Choosing between dialysis and kidney transplant

“Renal replacement therapy” is another term for the different treatments for kidney failure.

Normally, the kidneys filter the blood and remove waste and excess salt and water . Kidney failure, also called “end-stage kidney disease,” is when the kidneys stop working completely.

If your kidneys stop working completely, you can choose between 3 different treatments to take over their job. These treatments can extend your life, as without them, kidney failure can lead to death.

You can choose between:

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

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

  • Peritoneal dialysis – Peritoneal dialysis is a procedure that people do at home every day. It involves piping a special fluid into the belly. This fluid collects waste and excess salt and water from the blood. Then, the used fluid drains out of the belly. Before people can have peritoneal dialysis, they need surgery to have a tube put in their belly. The tube allows the fluid to get in and out of the belly.
  • Hemodialysis – Hemodialysis is a procedure in which a dialysis machine takes over the job of the kidneys. The machine pumps blood out of the body, filters it, and returns it to the body. Before people can have hemodialysis, they need surgery to create an “access.” An access is a way for the blood to leave and return to the body.

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

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

You, your doctor, and your family will 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 a kidney transplant.

When thinking about your choices, you should also 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 of dialysis.

Yes, you can choose not to have any renal replacement therapy. But it’s important to 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 renal replacement therapy, waste will build up in your blood. This can make you feel tired, itchy, or sick to your stomach. 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.