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Kidney Failure: Should I Start Dialysis?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Kidney Failure: Should I Start Dialysis?

Get the facts

Your options

  • Start kidney dialysis, which may help you live longer.
  • Don't start dialysis, which will allow death to occur naturally.

Key points to remember

  • It's your choice whether to have dialysis or not have it. You and your family can talk with your doctor about the benefits and side effects of dialysis.
  • Dialysis can't cure kidney failure, but it may help you live longer and feel better.
  • If you have other serious health problems, dialysis may not help you live much longer than you would without it.
  • Dialysis takes time and commitment. You also have to watch how much fluid you drink and be careful about what you eat.
  • Dialysis can have side effects such as low blood pressure, muscle cramps, or infection.
FAQs

What is kidney failure?

Having chronic kidney disease means that for some time your kidneys have not been working the way they should. Your kidneys have the important job of filtering your blood. They remove waste products and extra fluid and flush them from your body as urine. When your kidneys don't work right, wastes build up in your blood and make you sick. When kidney function falls below a certain point, it is called kidney failure.

What is dialysis?

Dialysis is a process that filters wastes from the blood when your kidneys can no longer do the job. It is not a cure for kidney disease, but it can help you live longer and feel better. It is a lifesaving treatment when you have kidney failure.

You have two types of dialysis to choose between: hemodialysis (say "HEE-moh-dy-AL-uh-sus") and peritoneal dialysis (say "pair-uh-tuh-NEE-uhl dy-AL-uh-sus").

Most people feel better within a week or two after starting dialysis. But it can sometimes take longer to see a change in your symptoms.

What happens during dialysis?

Hemodialysis

Hemodialysis uses a man-made membrane called a dialyzer to clean your blood. You are connected to the dialyzer by tubes attached to your blood vessels through a vascular access—a place where the blood can flow in and out of your body during your dialysis sessions. Your doctor will prepare the vascular access weeks to months before dialysis starts. The access is usually in an arm.

Dialysis is done mainly by trained health professionals who can watch for any problems. You will need dialysis on a regular basis, usually several times a week.

In some cases, hemodialysis can be done at home. You will need to be trained, and will need to make room for the dialysis machine. You may have choices for how often and how long you need dialysis.

Peritoneal dialysis

Peritoneal dialysis uses your body's own tissue (the peritoneal membrane) as a filter to clear wastes and extra fluid from your body and to return electrolyte levels to normal. Unlike with in-center hemodialysis, you don't need to travel to a dialysis center for your treatment. Peritoneal dialysis is done every day. It can often be done at night, while you sleep.

You will need to have a catheter (dialysis access) placed in your belly before you start dialysis.

What will happen if you don't start dialysis?

If you don't have dialysis, your kidneys will continue to fail and you eventually will die. How long you could live depends on your overall health aside from your kidney disease and how much kidney function you have left.

As death nears, you will start to:

  • Feel sleepy and weak. You may sleep more and need help to walk, bathe, and use the toilet.
  • Be less hungry. You may eat and drink less than normal.
  • Lose interest in daily life. You may lose interest in the outside world and the details of daily life, including the day or time.

If you don't have dialysis, health professionals who provide end-of-life care can help you have the highest quality of life possible. This may be done through hospice care. Hospice offers the chance to think about personal goals, relieve pain, and take care of your emotional and spiritual needs.

Why would you consider starting dialysis?

  • Your doctor has told you that you need dialysis to live, and you want more time.
  • You don't have other serious health problems that would end your life soon.
  • You want more time to spend with loved ones or to complete other goals.

Why would you consider not having dialysis?

  • You have other serious health problems that may shorten your life.
  • You don't want to spend the time you have left on dialysis. You want to spend it how and where you want.
  • Dialysis can cause side effects such as low blood pressure, muscle cramps, and infection.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Start kidney dialysis Start kidney dialysis
  • You have a procedure to put in a dialysis access.
  • You have dialysis treatments several times a week.
  • You must be careful about how much fluid you drink and what you eat.
  • You may have more energy and feel better than you did before.
  • You may be able to return to normal activities.
  • If you do not have other serious health problems, dialysis may keep you alive longer.
  • Treatment may allow you to meet goals you have set for yourself.
  • Dialysis won't cure you.
  • Dialysis may involve frequent travel to and from where you have treatments.
  • Dialysis takes a lot of time and can affect your quality of life.
  • Dialysis has risks, including low blood pressure, muscle spasms, infection, abnormal heart rhythms, and low levels of protein.
Don't have kidney dialysis Don't have kidney dialysis
  • Your body will start to shut down, and you will experience normal changes from the dying process.
  • You may need the support of a hospice team.
  • You won't have side effects or problems from dialysis.
  • You won't need to limit what you eat and drink.
  • If you have other serious health problems, your life span may be the same even if you choose not to have dialysis.
  • The time you have left is your own to spend as you want, not on dialysis treatments.
  • You may die sooner than if you had dialysis, especially if you have no other serious health problems.

Personal stories about considering starting dialysis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I want to have dialysis, because I'm not ready to die. I still feel young. I have a lot of things I still want to do with my life. I want to work on my craft projects and spend more time with my grandchildren.

Teresa, age 60

I have other bad health problems. I've had heart attacks, and I also have heart failure. I don't think dialysis will give me much more time. I feel like I've had a good life. I'm ready to go whenever it's my time.

Stan, age 72

I know I'll spend a lot of time at dialysis. But I can read there. And I love writing letters to family and friends. My partner can drop by sometimes and spend some time with me, and maybe I can make some friends at the dialysis center.

Raul, age 62

I want to spend the time I have left with my family, not having dialysis. My daughter said I can come live with her, so I can spend more time with her and her husband.

Helen, age 83

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have kidney dialysis

Reasons not to have kidney dialysis

I'm not ready to die.

I'm ready to face my death.

More important
Equally important
More important

I have goals I still want to meet.

I have met all the goals I had for my life.

More important
Equally important
More important

I don't mind having to rely on others for transportation or other help.

I don't want to keep relying on others for help with my dialysis treatments.

More important
Equally important
More important

I feel pretty good overall, because kidney failure is my only major health problem.

I'm already sick from other health problems and am not sure dialysis will help me feel any better or live any longer.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Starting dialysis

NOT starting dialysis

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Dialysis can cure my kidney failure.
2, Dialysis can help me feel better.
3, I may be able to have dialysis at home and not go to a center.

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
2, Check what you need to do before you make this decision.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

What matters to you  

Print Summary

Credits

Credits
Author Healthwise Staff
Primary Medical Reviewer Anne C. Poinier MD - Internal Medicine
Primary Medical Reviewer E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer Kathleen Romito MD - Family Medicine
Primary Medical Reviewer Tushar J. Vachharajani MD, FASN, FACP - Nephrology
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Kidney Failure: Should I Start Dialysis?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Start kidney dialysis, which may help you live longer.
  • Don't start dialysis, which will allow death to occur naturally.

Key points to remember

  • It's your choice whether to have dialysis or not have it. You and your family can talk with your doctor about the benefits and side effects of dialysis.
  • Dialysis can't cure kidney failure, but it may help you live longer and feel better.
  • If you have other serious health problems, dialysis may not help you live much longer than you would without it.
  • Dialysis takes time and commitment. You also have to watch how much fluid you drink and be careful about what you eat.
  • Dialysis can have side effects such as low blood pressure, muscle cramps, or infection.
FAQs

What is kidney failure?

Having chronic kidney disease means that for some time your kidneys have not been working the way they should. Your kidneys have the important job of filtering your blood. They remove waste products and extra fluid and flush them from your body as urine. When your kidneys don't work right, wastes build up in your blood and make you sick. When kidney function falls below a certain point, it is called kidney failure.

What is dialysis?

Dialysis is a process that filters wastes from the blood when your kidneys can no longer do the job. It is not a cure for kidney disease, but it can help you live longer and feel better. It is a lifesaving treatment when you have kidney failure.

You have two types of dialysis to choose between: hemodialysis (say "HEE-moh-dy-AL-uh-sus") and peritoneal dialysis (say "pair-uh-tuh-NEE-uhl dy-AL-uh-sus").

Most people feel better within a week or two after starting dialysis. But it can sometimes take longer to see a change in your symptoms.

What happens during dialysis?

Hemodialysis

Hemodialysis uses a man-made membrane called a dialyzer to clean your blood. You are connected to the dialyzer by tubes attached to your blood vessels through a vascular access—a place where the blood can flow in and out of your body during your dialysis sessions. Your doctor will prepare the vascular access weeks to months before dialysis starts. The access is usually in an arm.

Dialysis is done mainly by trained health professionals who can watch for any problems. You will need dialysis on a regular basis, usually several times a week.

In some cases, hemodialysis can be done at home. You will need to be trained, and will need to make room for the dialysis machine. You may have choices for how often and how long you need dialysis.

Peritoneal dialysis

Peritoneal dialysis uses your body's own tissue (the peritoneal membrane) as a filter to clear wastes and extra fluid from your body and to return electrolyte levels to normal. Unlike with in-center hemodialysis, you don't need to travel to a dialysis center for your treatment. Peritoneal dialysis is done every day. It can often be done at night, while you sleep.

You will need to have a catheter (dialysis access) placed in your belly before you start dialysis.

What will happen if you don't start dialysis?

If you don't have dialysis, your kidneys will continue to fail and you eventually will die. How long you could live depends on your overall health aside from your kidney disease and how much kidney function you have left.

As death nears, you will start to:

  • Feel sleepy and weak. You may sleep more and need help to walk, bathe, and use the toilet.
  • Be less hungry. You may eat and drink less than normal.
  • Lose interest in daily life. You may lose interest in the outside world and the details of daily life, including the day or time.

If you don't have dialysis, health professionals who provide end-of-life care can help you have the highest quality of life possible. This may be done through hospice care. Hospice offers the chance to think about personal goals, relieve pain, and take care of your emotional and spiritual needs.

Why would you consider starting dialysis?

  • Your doctor has told you that you need dialysis to live, and you want more time.
  • You don't have other serious health problems that would end your life soon.
  • You want more time to spend with loved ones or to complete other goals.

Why would you consider not having dialysis?

  • You have other serious health problems that may shorten your life.
  • You don't want to spend the time you have left on dialysis. You want to spend it how and where you want.
  • Dialysis can cause side effects such as low blood pressure, muscle cramps, and infection.

2. Compare your options

  Start kidney dialysis Don't have kidney dialysis
What is usually involved?
  • You have a procedure to put in a dialysis access.
  • You have dialysis treatments several times a week.
  • You must be careful about how much fluid you drink and what you eat.
  • Your body will start to shut down, and you will experience normal changes from the dying process.
  • You may need the support of a hospice team.
What are the benefits?
  • You may have more energy and feel better than you did before.
  • You may be able to return to normal activities.
  • If you do not have other serious health problems, dialysis may keep you alive longer.
  • Treatment may allow you to meet goals you have set for yourself.
  • You won't have side effects or problems from dialysis.
  • You won't need to limit what you eat and drink.
  • If you have other serious health problems, your life span may be the same even if you choose not to have dialysis.
  • The time you have left is your own to spend as you want, not on dialysis treatments.
What are the risks and side effects?
  • Dialysis won't cure you.
  • Dialysis may involve frequent travel to and from where you have treatments.
  • Dialysis takes a lot of time and can affect your quality of life.
  • Dialysis has risks, including low blood pressure, muscle spasms, infection, abnormal heart rhythms, and low levels of protein.
  • You may die sooner than if you had dialysis, especially if you have no other serious health problems.

Personal stories

Personal stories about considering starting dialysis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I want to have dialysis, because I'm not ready to die. I still feel young. I have a lot of things I still want to do with my life. I want to work on my craft projects and spend more time with my grandchildren."

— Teresa, age 60

"I have other bad health problems. I've had heart attacks, and I also have heart failure. I don't think dialysis will give me much more time. I feel like I've had a good life. I'm ready to go whenever it's my time."

— Stan, age 72

"I know I'll spend a lot of time at dialysis. But I can read there. And I love writing letters to family and friends. My partner can drop by sometimes and spend some time with me, and maybe I can make some friends at the dialysis center."

— Raul, age 62

"I want to spend the time I have left with my family, not having dialysis. My daughter said I can come live with her, so I can spend more time with her and her husband."

— Helen, age 83

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have kidney dialysis

Reasons not to have kidney dialysis

I'm not ready to die.

I'm ready to face my death.

       
More important
Equally important
More important

I have goals I still want to meet.

I have met all the goals I had for my life.

       
More important
Equally important
More important

I don't mind having to rely on others for transportation or other help.

I don't want to keep relying on others for help with my dialysis treatments.

       
More important
Equally important
More important

I feel pretty good overall, because kidney failure is my only major health problem.

I'm already sick from other health problems and am not sure dialysis will help me feel any better or live any longer.

       
More important
Equally important
More important

My other important reasons:

My other important reasons:

  
       
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Starting dialysis

NOT starting dialysis

       
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Dialysis can cure my kidney failure.

  • True
  • False
  • I'm not sure
That's right. Dialysis may help you live longer, but it can't cure kidney failure.

2. Dialysis can help me feel better.

  • True
  • False
  • I'm not sure
That's right. Dialysis can help you feel better.

3. I may be able to have dialysis at home and not go to a center.

  • True.
  • False
  • I'm not sure
That's right. Some people go to a center. But others are able to have dialysis at home, often while they sleep. Your doctor can help you decide if that's a good choice for you.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

     
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier MD - Internal Medicine
Primary Medical Reviewer E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer Kathleen Romito MD - Family Medicine
Primary Medical Reviewer Tushar J. Vachharajani MD, FASN, FACP - Nephrology
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