The kidneys are small, bean-shaped organs that play a central role in maintaining overall health by filtering waste products and excess fluid from the blood. When these organs lose their ability to function adequately, a serious condition known as kidney failure can develop. Dialysis is a medical treatment that takes over some of the functions of failing kidneys, helping to remove waste and fluid from the body.
Kidney Function and Failure
The kidneys perform a range of essential functions beyond simply producing urine. They filter blood, removing waste products like urea and creatinine. Kidneys also balance electrolytes, help control blood pressure, and produce hormones that stimulate red blood cell production and support bone health.
When kidneys can no longer perform these tasks effectively, waste products and excess water build up in the body, a condition known as uremia. This progressive loss of kidney function can lead to end-stage renal disease (ESRD), where kidney function drops to 10 to 15 percent of normal capacity. Without intervention, the accumulation of toxins can become life-threatening, necessitating treatments like dialysis or a kidney transplant.
Medical Criteria for Dialysis Recommendation
The decision to recommend dialysis is based on a comprehensive assessment of a patient’s medical condition and specific laboratory findings. A key indicator is the Glomerular Filtration Rate (GFR), which measures how well the kidneys are filtering blood. Dialysis is generally considered when the GFR falls below 15 mL/min/1.73m², signifying Stage 5 chronic kidney disease (CKD). However, GFR is not the sole factor determining the need for treatment.
Severe uremic symptoms often prompt the initiation of dialysis, even if the GFR is slightly higher. Uncontrolled fluid overload, which can lead to swelling in the limbs and potentially fluid in the lungs (pulmonary edema), is another important consideration. Life-threatening imbalances, such as high potassium levels (hyperkalemia) or severe metabolic acidosis that do not respond to medication, also necessitate dialysis.
Recognizing Signs of Advanced Kidney Disease
As kidney disease progresses, individuals may experience a range of symptoms that suggest the need for medical evaluation. Persistent fatigue and generalized weakness are common, often due to the buildup of toxins and associated anemia. Swelling, particularly in the legs, ankles, or around the eyes, can indicate fluid retention. A noticeable decrease in urine output is another sign that the kidneys are losing their ability to remove excess fluid.
Muscle cramps, restless legs, and difficulty concentrating or mental fogginess may also occur as waste products affect nerve and brain function. Digestive issues such as nausea, vomiting, or a metallic taste in the mouth can arise from uremia. Additionally, shortness of breath and persistent itching of the skin are symptoms that can develop in advanced kidney disease. These signs warrant prompt medical attention.
The Dialysis Decision-Making Process
The decision to begin dialysis is a collaborative effort involving the patient, their family, and the healthcare team, typically led by a nephrologist. This process goes beyond just medical test results, incorporating a comprehensive view of the patient’s overall health and comorbidities. Quality of life considerations are important, as dialysis significantly impacts daily routines.
Patient preferences and values are central to this shared decision-making. Discussions include the various types of dialysis, such as hemodialysis and peritoneal dialysis, and their suitability for an individual’s lifestyle. Early discussions with a nephrologist are important to ensure patients are well-informed about their condition and all available treatment options. This collaborative approach aims to align treatment plans with the patient’s individual needs and choices.