Dialysis is a medical treatment that acts as an artificial kidney, filtering waste products, excess fluids, and balancing electrolytes when the kidneys can no longer adequately perform these functions. This therapy becomes necessary when kidney function declines significantly, often due to chronic kidney disease reaching its final stage. Its primary purpose is to sustain life and improve well-being by preventing the dangerous buildup of toxins and fluids that failing kidneys cannot manage.
Understanding Kidney Failure
Chronic kidney disease (CKD) describes a gradual loss of kidney function over time, progressing through several stages. End-Stage Renal Disease (ESRD), also known as kidney failure or stage 5 CKD, represents the most advanced stage. At this point, kidney function is severely impaired, often operating at 10 to 15 percent of their normal capacity.
When kidneys reach ESRD, they can no longer effectively remove waste products or excess fluid from the blood. This means waste and fluid accumulate to dangerous levels in the body. Without intervention like dialysis or a kidney transplant, these accumulations can lead to severe health complications.
Medical Indicators for Starting Dialysis
The decision to begin dialysis is guided by several medical criteria. The estimated Glomerular Filtration Rate (eGFR) is a key indicator, measuring how well the kidneys filter substances. A normal eGFR is typically above 90 mL/min/1.73m². Dialysis is generally considered when the eGFR falls below 15 mL/min/1.73m², signifying severe kidney function loss. While eGFR provides a numerical threshold, it is not the sole factor.
Clinical symptoms from the accumulation of toxins also play a significant role. Patients may experience overwhelming fatigue, nausea, vomiting, appetite loss, confusion, difficulty concentrating, and a metallic taste. These symptoms indicate waste products are building to harmful levels.
Unmanageable fluid overload, or hypervolemia, is another important medical indication. Failing kidneys cannot properly remove excess fluid, leading to its buildup. This causes noticeable swelling (edema) in the hands, ankles, feet, and face, and shortness of breath from fluid in the lungs. Fluid overload can also elevate blood pressure and strain the heart.
Electrolyte imbalances, such as high potassium (hyperkalemia) and phosphorus, can also necessitate dialysis. Kidneys balance these minerals, and their dysfunction leads to dangerous imbalances affecting heart function and bone health. These symptoms and lab abnormalities signal that kidneys can no longer maintain the body’s internal balance, making dialysis necessary.
The Collaborative Decision to Begin
The choice to start dialysis involves a shared decision-making process between the patient, their family, and the healthcare team, particularly a nephrologist. This approach acknowledges that while medical indicators are important, personal preferences and values also hold significant weight. Patients are encouraged to actively participate in understanding their condition and available treatment options.
Discussions often include the impact of dialysis on daily life, quality of life, and potential changes to routines. The healthcare team provides information about the benefits and challenges of dialysis, allowing patients to weigh these factors against their personal goals. Preparing for dialysis also involves planning for vascular access, such as creating a fistula—a surgical connection between an artery and a vein—to facilitate the treatment.
What Happens Without Dialysis
Without dialysis when medically indicated, waste products and excess fluid progressively accumulate in the body. Kidneys can no longer filter these substances, leading to their buildup in the bloodstream. This accumulation results in uremia, where toxins poison the body.
Not starting dialysis has severe, life-threatening consequences. The unchecked buildup of waste products and fluid can lead to multi-organ failure, affecting the heart, lungs, and brain. Symptoms can worsen to include severe shortness of breath, coma, and ultimately, death. Dialysis serves as a life-sustaining treatment, preventing these dire outcomes when kidney function has failed.