Is Dialysis Your Best Option?

If you have late-stage kidney disease, you may need to have medical management, dialysis, a kidney transplant, or a combination of these treatment approaches. Dialysis is a life-saving process that is expected to increase your life expectancy if you have end-stage renal disease (ESRD).

If dialysis is a treatment option for you, your doctor will discuss the risks and benefits, as well as optimal timing. You may have a tough decision to make, so it helps to understand the expected outcomes of dialysis as well as the potential physical and emotional consequences of not having dialysis.

The kidneys remove waste material from the body, and they balance fluid and electrolytes. If you have kidney disease, you may experience a harmful buildup of toxins and an imbalance of fluids and electrolytes.

Your nephrologist is the doctor who will manage your dialysis and other aspects of your kidney care. Even if you will not have dialysis, your nephrologist will work with you on minimizing the effects of your condition. In addition to medication, you may be given some guidelines regarding your diet when you have kidney failure.

Chronic kidney disease is often classified by stages, ranging from stage 1 to stage 5. In the earlier stages, medical management and diet can be helpful. If you reach stage 5, you may need dialysis or a kidney transplant because your kidneys would not be able to function adequately to keep you alive—even with maximal conservative management.

Deciding when to start dialysis can be tricky. The longer you go untreated, the more harm your body can incur as a result of kidney failure.

Once you begin dialysis, you will need to maintain the treatment for the long term—you can't flip flop back and forth between having dialysis and not having it—so you need to think through the long term implications of your decision.

The process involves a machine that artificially removes toxins and balances fluid and electrolytes.

There are two types of dialysis:

• Hemodialysis can be done at home or at a dialysis center. A catheter (tube) is placed in your blood vessels to send and receive blood to and from the machine.
• Peritoneal dialysis is done at home through a catheter that is placed in your abdominal area and is hooked to a machine. You can have this treatment at night while you sleep.

In-center hemodialysis is the most common type of dialysis in the U.S. Even if you choose at-home dialysis, you will need to see your medical team at least once per month.

There are potential complications of hemodialysis as well as adverse effects of peritoneal dialysis, although the former is associated with fewer such concerns and dialysis-related hospitalizations.

ESRD is fatal. If you have this condition, dialysis can improve your quality of life and prolong your survival. Improvements are noted even when people have other health conditions, although the benefits are not as significant for elderly people or those who have many medical problems.

The United States Renal Data System annual data report shows that for people with ESRD, hemodialysis improves survival by 28% and peritoneal dialysis improves survival by 43%. Which form of dialysis is better for you depends on your overall health and kidney function.

However, because dialysis does not completely make up for diminished kidney function, a person who has ESRD and receives dialysis is expected to live about 11 years less than a person without the condition.

Despite the benefits of dialysis, some people who have ESRD decide not to opt for this treatment. Others may not be able to have dialysis due to other health issues. For example, advanced age, frailty, severe dementia, heart failure, or metastatic cancer may make dialysis extremely difficult.

If your life expectancy is markedly limited, dialysis could interfere with your quality of life during your remaining months. In these situations, it is hard to predict with certainty whether dialysis would be beneficial.

Opting out of dialysis is not something to take lightly. You and your loved ones will need to think about heavy issues such as mortality and end of life care—issues that are not easy to face or talk about.

While you might not be considering the possibility at this time, some people eventually decide to discontinue dialysis after relying on it for years. This will have serious consequences, and death may occur within a few weeks or months after stopping treatment.

The reasons for withdrawing dialysis vary and can include major health issues such as advanced dementia, metastatic cancer, and prolonged unresponsiveness.

Dialysis, for all its benefits, can also be exhausting. When you or your loved one feel the cons of treatment outweigh the pros—either in terms of quality of life or life expectancy—the decision to withdraw dialysis may also be considered.

Dialysis can prolong your life. But the benefits aren't always so clear-cut if you have another major illness in addition to your kidney failure. Deciding whether to start dialysis or opt-out of it is a big decision, and it involves weighing the facts about your condition along with your emotions, spiritual considerations, and practical concerns.

In addition to gathering information about the risks and benefits through discussions with your medical team, you might also want to talk with other patients who use dialysis to hear how it affects their lives. Friends, family members, spiritual advisors, and professional counselors may also be able to provide a listening ear for your thoughts and concerns.