Do you have chronic kidney disease (CKD) that may be nearing end-stage kidney disease (ESKD)? If you are unable to receive a kidney transplant and desire treatment for ESKD, you will need to choose between dialysis and medical management without dialysis. 

Before getting to the ESKD stage, it is important to carefully consider the options with your healthcare team and trusted family and friends. Learn more

What is dialysis?

At ESKD, your kidneys are no longer able to function properly on their own. With dialysis treatments, the dialysis machine or equipment is able to remove the waste products and excess fluid from your blood like a healthy kidney would. Most people require dialysis treatments multiple times a week and each treatment lasts for multiple hours. 

Some people worry they will lose their independence with dialysis. Fortunately, there are different dialysis modalities and some allow for more freedom to be had. Your doctor and healthcare team can help you decide which dialysis modality is best for you. 

What are the dialysis options?

To best fit the needs of each patient, most dialysis companies offer different options, which include:

• In-center hemodialysis (ICHD) gives more security to some patients as nurses and other trained staff members are present to help during a patient’s treatment. 
• After significant training with a registered nurse (RN), home hemodialysis (HHD) is done by you. It allows for more flexibility than in-center, as you receive treatment in the comfort of your own home and can choose when you receive it.
• Self-care in-center hemodialysis is similar to HHD as you will be fully trained by an RN, but you will perform hemodialysis at a clinic with little or no assistance from an RN. It is ideal for patients who may not have space at home for HHD but enjoy the independence of self-management. 
• Peritoneal dialysis (PD) patients are also trained by an RN and receive treatment at home by themselves. PD involves having a small tube placed in the abdomen where fluid can be drained in and drained out, which allows for toxins and excess fluid to be removed. 

What are the benefits of self-care dialysis?

While in-center dialysis provides security as care is completed by a trained staff member, you may find many more benefits of self-care dialysis options. Self-care dialysis will always come with extensive training and a supportive dialysis team made up of a nurse, nephrologist, social worker, and dietitian.

“The home dialysis unit does take absolutely good care of me. I don’t see dialysis as a hindrance,” states Enoch, an HHD patient. “For instance, if I have family functions or I have to go somewhere, I dialyze so that it doesn’t disrupt my movement.”

PD works great for busier lifestyles as it allows for easier travel and can be completed while you sleep. Amaka, a PD patient states, “My treatment runs over a course of eight hours every night while I’m sleeping, and when I wake I disconnect from the machine and carry on with my day.” 

Ultimately, self-care dialysis gives some patients a sense of worth and freedom. “I chose self-care because I found it to be quite empowering where you can determine and decide your own healthcare,” says Adisa, a self-care dialysis patient. 

How do I decide which dialysis is right for me?

Learning more and talking your options out with others can help you to make the best decision for yourself. Here are some resources to help you:

• Talk to a peer on dialysis from the National Kidney Foundation’s peer mentoring program who can share their experiences with dialysis
• Ask your doctor about education sessions you may attend in your area

While choosing a dialysis option is a serious decision, it does not have to be permanent. If you are unhappy with the option you chose after a while, you can talk to your doctor about changing dialysis modalities. 

*Guy’s and St Thomas’ NHS Foundation Trust. (2019, January 3). Having dialysis [YouTube Video]. https://www.youtube.com/watch?v=zFULCRQRaew

“Hemodialysis machine INNOVA.” by Виталий Поспелов is licensed under CC-BY-SA-3.0