# Treatment Methods for Kidney Failure and Dialysis
The treatment of kidney failure depends strongly on which stage you are in and how well your kidneys still function. In the early stages, it is mainly about slowing down deterioration. Once the kidneys no longer work adequately, replacement therapy becomes necessary — dialysis or transplantation. This chapter describes the regular treatments that are applied at each stage.
Treatment in the Early Stages (CKD Stages 1-3)
In these phases, your kidneys still work for the most part. The goal is to prevent damage and avoid complications.
**Blood Pressure Medications (ACE Inhibitors and ARBs)**
ProveniIncluded in official guidelines, or approved by EMA or FDA
ACE inhibitors (such as enalapril) and ARBs (such as losartan) are standard medications that lower blood pressure and at the same time provide protection to kidney tissue. They work by slowing down certain hormone processes that accelerate damage to the kidneys. These agents are especially used if you have high blood pressure or diabetes. Many kidney specialists prescribe them because they can also reduce protein excretion in the urine. Known side effects include dry cough, dizziness, and in rare cases an elevation of potassium levels in the blood.
**Blood Sugar Control**
ProveniIncluded in official guidelines, or approved by EMA or FDA
In patients with diabetes, well-controlled blood sugar is essential to slow kidney damage. This is achieved with different medications or insulin. Some newer diabetes medications (SGLT2 inhibitors) have also proven beneficial for the kidneys, independent of their effect on blood sugar. Side effects vary by medication, but can include yeast and urinary tract infections.
**Statins (Cholesterol Medications)**
ProveniIncluded in official guidelines, or approved by EMA or FDA
These medications lower cholesterol and also have anti-inflammatory effects, which can be beneficial for the kidneys. They are especially prescribed for older people or when heart and vascular disease is involved. Muscle complaints occur, but are uncommon.
**Sodium Restriction**
ProveniIncluded in official guidelines, or approved by EMA or FDA
A lower salt intake helps lower blood pressure and can reduce fluid retention. This is not a medication, but a lifestyle adjustment that many kidney specialists recommend.
Treatment When Dialysis Becomes Necessary (CKD Stages 4-5)
Once kidney function drops below 15%, your body can no longer remove enough waste products. Then dialysis or transplantation becomes necessary.
Hemodialysis
ProveniIncluded in official guidelines, or approved by EMA or FDA
This is the most common form of dialysis. Your blood is pumped from your body, passed through an artificial filter membrane where waste products and excess fluid are removed, and the cleaned blood goes back in. The treatment usually takes place three times a week, each time for four hours, at a dialysis center. There are also home variants where you can dialyze at home (two to six times a week, sometimes shorter in duration), which gives more control and less fluctuations in body fluids.
Side effects and consequences of hemodialysis include:
- Blood pressure drop and dizziness during or shortly after treatment
- Muscle and bone pain (dialysis-related amyloidosis, a rare problem in long-term hemodialysis)
- Infections of the access site (shunt or catheter) where the needle goes in
- Risk of bleeding, because you receive medications during dialysis that inhibit blood clotting
- Air bubbles in blood vessels (very rare, but serious)
- Psychological burden; studies show that dialysis patients can suffer from fatigue, depression and demoralization, and that targeted support (mindfulness interventions, behavioral activation) can help here
Peritoneal Dialysis (PD)
ProveniIncluded in official guidelines, or approved by EMA or FDA
In this form, a catheter is placed in your abdominal cavity. A clean dialysate solution fills your abdomen; the peritoneal membrane (peritoneum) acts as a filter. After several hours, the fluid is exchanged. This can be done at home, sometimes multiple times a day. Advantages are more flexibility and less drastic fluid loss per session. Disadvantages are:
- Abdominal inflammation (peritonitis), due to infection via the catheter
- Increased intra-abdominal pressure, which over time can lead to hernias
- Less effective removal of certain waste products for some people
- Weight gain from the dialysate (much of which is absorbed)
Kidney transplantation
ProveniIncluded in official guidelines, or approved by EMA or FDA
A functioning donated kidney (from a living or deceased donor) works much better than dialysis. You take medications to prevent rejection (immunosuppressants), but many people feel much better than on dialysis. Availability and criteria vary greatly between countries. Known risks include:
- Rejection of the transplanted kidney
- Infections, especially in the first year after transplantation
- Certain types of cancer (approximately two to three times more common than in the general population)
- Side effects of immunosuppressants, such as high blood pressure, diabetes, and loss of kidney function over time
Tests for HLA and non-HLA compatibility between donor and recipient show that better matching improves kidney survival; however, this is complex and not always in your control.
Additional medications and adjustments
Medications for fluid retention
ProveniIncluded in official guidelines, or approved by EMA or FDA
Diuretics help remove excess fluid, which is especially important if you still have your own kidney function or outside of dialysis. In dialysis patients, fluid loss through dialysis itself is usually the main method.
Phosphate binders
ProveniIncluded in official guidelines, or approved by EMA or FDA
In kidney failure, phosphate builds up in the blood and can cause bone damage, heart problems, and itching. Phosphate binders (such as calcium carbonate or newer non-calcium medications) are taken in or after meals and bind phosphate in your intestines so it is not absorbed. Side effects vary by type: calcium-based medications can cause constipation, iron-based binders sometimes cause black stools.
Medications for anemia
ProveniIncluded in official guidelines, or approved by EMA or FDA
Kidney failure reduces the production of erythropoietin (EPO), which causes anemia. EPO-like medications (erythropoiesis-stimulating agents) are injected to boost red blood cell production. Iron supplements are also often given. Side effects of EPO medications include headache, flu-like symptoms, and in rare cases, blood clots.
Potassium restriction and medications
ProveniIncluded in official guidelines, or approved by EMA or FDA
In kidney failure, potassium can build up to dangerous levels, which can cause heart rhythm disturbances. Dietary restriction and sometimes medications (potassium absorbers) are used. In severe emergencies, potassium can be quickly removed from the blood.
Treatment of itching
ResearchediPositive results in clinical studies, not yet standard treatment
Chronic itching in dialysis patients is difficult and affects quality of life. Various treatments are tried: anti-itch medications (antihistamines), creams, and addressing underlying causes such as phosphate imbalance. Further research into itching is ongoing and shows that more intensive treatment of waste products helps.
Mental health support
ResearchediPositive results in clinical studies, not yet standard treatment
Dialysis patients have increased risks of depression and alienation (demoralization). Mindfulness interventions and behavioral activation therapy show positive effects on wellbeing in studies and prove feasible in dialysis centers.
Medications to prevent further complications
**Bone mineral and calcium balance**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Kidney disease disrupts calcium regulation and vitamin D metabolism. Calcium supplements, vitamin D analogs (calcitriol), and medications that suppress parathyroid hormone (cinacalcet) are used to prevent severe bone disease and artery calcification. Dosage and type vary greatly per patient.
**Food and food supplements**
ProveniIncluded in official guidelines, or approved by EMA or FDA
An adapted diet (limited sodium, potassium, phosphate; appropriate protein intake) is part of standard treatment. Dietitians guide dialysis patients intensively. Protein malnutrition is a risk, especially if dialysis removes insufficient waste products.
Future-focused treatments under investigation
**Less frequent dialysis in older adults**
ResearchediPositive results in clinical studies, not yet standard treatment
Studies examine whether older adults with kidney failure can get by with less frequent dialysis without serious consequences. This would improve quality of life and flexibility, but requires careful selection and monitoring.
**Improved waste removal**
ResearchediPositive results in clinical studies, not yet standard treatment
Research focuses on better removal of indoxyl sulphate and other kidney disease-related toxic substances that contribute to inflammation and infectious risk. This can be achieved through more intensive dialysis or new adsorbers.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._