Patient education: Choosing between dialysis and kidney transplant (The Basics)

What is kidney replacement therapy? — 

This is another term for the different treatments for kidney failure.

Normally, the kidneys filter blood and remove waste and excess salt and water (figure 1). Kidney failure, also called "end-stage kidney disease," is when the kidneys can no longer filter blood properly.

If you have kidney failure, you can choose between 3 different treatments to take over the job of your kidneys. These treatments can extend your life, since without them, kidney failure can lead to death.

What are my choices for kidney replacement therapy? — 

You can choose between:

●Kidney transplant – This is surgery in which a doctor puts a healthy kidney into a person whose kidneys have failed (figure 2). The new, healthy kidney can then do the job of the diseased kidneys. (People need only 1 kidney to live).

The new kidney can come from a living donor (usually a family member or friend) or a dead donor. After a kidney transplant, you need to take medicines for the rest of your life to keep your body from reacting badly to the new kidney.

●Peritoneal dialysis – This is a procedure that people do at home every day. You pipe a special fluid into your belly. The fluid collects waste and excess salt and water from your blood. Then, the used fluid drains out of your belly (figure 3). Before you can have peritoneal dialysis, you need surgery to put a tube in your belly. The tube lets the fluid get in and out of your belly.

●Hemodialysis – This is a procedure in which a dialysis machine takes over the job of the kidneys. The machine pumps blood out of your body, filters it, and returns it to your body (figure 4). Before you can have hemodialysis, you need surgery to create an "access." This is a way for blood to leave and return to your body.

You will have hemodialysis at least 3 times a week. Most people can choose between having it at a dialysis center (in a hospital or clinic) or at home.

What are the benefits and downsides of the different treatments? — 

The following table lists the benefits and downsides of a kidney transplant, peritoneal dialysis, and hemodialysis (table 1).

How do I choose between the different treatment options? — 

You, your doctor, and your family need to work together to find the treatment that's right for you. It will depend partly on your condition, overall health, and home situation. Your doctor can explain all of your options.

People usually benefit most from a kidney transplant. But a new kidney is not always available. Plus, not everyone who wants a kidney transplant can get one. People need to meet certain conditions to be able to get one.

When thinking about your choices, know that:

●If you are on a list to get a kidney from a dead donor, you might need to wait a long time. You will most likely need to start peritoneal dialysis or hemodialysis while you wait.

●If you start one type of dialysis and it doesn't work for you, you can switch to the other type.

Can I choose not to have any of these treatments? — 

Yes, you can choose not to have any kidney replacement therapy. But know that without a transplant or dialysis, kidney failure can lead to death. How long you can live without treatment depends on your kidneys, symptoms, and overall health. This usually ranges from days to months in some cases.

If you don't have kidney replacement therapy, waste will build up in your blood. This can make you feel tired, itchy, or nauseous. Fluid will also build up in your body. This can cause swelling and trouble breathing. During this time, you can have something called "conservative kidney management." This involves giving you medicines to treat your symptoms and help make you more comfortable. It does not stop your kidney failure, but might help you feel better temporarily.

More on this topic

Patient education: Planning for a kidney transplant (The Basics)
Patient education: Kidney transplant (The Basics)
Patient education: Peritoneal dialysis catheter placement (The Basics)
Patient education: Peritoneal dialysis (The Basics)
Patient education: Preparing for hemodialysis (The Basics)
Patient education: Hemodialysis catheter placement (The Basics)
Patient education: Hemodialysis (The Basics)
Patient education: Dialysis and diet (The Basics)
Patient education: Chronic kidney disease (The Basics)
Patient education: End-stage kidney disease (kidney failure) (The Basics)

Patient education: Dialysis or kidney transplantation — which is right for me? (Beyond the Basics)
Patient education: Peritoneal dialysis (Beyond the Basics)
Patient education: Hemodialysis (Beyond the Basics)
Patient education: Chronic kidney disease (Beyond the Basics)