When kidneys no longer function adequately, dialysis serves as a medical treatment that takes over some of their functions. This process removes waste products, excess fluids, and toxins from the bloodstream, substances that healthy kidneys would typically filter and excrete as urine. Without such intervention, these harmful accumulations can lead to severe complications and become life-threatening. Dialysis thus acts as a life-sustaining therapy for individuals experiencing kidney failure.
Understanding Life Expectancy on Dialysis
The average life expectancy for individuals undergoing dialysis varies, with reported median overall survival times being approximately five years. For patients starting dialysis, the overall one-year survival rate is around 88%, the three-year survival rate is about 70%, and the five-year survival rate is approximately 52%. Data from sources like the United States Renal Data System (USRDS) show that the adjusted survival rate for patients on hemodialysis is 57% at three years and 42% at five years. For those on peritoneal dialysis, the three-year survival rate is 68% and the five-year rate is 52%. The mortality rate for dialysis patients is considerably higher than that of the general population, with some studies indicating it can be 10 to 20 times greater.
Factors Affecting Longevity
Several factors influence how long an individual may live while undergoing dialysis. Age at the initiation of dialysis plays a role, with younger patients generally experiencing better outcomes. For example, patients under 50 years old starting dialysis have an approximate one-year survival rate of 95%, a five-year survival rate of 80%, and a ten-year survival rate exceeding 50%. In contrast, for those over 80 years old, the approximate one-year survival is 80%, and the five-year survival is 33%.
The presence of other underlying medical conditions, known as comorbidities, also significantly impacts longevity. Conditions such as heart disease, diabetes, and hypertension are common among dialysis patients and can increase the risk of death. Malnutrition, often referred to as protein-energy wasting, is another factor associated with increased illness and mortality in individuals undergoing maintenance hemodialysis. Low protein and energy intake are frequently observed in these patients.
Maintaining good nutritional status, including adequate protein and energy intake, is associated with improved outcomes. Adherence to the prescribed treatment regimen, including attending all dialysis sessions and following dietary and fluid restrictions, also contributes to better health outcomes and can indirectly support longevity.
Different Dialysis Modalities
There are two primary types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis is the more common method, where a machine acts as an artificial kidney to filter the blood. Blood is removed from the body, typically from a vein in the arm, passed through a specialized filter called a dialyzer, and then returned as cleaned blood to the body. This process usually occurs at a clinic or hospital several times a week, with each session lasting around four hours.
Peritoneal dialysis utilizes the lining of the abdomen, called the peritoneum, as a natural filter inside the body. A dialysis solution is introduced into the peritoneal cavity through a surgically placed catheter. This solution remains in the abdomen for a period, absorbing waste products and excess fluids from the blood vessels in the peritoneum. After a few hours, the used solution, now containing the waste, is drained out and replaced with fresh solution. This exchange process can be performed manually throughout the day or automatically by a machine overnight while the patient sleeps.
Quality of Life While on Dialysis
Living with dialysis involves significant adjustments that can affect a person’s daily life and overall well-being. The treatment itself demands a considerable time commitment, requiring regular sessions that can disrupt work, social, and family routines. Patients must also adhere to strict dietary restrictions and fluid intake limits to manage waste and fluid buildup between treatments.
Physical symptoms are commonly experienced, including fatigue, muscle cramps, and itching, which can diminish comfort and energy levels. Emotional well-being is also impacted, with many individuals experiencing stress, anxiety, and depression due to the illness’s chronicity and dependence on treatment. Support systems from family, friends, and healthcare professionals are important for managing these challenges and fostering a sense of control and acceptance.
The Role of Kidney Transplantation
Kidney transplantation offers an alternative treatment path for end-stage renal disease that can significantly alter a person’s prognosis. For eligible patients, transplantation is generally associated with a longer and better quality of life compared to remaining on long-term dialysis. A successful kidney transplant can eliminate the need for regular dialysis treatments, allowing for greater freedom and a return to activities that may have been limited.
Transplants can come from either living donors or deceased donors. While both options provide substantial benefits over dialysis, living donor kidney transplants are often associated with better long-term patient and graft survival rates compared to deceased donor transplants. This is often considered the preferred treatment strategy for many individuals with kidney failure.