What is dialysis?
When kidneys fail, dialysis acts as a replacement. Dialysis is an artificial process that uses a special fluid containing a mixture of pure water and chemicals to carefully eliminate wastes, salt, and extra water from the blood without removing substances the body needs. This process helps control blood pressure and keeps the body’s electrolytes in balance by keeping safe levels of potassium, sodium, and bicarbonate in the blood.
When is dialysis necessary?
In some cases of acute or sudden kidney failure, dialysis may only be needed for a short time until the kidneys heal. In chronic or end-stage renal failure, the kidneys do not improve and dialysis will be needed until a transplant organ is available.
Patients usually need dialysis when the waste products in their body become so high that the patients become sick and their bodies cannot maintain proper electrolyte balance. Symptoms include shortness of breath, fatigue, muscle cramps, nausea, and vomiting. Typically a patient will begin discussing dialysis with his or her medical team when kidney function is around 30%. Depending on symptoms and lab values, many patients are able to wait for dialysis until their kidney function is around 15%.
What are the different types of dialysis?
There are two main types of dialysis: Hemodialysis (HD) and Peritoneal Dialysis (PD).
Hemodialysis is the most common form of dialysis. In hemodialysis, an external machine filters wastes, salts and fluid from the blood. Click here to learn more about hemodialysis.
In peritoneal dialysis, the inside lining of the stomach, the peritoneum, acts as a natural filter. Wastes are carried out via a cleansing fluid that goes in and out in cycles through a catheter in the abdomen. Click here to learn more about peritoneal dialysis.
It is important to talk to your doctor about the types of dialysis and decide which type is best for you. Use Davita’s Treatment Evaluator to see which type of dialysis might best fit your lifestyle.
How do I choose a dialysis center?
Once a patient starts dialysis, even if he or she is doing in-home treatment, the patient will need to be followed by a dialysis clinic. Many nephrologists travel to specific clinics, so a patient’s first step is to talk with his or her doctor. Most pediatric nephrologists only have one center for children to receive dialysis, so they will need to travel to that center to receive care. Adults, however, often have more flexibility in choosing their treatment facility.
Dialysis patients will spend a lot of time at their dialysis centers and will depend on the care team there to help keep them feeling their best. Because of this, patients should take time to choose a center that they are comfortable with. Again, they should first ask their doctor who they would recommend. Next, they should find a center that is convenient for them. Department of Health and Human Services has a Dialysis Center Comparison tool to help get patients started! Asking for referrals from friends, family or other patients is also a great way to find center.
Other tips for choosing a dialysis center include:
- Call and make an appointment to visit the clinic.
- Be sure staff is polite, timely and considerate but also knowledgeable and able to answer your questions.
- Consider cleanliness of the facility while visiting.
- Is the facility convenient for you to get to?
- Is your nephrologist a part of the clinic’s team?
- Ask about schedule openings. Do they offer a dialysis schedule that fits your needs?
- If you are interested in home dialysis, be sure that the clinic offers the type of dialysis you are interested in.
If you have questions or concerns about the quality of care in a particular facility, we encourage you to contact the ESRD Network in the region where the facility is located.
Can I afford dialysis?
The majority of dialysis costs are paid through medical insurance; either the patient’s own private insurance or the government-sponsored Medicare program.
ESRD patients qualify for Medicare insurance through the federal government. Medicare has three main parts: A, B, and D. Part A helps with inpatient costs, such as hospital stays, and has no premium. Part B pays for outpatient care, such as dialysis and doctor and specialist visits, and does have a premium. Part D helps pay for prescription coverage, which also has a premium.
Medicare part B will cover approximately 80 percent of the cost of dialysis. Ask a member of your care team, your social worker or your dialysis insurance counselor to educate you on other finance options such as Medicare supplements, Medicaid, or other programs available in your area.
For more information, please visit our ‘Resources’ section at the bottom of this page.
Is travel possible while on dialysis?
Yes, most patients who receive dialysis can travel safely and continue their treatment while away from home. Patients should always consult their doctor before planning to travel. Most doctors allow and encourage travel if the patient’s health is stable.
It is important to plan ahead, ideally at least six weeks in advance.
Many dialysis centers have a staff member who is experienced in arranging dialysis treatments away from home. Some centers will assist patients in making their own arrangements.
Hemodialysis patients will need to contact dialysis centers in the area they plan to travel and set up treatments ahead of time. Check with the center as soon as you arrive to confirm your appointment.
Peritoneal dialysis patients will need contact their PD supply company and set up a shipment of supplies to be delivered to their travel destination ahead of time. They will also need to obtain a PD Machine travel case.
If flying, all patients should always check the Transport Security Administration Disabilities and Medical Condition Policy while planning a trip. It is also a good idea to check individual airline policies as well. Finally, patients should obtain a letter from their doctor explaining their medications and dialysis machine/supplies to give to airport security, should concerns arise.
Dialysis Patients Citizens – Nationwide, non-profit, patient-led organization with membership open only to dialysis and pre-dialysis patients and their families.
Renal Support Network – Helps CKD patients become self-sufficient through education, advocacy, and employment resources.
Global Dialysis – A resource for dialysis patients who want to travel nationally and internationally.
Home Dialysis Central – Learn about all the options for home dialysis, including a listing of every center in the US offering this modality of treatment, equipment and new technology, patient profiles, Medicare reimbursement, discussion boards, and how pending laws may affect dialyzing at home.
IHateDialysis – A site for patients, by patients. Do not let the site’s name fool you. They are not negative, they hate dialysis – but they love life. IHD is the largest and most active dialysis message board on the Internet.
American Kidney Fund – AKF leads the nation in charitable assistance to dialysis patients.