Why is it important to think about this decision now?
When your kidneys start to fail, it is difficult to predict when they will fail completely. The sooner you begin to think about your options, the more time you will have to plan for the treatment that best fits your lifestyle and preferences.
You may be feeling a lot of emotions at this time: overwhelmed, shocked, confused, angry. You may also be feeling a sense of loss or grief. This is ok. Many people in your situation have had some of these same feelings.
I was angry at everything. I was angry with myself. I was angry with God, too. I wondered, ‘How did I get here? How did this happen to me?’ But through all of that anger, I realized I had to do what I had to do. I felt like, ‘OK, I’m here, and now I need to figure out how to move forward.
Remember, this is your choice, but you are not alone. Your health care team is there to help you with this decision, and you should feel free to ask them any questions. Your loved ones may be a part of the decision, too. No matter who else is involved, we encourage you to have a strong voice in choosing the type of dialysis that is right for you.
In the United States, more than 96% of patients who need treatment for kidney failure (also called renal failure) start either in-center hemodialysis (HD) or peritoneal dialysis (PD). We focus on these two types of dialysis since they are the most common. However, keep in mind that there are other options not included on this website:
To learn more about these treatments, please see Additional Resources.
Everyone's situation is different
Here are some stories from people who started dialysis.
Initially of course, it was disappointing to learn about my kidneys failing, but there was also some relief. I spent so much time feeling lousy and not knowing why. Getting a diagnosis was a new starting point for me. I was like, "ok I know what I have, now I need to figure out what I'm going to do to feel better.
I wanted to be able to know that I could still travel and see my other children and my grandchildren. When I started dialysis, I told everybody, "I wanna live until I'm a hundred! I just hope this can get me there.
Well, you know, you just take a deep breath and say, "This is the way it is." And, you deal with it. You just can't mope and be too depressed and so on and so forth. You have to have faith...that you're gonna get through this.
I want to maintain quality of life. Everybody wants that! No matter who you are. I'd say that's like a no-brainer! Ya know? But, you got to choose the best you, you got. You got to choose the best hand that you're given or you're dealt.
I have type 2 diabetes already, so being diagnosed with kidney disease was kind of a double whammy you know? It was very hard to deal with it. I was very emotional for the first year and a half. But as time passed, I got used to it. It takes time to cope with it.
Dialysis has provided me the opportunity to inform people, because there was a lot of misinformation and misconceptions about people on dialysis, like that it's a death sentence or you don't have long to live. I've been able to disprove a lot of that, by sharing my experience with people. I'm getting on, I'm not going anywhere any time soon. As long as I do the things that are required of me, I know that I can live with this thing now.
When it’s not your choice
Sometimes, a person’s body may not allow for a certain type of dialysis. Other times, someone might be in an emergency situation, and the health care team has to make the choice. If this is your situation, it doesn’t mean that you have lost control of the rest of your dialysis journey. Remember, you will still have the opportunity to be the leader in your dialysis care.
Because of some of the scarring that I have internally, PD wasn’t a good option for me. The fluid for dialysis wouldn’t fit in my body, so my doctor recommended that HD would be the best for my situation.
The dialysis journey
Remember, each journey is different. Here's an overview of what you may experience when starting dialysis.
This website was developed by patients, family members, and professionals who are committed to empowering people just like you facing the decision of what type of dialysis to start. We are a group of people with a wide range of backgrounds. Some of us are patients, just like you, and some of us are social workers, researchers, and doctors representing Arbor Research Collaborative for Health; the University of Michigan; and Greenfield Health Systems, a division of the Henry Ford Health System.
As a team, we have gathered information from over 180 people who are currently living with chronic kidney disease (CKD) or who are on hemodialysis (HD) or peritoneal dialysis (PD). The people who took part in our research provided helpful information, like what it feels like to be on dialysis on a daily basis, concerns of being on dialysis, quality of life on dialysis, and things they wish they would have known before starting dialysis.
It is our goal to give you the information you need to make a decision, as well as to share other patients’ experiences, to help you make the choice that’s best for you. Your role in this decision is very important, and we want you to feel comfortable being involved in the decision as much as you want.
Advanced Kidney Disease: A term sometimes used to describe kidney failure.
Automated Peritoneal Dialysis (APD): Peritoneal dialysis that uses a machine, called a cycler, to fill the belly with dialysate, and then drains dialysate and wastes out of the belly. Catheter (Hemodialysis): A plastic tube that is placed in the neck and is inserted into a large vein to take blood in and out of the body.
Catheter (Hemodialysis): A plastic tube that is placed in the neck and is inserted into a large vein to take blood in and out of the body.
Catheter (Peritoneal Dialysis): A plastic tube that is used to put dialysate fluid into the belly and to take the fluid, along with wastes, out of the body. One end is inserted under the skin into the belly (peritoneum), while the other end sticks out from the skin, usually below the belly button.
Chronic Kidney Disease (CKD): A long-term condition when the kidneys do not work properly.
Conservative Management: Supportive care for advanced chronic kidney disease that includes medications and diet restrictions without dialysis.
Continuous Ambulatory Peritoneal Dialysis (CAPD): Peritoneal dialysis in which the patient connects to bags of dialysate fluid and uses only gravity, not a machine, to fill the belly (peritoneum) with dialysate fluid, and drain the fluid along with wastes.
Creatinine: A product of muscle metabolism that is normally eliminated by the kidneys. Creatinine levels in the blood are used to estimate kidney function.
Cycler: A machine used during Automated Peritoneal Dialysis (APD) to put dialysate into the belly and drain the fluid, along with wastes, out of the belly.
Dialysate: A fluid used in dialysis to draw fluids and toxins out of the bloodstream and supply electrolytes and other chemicals.
Dialysis: A treatment that can remove waste and excess fluid from the body.
Dialysis Nurse: A trained medical professional who will assist in your care and dialysis treatment.
End-stage renal disease (ESRD): A condition in which the kidneys have stopped working. Also called kidney failure.
Fistula: An access site to the bloodstream used in hemodialysis to take blood out and put it back into the body; usually placed in the arm.
Glomerular Filtration Rate: A test that measures the function of kidneys. This is based on creatinine levels, age, weight, and sex.
Graft: An access site to the bloodstream used in hemodialysis to take blood out and put it back into the body; usually placed in the arm.
Hemodialysis: A type of dialysis that uses a machine to take blood out of the body, filter it, and put it back in; it is usually done at a specialized center.
Home Hemodialysis: Hemodialysis that is done at home, in which the patient provides his/her own treatment.
In-Center HD: Hemodialysis that is done in a specialized clinic, called a dialysis center.
Kidneys: Internal organs that clean the blood and produce urine.
Kidney Disease: A condition when the kidneys do not work properly.
Kidney Failure: A condition in which the kidneys have stopped working. Also called renal failure.
Kidney Transplant: A surgical operation in which a healthy kidney donated by another person is placed into the body of person with kidney failure.
Nephrologist: A doctor who works with people with kidney problems
Patient Care Technician (PCT): A health care worker trained to give care during hemodialysis treatments.
PD Exchange: The process in which sterile fluid called dialysate is put into and removed from the belly.
Peer Mentor: A kidney patient who has been trained to support other patients.
Peritoneal Dialysis (PD): A type of dialysis that uses the membrane that lines the inside of the belly (peritoneum) to purify the blood from wastes; it is usually done at home. There are two types of PD: Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis (see definitions).
Peritoneum: Membrane that lines the inside of the belly.
Renal Failure: A condition in which the kidneys have stopped working. Also called kidney failure.
Social Worker: A trained professional who gives all levels of support, including educational and emotional, to patients before and after beginning dialysis.
Waste Products: Products of metabolism (urea, creatinine, uric acid), that are removed from the body by healthy kidneys.
Are you looking for more information about dialysis? You may want to visit these websites: