Care and treatments for people with kidney failure
If you have been told that you have advanced kidney disease or end-stage kidney failure you may have been advised to start thinking about how you would like your kidney disease managed in the future.
You may be considering the possibility of eventually having some form of kidney replacement therapy (also known as renal replacement therapy) which will do some of the work of your kidneys. This could include dialysis or a kidney transplant.
Alternatively, you may be thinking about having active supportive care instead. This type of treatment aims to manage the symptoms of your kidney disease and keep your kidneys working for as long as possible, but without kidney replacement therapy.
Dialysis is where a machine (or a natural lining in your body) is used to clean your blood and remove excess fluid. It can do about 10% of the work of healthy kidneys. There are two main types of dialysis:
- Haemodialysis – where blood is pumped out of your body and passed through a machine (which acts as an artificial kidney). The machine filters your blood, gets rid of waste products and then pumps your cleaned blood back into your body. Haemodialysis can be done at a kidney unit or in your own home and usually involves at least three four-hour sessions of treatment each week. Read about Maddy Warren's experience of noturnal dialysis at home.
- Peritoneal dialysis – where your blood is cleaned inside your body by the membrane covering your internal organs (the peritoneum). The peritoneum is a natural filter with a rich supply of tiny blood vessels (capillaries) and it lines a space in your body called the peritoneal cavity or abdominal cavity. During peritoneal dialysis, fluid is put into the space and allowed to sit there for several hours whilst waste products are passed from the capillaries into the fluid. The fluid is then drained out. This continuous process, repeated several times a day, is known as continuous ambulatory peritoneal dialysis (CAPD). Alternatively, the process can be done overnight, leaving daytimes free of dialysis. This is known as automated peritoneal dialysis (APD). Both forms of peritoneal dialysis can be done in your own home.
Dialysis Choices: What are the options?
This film provides an insight into the dialysis options available. It aims to give you an idea of some of the practical realities and what it's like living with that choice on a day-to-day basis.
A kidney transplant is where you receive a healthy kidney during an operation from a live donor or someone who has died. The transplanted kidney does up to 50% of the work of two healthy kidneys.
Kidney transplant operations and the treatment required to prevent rejection of the kidney transplant involve risks, and kidneys from donors who have died are in short supply, so you will be asked to have tests to assess your suitability for a transplant.
Active supportive care (sometimes known as conservative care) is where your symptoms of kidney disease are managed to keep your kidneys working for as long as your kidney disease allows. This type of treatment does not replace the work of the kidneys. You may be at a stage in your life where you feel that the burden of dialysis or a transplant may not necessarily outweigh the benefits of managing your kidney disease.
Your right to choose
Some of these options may fit in with your lifestyle and values better than others and many people will have one or more of these treatments or decide to change their choices over time.
It can be extremely daunting to consider such major decisions but your kidney doctor or nurse will be on hand to explain the treatments available to you and help you to plan. You may be invited to hear presentations about the various options, where you can talk to other people who have experience of these treatments. You may also be visited at home to discuss things further.
It’s perfectly natural to feel anxious about how your kidney disease may affect your life, and the lives of your loved ones so talk to your kidney doctor or nurse about any concerns you may have. They may also be able to put you in touch with other professionals, such as counsellors, dietitians and social workers, who can help you with your mental wellbeing, give you dietary advice and information about benefits and other financial advice.
Take a look at our Dialysis Decision Aid booklet. It has been specially developed to give clear information about the types of treatments generally available to people with kidney failure, particularly on the choice of different types of dialysis.
The booklet has space for your own notes and some suggested prompts to help you raise any issues that may be concerning you.
Reviewed April 2019
The need for more research
There is unexplained variation between different treatment centres in the proportion of patients receiving different types of treatment for kidney failure. Understanding the causes of this variation could help policy-makers and others ensure that each and every patient gets offered the treatment that best suits their own needs.
"I had the transplant in summer 2014, just a month before my fifteenth birthday, and began to get better."
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