Renal Frequently Asked Questions

For some people there are medical reasons why one type of dialysis treatment is definitely better. For example if you have had abdominal operations in the past peritoneal dialysis may not work. For most people either type of dialysis would provide good treatment and the type you are on should depend upon what most suits your lifestyle. If you do not understand why you are on the type of dialysis you are on then you should ask one of the doctors or nurses to explain.

For some people there are medical reasons why one type of dialysis treatment is definitely better. For example if it is not possible to form a fistula (vascular access) you might be better off on peritoneal dialysis. For most people either type of dialysis would provide good treatment and the type you are on should depend upon what most suits your lifestyle. If you do not understand why you are on the type of dialysis you are then you should ask one of the doctors or nurses to explain.

Between dialysis treatments toxins build up in the blood and these will eventually make you unwell. The more often you have treatment the easier it will be to control the toxins. For most people the minimum frequency of dialysis that will keep them well in the long term is 3 times a week. Some people who do dialysis at home have shorter treatments upto 6 times weekly and feel better on this more frequent treatment. Unfortunately it is not possible to organise dialysis more than 3 times a week in a dialysis unit.

Normal kidneys are working all day every day. When doing dialysis we are trying to fit in the same amount of work in a much shorter time. For most people 12 hours of dialysis per week (3 sessions of 4 hours) is the minimum needed keep them well. We do regular measurements of the amount of toxins the dialysis machine is removing from your body during treatment and may adjust your dialysis time to ensure you get enough treatment. In reality very few need less than 4 hours and often more is needed.

The answer to this is different for different people. For some people the toxin levels in the blood build up very rapidly between treatments and if a dialysis treatment were missed the toxins and fluid could reach a point where they made you very unwell and could potentially be fatal. More commonly the toxin levels and fluid build up more slowly and the body can cope if you miss a single dialysis treatment. Missing more than one treatment in a row is always dangerous. Frequently missing a single dialysis will mean that you do not receive enough treatment in the long run and this will eventually affect your health. It is unwise to miss any dialysis treatment without discussing it with your doctor in advance.

Dialysis should not usually be missed without medical monitoring. If you feel ill before a dialysis treatment and don't know if you can make it in for treatment then you should ring your dialysis unit for advice. They will try to find a way of getting you in.

Like all treatments dialysis has possible complications. Modern dialysis machines have many monitoring devices to try and detect any complications before they cause real problems. The nurses will also monitor the machine and your blood pressure to detect any areas for concern early. The most common complication during treatment is the blood pressure dropping which can make you feel faint or sick. Some patients learn what this feels like and can call for help from a nurse before they become very unwell. The nurses are trained in how to correct this complication rapidly.

Peritoneal dialysis also has some complications. The most well known is peritonitis which happens when infection gets into the dialysis fluid. You will be told what to do if peritonitis is suspected during the dialysis training. Other complications include failure of the fluid to flow in and out of the tube and constipation.

Kidneys are vital to many functions of the body and when they fail different medications are needed to manage the problems that arise. Dialysis treatment can take over many of the functions but not all and so medication is needed in addition to dialysis to keep the body systems working well. As more scientific evidence becomes available more and more medications are found to extend or enhance the life of people with kidney failure and for many people the list of useful drugs is very long. With any new drug that might be suggested for you the doctor will consider the benefits and possible side effects. This should be discussed with you before anything new is prescribed. Your doctor will also consider if there are any important interactions with the drugs you already take before advising anything new. If you are concerned about any of your drugs then discuss this with your doctor or nurse.

Diet is very important for people with kidney failure. It is very important that you eat sufficient protein and calories. Because of this we try to keep any restrictions to your diet to a minimum. Everyone’s needs are different and some people will need particular diets for example for potassium or phosphate. A dietician will talk to you about what would be the best diet to keep you well. The dietician will see you if they pick up any problems from the regular blood tests that you have but if you have any concerns then please ask to see a dietician and it can be arranged.

Kidney transplantation is good treatment for many people with kidney failure but like all treatments there are risks as well as benefits. For quite a lot of people with kidney failure the risks of having a kidney transplant outweigh any benefits and so they are not on the transplant waiting list. You and your doctor will decide if kidney transplantation would be good treatment for you and if you should be on the waiting list. If you are not sure what is best for you or whether you are on the list then ask your doctor.

The only definite way to get a kidney is through a live donor. If you do not have a suitable live donor then you will go onto the deceased donor waiting list if you and your doctor think it would be good treatment for you. The transplant waiting list is more of a lottery than a conventional waiting list because who gets a kidney depends on matching to the tissue type of people who have donated their kidneys. Occasionally people get kidneys within a few days of going onto the list. Others could have to wait for years or never get a kidney. On average people wait 2-3 years.