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.
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Some people may decide not to treat their kidney failure with dialysis. This information is for people who have
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.
A measure of your kidney function (estimated glomerular filtration rate, or eGFR) is used to show how well your kidneys work. (The eGFR is calculated from the results of a
As your kidney function gets worse, you may:
Kidney failure can cause serious heart, bone, and brain problems.
When you get close to kidney failure, your doctor will likely talk to you about your options. You may choose to treat your kidney failure with dialysis, to have a kidney transplant, or to have no treatment.
Dialysis is a process that filters your blood when your kidneys no longer can. It isn't a cure, but it can help you feel better and live longer. You can
A kidney transplant may be the best choice if you are otherwise healthy. With a new kidney, you would feel much better and be able to live a more normal life. But you may have to wait for a kidney that is a good match for your blood and tissue type. After the transplant, you would need to take medicines to keep your body from rejecting the new kidney. And you would need to see your doctor often and have blood tests to check how you're doing.
Not having dialysis or a transplant also is an option for people with kidney failure. Older adults or those with other serious health problems may decide instead to take medicines and make changes to their diet as their doctor recommends. Whatever you decide, discuss it with your family, friends, and medical team.
Deciding when to start dialysis can be confusing. Even the experts don't always agree on the best time to start or how long to wait. Waiting usually means 6 months to a year. But how long you can wait depends on several things, including your age and overall health aside from your kidneys.
Most people go on dialysis or get a kidney transplant when they have symptoms of kidney failure or when the main measure of their kidney function (estimated glomerular filtration rate, or eGFR) is less than 10 milliliters per minute (mL/min).
Guidelines for doctors about when to start dialysis include kidney failure symptoms, problems controlling blood pressure, problems controlling fluid, and problems with nutrition. The guidelines suggest these problems happen when the eGFR is between 5 to 10 mL/min.
Your eGFR isn't the only thing you and your doctor will look at in deciding when you should start dialysis. You will also consider:
Dialysis can help you feel better before you start to have bad symptoms. It may improve your ability to get good nutrition and reduce the chances of going into the hospital from complications of kidney failure. It also may lower blood pressure in people who have high blood pressure.
Many experts recommend starting dialysis before you have any complications of kidney failure. That's because many of the complications can be deadly, such as not getting good nutrition, having too much fluid, or having too many wastes building up in your body.
Even if you don't start dialysis, you may want to plan for dialysis if your kidney function is getting worse. You could have surgery months ahead of time to create a place, called an access, to take the blood from your body to the dialysis machine.
Dialysis—whenever it's started—can cause side effects. The longer you have dialysis, the longer you expose yourself to the chance of side effects. Hemodialysis can cause low blood pressure and heart problems, such as sudden cardiac arrest. Peritoneal dialysis increases the risk of infection in the lining of your belly (peritonitis).
If you wait, you won't have as many limits on your time and lifestyle. Hemodialysis takes about 12 or more hours a week, usually in a dialysis center. Peritoneal dialysis needs to be done about 4 times a day, although it often can be done while you sleep.
If you decide to start dialysis, it may help to know that it's common to feel a little overwhelmed and even scared at first. It's a big change in your life. But if you choose to start dialysis, you can make good choices in your lifestyle to help you get the most from it.
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What is usually involved? |
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What are the benefits? |
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What are the risks and side effects? |
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These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
For years now, I've been worrying about when I might need dialysis. Even though my labs results are still okay, and my doctor says I could wait a little longer, I don't feel that great. I'm tired all the time. My doctor agreed it would be okay for me to start dialysis now and see if I start to feel better.
Sandra, age 64
I'm just not ready to have dialysis. My test results are right on the edge, and I know I'd probably feel better if I did it. But I feel like having dialysis is giving up, like my life as I know it is over. It would depress me. I know I might have to do it sometime. But I'm just going to try to do everything my doctor asks me to so I can go as long as I can without it.
Fred, age 58
I feel pretty good. But my lab results have dropped a lot, so I know my kidneys are getting worse. I don't want to wait till I have symptoms, because by that point I could feel really sick. So I'm going to start dialysis while I'm still feeling okay.
Jose, age 40
I have a couple of family members who are interested in donating a kidney for me. They are having tests to see if one of them is a good match. The rest of my health is pretty good. So I'm not going to have dialysis yet.
Teresa, age 49
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 dialysis now
Reasons to wait to have dialysis
I'm ready to make lifestyle changes and commit time to dialysis.
I'm not ready to make lifestyle changes and commit time to dialysis.
I don't want to wait until I feel bad and maybe have complications.
I feel good now, so I think I can wait a while longer.
I'm worried because my lab results are getting worse.
My lab results aren't great, but I'm not worried about it right now.
I can accept how dialysis would change my life.
I'm afraid dialysis would change my life for the worse.
My other important reasons:
My other important reasons:
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.
Have dialysis now
Wait to have dialysis
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Author | |
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Clinical Review Board | All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
Some people may decide not to treat their kidney failure with dialysis. This information is for people who have
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.
A measure of your kidney function (estimated glomerular filtration rate, or eGFR) is used to show how well your kidneys work. (The eGFR is calculated from the results of a
As your kidney function gets worse, you may:
Kidney failure can cause serious heart, bone, and brain problems.
When you get close to kidney failure, your doctor will likely talk to you about your options. You may choose to treat your kidney failure with dialysis, to have a kidney transplant, or to have no treatment.
Dialysis is a process that filters your blood when your kidneys no longer can. It isn't a cure, but it can help you feel better and live longer. You can
A kidney transplant may be the best choice if you are otherwise healthy. With a new kidney, you would feel much better and be able to live a more normal life. But you may have to wait for a kidney that is a good match for your blood and tissue type. After the transplant, you would need to take medicines to keep your body from rejecting the new kidney. And you would need to see your doctor often and have blood tests to check how you're doing.
Not having dialysis or a transplant also is an option for people with kidney failure. Older adults or those with other serious health problems may decide instead to take medicines and make changes to their diet as their doctor recommends. Whatever you decide, discuss it with your family, friends, and medical team.
Deciding when to start dialysis can be confusing. Even the experts don't always agree on the best time to start or how long to wait. Waiting usually means 6 months to a year. But how long you can wait depends on several things, including your age and overall health aside from your kidneys.
Most people go on dialysis or get a kidney transplant when they have symptoms of kidney failure or when the main measure of their kidney function (estimated glomerular filtration rate, or eGFR) is less than 10 milliliters per minute (mL/min).
Guidelines for doctors about when to start dialysis include kidney failure symptoms, problems controlling blood pressure, problems controlling fluid, and problems with nutrition. The guidelines suggest these problems happen when the eGFR is between 5 to 10 mL/min.
Your eGFR isn't the only thing you and your doctor will look at in deciding when you should start dialysis. You will also consider:
Dialysis can help you feel better before you start to have bad symptoms. It may improve your ability to get good nutrition and reduce the chances of going into the hospital from complications of kidney failure. It also may lower blood pressure in people who have high blood pressure.
Many experts recommend starting dialysis before you have any complications of kidney failure. That's because many of the complications can be deadly, such as not getting good nutrition, having too much fluid, or having too many wastes building up in your body.
Even if you don't start dialysis, you may want to plan for dialysis if your kidney function is getting worse. You could have surgery months ahead of time to create a place, called an access, to take the blood from your body to the dialysis machine.
Dialysis—whenever it's started—can cause side effects. The longer you have dialysis, the longer you expose yourself to the chance of side effects. Hemodialysis can cause low blood pressure and heart problems, such as sudden cardiac arrest. Peritoneal dialysis increases the risk of infection in the lining of your belly (peritonitis).
If you wait, you won't have as many limits on your time and lifestyle. Hemodialysis takes about 12 or more hours a week, usually in a dialysis center. Peritoneal dialysis needs to be done about 4 times a day, although it often can be done while you sleep.
If you decide to start dialysis, it may help to know that it's common to feel a little overwhelmed and even scared at first. It's a big change in your life. But if you choose to start dialysis, you can make good choices in your lifestyle to help you get the most from it.
Start dialysis | Wait to have dialysis | |
---|---|---|
What is usually involved? |
|
|
What are the benefits? |
|
|
What are the risks and side effects? |
|
|
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"For years now, I've been worrying about when I might need dialysis. Even though my labs results are still okay, and my doctor says I could wait a little longer, I don't feel that great. I'm tired all the time. My doctor agreed it would be okay for me to start dialysis now and see if I start to feel better."
— Sandra, age 64
"I'm just not ready to have dialysis. My test results are right on the edge, and I know I'd probably feel better if I did it. But I feel like having dialysis is giving up, like my life as I know it is over. It would depress me. I know I might have to do it sometime. But I'm just going to try to do everything my doctor asks me to so I can go as long as I can without it."
— Fred, age 58
"I feel pretty good. But my lab results have dropped a lot, so I know my kidneys are getting worse. I don't want to wait till I have symptoms, because by that point I could feel really sick. So I'm going to start dialysis while I'm still feeling okay."
— Jose, age 40
"I have a couple of family members who are interested in donating a kidney for me. They are having tests to see if one of them is a good match. The rest of my health is pretty good. So I'm not going to have dialysis yet."
— Teresa, age 49
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 dialysis now
Reasons to wait to have dialysis
I'm ready to make lifestyle changes and commit time to dialysis.
I'm not ready to make lifestyle changes and commit time to dialysis.
I don't want to wait until I feel bad and maybe have complications.
I feel good now, so I think I can wait a while longer.
I'm worried because my lab results are getting worse.
My lab results aren't great, but I'm not worried about it right now.
I can accept how dialysis would change my life.
I'm afraid dialysis would change my life for the worse.
My other important reasons:
My other important reasons:
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.
Have dialysis now
Wait to have dialysis
1. Many kidney specialists recommend starting dialysis earlier rather than later to improve nutrition, reduce fluid in the body, and reduce the chance of going into the hospital for complications from kidney failure.
2. Starting dialysis earlier might help me feel better.
3. Waiting to have dialysis will shorten my life.
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?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
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Clinical Review Board | All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
Current as of: October 11, 2023
Author:
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
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