need to make any appointments. You do not need to make any appointments.
What do I need to do to prepare my home? Not applicable. You will need space to store your supplies and may need plumbing and electrical work. You will need a clean, dry space that is free from pets and plants for treatment and a large, clean, dry space to store your supplies.
Who will give me my treatment? A nephrology nurse or dialysis technician You and a partner after completing training You. A partner can also help, if needed.
Will I be able to go on vacation? Yes. You will need to find a dialysis center near your travel destination and schedule treatment sessions in advance. You may be charged a co-pay for out-of-state dialysis. Yes, usually you can bring your machine with you. Yes, you can do your treatments in any clean, dry place. Usually you can ship your supplies to your travel destination.
How does the treatment get into my body? AV fistula in arm; AV graft in arm, thighs, or groin area; catheter in chest AV fistula in arm; AV graft in arm, thighs, or groin area;catheter in chest Catheter in belly
Who is it best for? It may be best for someone who:
  • Has limited support and/or storage space at home
  • Isn’t willing or able to do dialysis at home
  • Needs in-person appointments to stay on track with treatment
  • Prefers or needs to have a healthcare professional do their dialysis sessions
Learn more about in-center hemodialysis
It may be best for someone who:
  • Has support at home
  • Prefers more freedom to work, travel, or do other activities without worrying about scheduling dialysis appointments at a center
Learn more about home hemodialysis
It may be best for someone who:
  • Has support at home
  • Prefers more freedom to work, travel, or do other activities without worrying about scheduling dialysis appointments at a center
  • Has more trouble following a strict meal plan
Learn more about PD

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How long can I live on dialysis?

How long you can live on dialysis can vary. Most people live 5-10 years on dialysis, and many have lived for 20 or more years.

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How long can I live without dialysis if I have ESRD?

It varies. People who decide not to start dialysis at all or to stop dialysis may live from a few weeks to a few months. It depends on their overall health and other chronic health conditions they have. Managing kidney failure without doing dialysis is called medical management. Learn more about medical management to determine if it might be an option for you.

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Can dialysis be temporary?

If you have ESRD, you will need to have dialysis treatments for the rest of your life, unless you are able to get a kidney transplant.

If you have acute kidney failure, you may only need dialysis for a short time until your kidneys get better. Acute kidney failure is when your kidneys stop working suddenly for a short period of time (usually 2 days or less). After treatment for acute kidney failure, your kidneys may work normally.

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Is dialysis painful?

You may have some discomfort when needles go into your body, but the dialysis treatment itself is painless. Many patients feel tired and weak before and after treatments. Some patients may have a drop in their blood pressure. This can make you feel sick to your stomach, throw up, have a headache, or cramps. Usually, these problems go away as you have treatments more often but some people may still have complications.

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How will I pay for dialysis?

Medicare, Medicaid, and many private insurance plans cover most of the costs of dialysis. Most people on dialysis are able to get Medicare coverage at any age. Depending on the type of treatment you choose, you may have to wait a few months before your insurance coverage begins. You may also need to pay some out-of-pocket costs, such as deductibles or copays. Learn more about Medicare coverage of dialysis.

If you are living with kidney failure and are unable to afford your treatment-related expenses, the American Kidney Fund (AKF) may be able to help too. Patients who demonstrate financial need may apply for assistance through AKF’s grant programs. Learn more about financial assistance available through AKF. If you have questions about the cost of dialysis, call your insurance company or ask your social worker.

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Who is on a dialysis care team ?

Think of everyone who helps care for you as part of a team. You are the team captain, and your dialysis care team members all play different roles to help you meet your health goals. Communication between team members is the key to success! Your dialysis care team may include:

  • Nephrologist: Your nephrologist is your kidney doctor. They can answer your question about treatment options, medicines, and how to care for your kidneys. You will meet with your nephrologist often to check on your kidney health and make any changes to your care plan. If you have a kidney transplant, you will still see a nephrologist to make sure your new kidney stays healthy.
  • Nephrology nurse: The nephrology nurse is a registered nurse who is trained to take care of kidney patients. You will see nephrology nurses in your doctor’s office and in your dialysis center.
    • If you choose to have in-center dialysis, you will see your nephrology nurses at every dialysis session. Your nurse will make sure that you are getting the right medicines every day and that you are getting your dialysis treatments correctly.
    • If you choose to do your dialysis at home, a nurse will teach you how to do it, and will plan, coordinate, and oversee your care.
  • Nurse practitioner or physician assistant: You may have a nurse practitioner (NP), physician assistant (PA), or both on your care team. NPs and PAs have additional training in kidney care beyond what a nephrology nurse has. NPs and PAs work closely with the nephrologist and the nephrology nurses. They may prescribe medicines, order tests, and examine you.
  • Renal dietitian: Your renal dietitian can help you meet your specific and unique food needs. Your renal dietitian will help you understand what foods and drinks are healthy for you and which ones are not. They will also help you plan how much of each nutrient you should eat each day.
  • Nephrology social worker: Your social worker will support you in many ways as you go through dialysis. Social workers provide emotional support to you and your family, help you communicate your needs to the other members of your care team, and help you find resources to improve your quality of life. For example, your social worker can help you apply to programs to get financial help, and help you get or keep health insurance.
  • Dialysis technicians: The dialysis technicians start your dialysis treatment at each session, watch to make sure everything is going well during your treatment, and end your treatment when it’s finished. They also make sure the dialysis machines are ready and working correctly for each patient. If you are on dialysis at home, the dialysis technicians will make sure you have the supplies you need to do your dialysis treatments.
  • Vascular access team: If you are on hemodialysis, either at home or in-center, a vascular access team will do the surgery to insert your vascular access that will connect you to the dialysis machine. Vascular access teams usually include a surgeon, a radiologist (a doctor who reads X-rays and other body scans), and a vascular access coordinator. The coordinator will work with you to review your medical history and make sure you get the right kind of vascular access for your treatment.

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