Understanding Dialysis and Its Role in Managing Kidney Disease

Kidney disease affects millions of people worldwide, often progressing silently until it reaches an advanced stage. When the kidneys can no longer do their work, dialysis becomes a vital treatment. It removes waste, excess fluid and toxins from the blood for people whose kidneys can no longer do so.

Understanding dialysis helps patients, families and carers. This article explains what dialysis is, how it works, the types available and its role in managing kidney disease.

What is kidney disease?

Chronic kidney disease (CKD) happens when the kidneys gradually lose their ability to filter the blood. Healthy kidneys remove waste and extra fluid, help control blood pressure and keep minerals such as potassium and sodium in balance. When they are damaged, these functions decline and waste builds up in the body.

Common causes of kidney disease include:

• Diabetes
• High blood pressure
• Glomerulonephritis (inflammation of the kidney filters)
• Polycystic kidney disease
• Long-term use of some medicines

Kidney disease often develops over years without obvious symptoms. Early signs can include tiredness, swollen legs or ankles and changes in urination. Without treatment it can progress to kidney failure, which needs dialysis or a transplant.

How dialysis supports kidney function

Dialysis replaces some of the work of the kidneys by filtering waste, excess fluid and toxins from the blood. It helps keep a safe balance of potassium, sodium and bicarbonate. Dialysis does not cure kidney disease, but it keeps people alive and well when their kidneys have failed.

Types of dialysis

There are two main types: haemodialysis and peritoneal dialysis.

Haemodialysis

Haemodialysis uses a machine and a filter called a dialyser to clean the blood. Blood flows from a vascular access, usually in the arm, through the dialyser, which removes waste and extra fluid, and returns to the body.

Treatment usually takes place three times a week in a dialysis centre, with sessions of about 3 to 5 hours. Some patients do haemodialysis at home after training.

Advantages:

• Efficient removal of waste and fluid
• Performed by trained professionals
• Treatment days rather than daily treatment

Things to consider:

• Needs a vascular access, created by surgery
• Sessions take time
• Possible side effects such as low blood pressure or cramps

Peritoneal dialysis

Peritoneal dialysis uses the lining of the abdomen (the peritoneum) as a natural filter. A sterile solution is put into the abdomen through a catheter. Waste and extra fluid pass into the solution, which is then drained and replaced.

There are two main forms:

• Continuous ambulatory peritoneal dialysis (CAPD): manual exchanges several times a day.
• Automated peritoneal dialysis (APD): a machine does the exchanges, usually overnight.

Advantages:

• More flexibility and independence
• Can be done at home or while travelling
• Continuous, gentle treatment

Things to consider:

• Risk of infection (peritonitis)
• Needs to be done every day
• Not suitable for every patient

Preparing for dialysis

Starting dialysis involves a medical assessment, education and the creation of an access: a fistula or graft for haemodialysis, or a catheter for peritoneal dialysis. Patients and carers who will dialyse at home receive training. Emotional support matters too, because dialysis changes daily life.

Living with dialysis

Diet and fluids

Kidney failure changes how the body handles fluid and nutrients. Most patients are asked to:

• Limit fluid to avoid overload
• Control salt, potassium and phosphorus
• Eat enough protein to stay strong

A renal dietitian helps build a plan that fits your blood results.

Medicines

People on dialysis often take medicines for blood pressure, anaemia and bone health. Take them as prescribed and tell your team about any side effects.

Follow-up

Regular blood tests show how well dialysis is working and guide changes to your treatment.

Challenges

Dialysis can bring tiredness, infection risk at the access, changes in blood pressure and emotional stress. Your care team, family and patient groups can help with each of these.

Advances in dialysis

Research continues to improve dialysis, with better dialyser membranes, more home dialysis programmes and remote monitoring.

When is a kidney transplant an option?

For some patients, a kidney transplant offers a better long-term solution than dialysis. Not everyone is eligible, and waiting times depend on donors. Dialysis can be a bridge to transplant or a long-term treatment. Your nephrologist is the right person to discuss which option suits you.

Sources

• National Kidney Foundation – Hemodialysis

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