When kidneys fail, something else must take up their functions in order to prolong life. Dialysis and kidney transplantation are the most common treatments for kidney failure (also called renal failure), but which is best for you? Here is an overview of dialysis and transplantation, so you can have informed discussions with your doctor about renal replacement before such treatment becomes necessary.* 

Types of dialysis

Experts recommend that you start dialysis when you’re still feeling fairly healthy and your symptoms are still mild. Symptoms of kidney failure can include:

• Weakness and fatigue
• Difficulty concentrating
• Loss of appetite
• Nausea and vomiting
• Swelling in the face and limbs

There are two basic types of dialysis: hemodialysis and peritoneal dialysis. Your nephrologist can help you decide if and when to begin dialysis, as well as which type is best suited to you and your situation. 

About hemodialysis

Hemodialysis can be performed at a dialysis center or at home. The process involves pumping your blood through a fistula or graft (the surgical creation of a vascular access) into a filtering machine to remove waste products and excess fluids. After filtering, the blood is pumped back into your body. 

Sessions at a dialysis center generally take three or four hours, and are performed about three times per week. In-center overnight sessions are also sometimes available. Hemodialysis sessions performed at home can take up to 10 hours, and are done three to six times a week. 

Pros and cons of hemodialysis

As is to be expected, all options have pros and cons. Advantages of hemodialysis include brief treatments, and little need for you to learn the technical aspects of the process, as a dialysis technician or dialysis nurse can perform those duties for you. 

Potential drawbacks of hemodialysis can include: 

• Physical symptoms during or after the dialysis session, including:
  • Lightheadedness  
  • Shortness of breath 
  • Abdominal cramps 
  • Nausea and vomiting 
• Time and energy spent traveling to/from dialysis centers
• Disruption of daily activities 
• Infections that can lead to sepsis

About peritoneal dialysis

Peritoneal dialysis, typically performed at home, involves filling your abdominal cavity with a fluid called the ‘dialysate’ (dye-AL-uh-sayt) through a catheter that is surgically inserted near your navel. 

The fluid is held in your abdomen for several hours, while excess fluids and wastes are filtered out of your bloodstream. The waste-filled dialysate is then drained, and the abdomen is refilled with fresh dialysate.  

Pros and cons of peritoneal dialysis

Major advantages of peritoneal dialysis over hemodialysis are having fewer disruptions to your work, family time, and social activities. 

Some potential disadvantages include:

• Having to learn to set up the equipment and self-administer the dialysis 
• Increased risk of hernia from internal fluid pressure
• Potential weight gain
• Increased risk of infection (at the catheter site)

Hemodialysis v. peritoneal dialysis

To-date, neither type of dialysis appears to have a clear advantage over the other regarding life expectancy. Your choice is mostly dependent on your personal preferences, overall health status, and home situation. You can also switch forms as your preferences and life circumstances change.

About kidney transplantation

Kidney transplantation, which takes about three to four hours, is the preferred treatment for many people with kidney failure. Transplant organs can come from living or deceased donors. During a kidney transplant, the surgeon places the healthy kidney in your lower abdomen and connects it to your bladder and blood vessels. 

The non-working kidney is not usually removed unless it poses a risk to your recovery and overall safety. You will likely spend several days in the hospital, and will immediately be started on anti-rejection medications.

Living v. deceased donor kidneys

Living donor kidneys are preferable, because they:

• Allow for faster transplants
• Tend to function better
• Have a greater chance of being accepted
• Function for longer periods of time (15 to 20 years) than deceased donor kidneys (10-15 years)

Pros and cons of kidney transplantation

The advantages of kidney transplantation are many, primarily: 

• A healthy donor kidney can filter wastes from the blood more efficiently than dialysis can.
• The need for dialysis treatments is eliminated, saving time, energy, and life disruption.
• Recipients generally feel better after transplantation than after dialysis sessions.

Disadvantages of kidney transplantation include:

• A potential wait of up to 10 years for a deceased donor
• A long list of eligibility factors 
• Having to take daily anti-rejection medications for the rest of your life 
• The possibility immediate organ rejection
• The risk of excessive blood loss, infection, and damage to nearby organs during surgery

Speak with your family members and healthcare team to explore all your options and make the best decisions for you. 

*Burns, J. S. (2023, June). Patient education: Dialysis or kidney transplantation — which is right for me? (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/dialysis-or-kidney-transplantation-which-is-right-for-me-beyond-the-basics

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