# Kidney failure and dialysis
What is it
Kidney failure means that your kidneys are no longer able to work properly. The kidneys are two bean-shaped organs that filter waste and excess fluid from your blood. These wastes normally leave your body through urine.
When the kidneys are seriously damaged, they can no longer perform this task. This is called end-stage kidney failure (also known as severe chronic kidney failure). Without treatment, the waste would accumulate in your blood and you would become seriously ill.
**Dialysis** is a treatment that takes over the work of your kidneys. It helps remove waste and extra fluid from your blood. There are different types of dialysis, with hemodialysis and peritoneal dialysis being the most common. In haemodialysis, your blood outside your body is cleansed using a machine. In peritoneal dialysis, the abdominal cavity is used as a natural filter.
Causes
Chronic kidney failure can develop slowly due to many different conditions. The most common causes include:
- **Diabetes**: High blood sugar damages the small blood vessels in your kidneys after years
- **High blood pressure**: Permanently elevated pressure can damage kidney tissue
- **Glomerulonephritis**: Inflammation of the filtering structures in the kidneys
- **Chronic pyelonephritis**: Repeated kidney infections that leave scars
- **Polycystic kidney diseases**: An inherited disorder where cysts grow in the kidneys
- **Blockades**: Kidney stones or tumors that obstruct urine outflow
- **Certain medications**: Prolonged use of some pain relievers or other medicines
For many people, a combination of factors is involved. Sometimes the cause is not entirely clear.
How the disease progresses
Chronic kidney failure is usually gradual. The kidneys lose their ability to filter properly in stages.
In the **early phases** (1 to 3), you may not notice anything at all. The kidneys are still partly working. Checkup visits and blood tests can detect the condition, but you're probably feeling normal.
In the **middle phases** (3 to 4), symptoms increase slowly. You may feel tiredness, or you may see changes in how often you go to the toilet. Blood pressure may rise. Doctors are monitoring this closely with regular tests.
When you reach **final stage** (phase 5), your kidneys are only 10 to 15 percent still working. At this time, dialysis usually begins. Symptoms may now be clear: tiredness, nausea, bloating, itching.
The time at which dialysis is required varies from person to person. This depends on how quickly your kidneys deteriorate and how well your body tolerates the build-up of waste.
Symptoms by phase
**Early phase (1-3) :**
- Often no symptoms
- Sometimes slightly increased blood pressure
- Changes in how your urine looks (frothy or blood red)
**Advanced phase (4) :**
- Increasing tiredness and weakness
- Headache
- Problems with concentration
- Swelling of feet and ankles
- Nausea
- Elevated blood pressure
**Final stage, before dialysis starts (5) :**
- Severe fatigue
- Lack of appetite
- Nausea and vomiting
- Taste changes
- Skin itching
- Swollen face, hands and feet
- Shortness of breath
**When dialysis has started: **
The symptoms usually decrease, but patients may suffer from:
- Itching (this has been reported frequently in studies)
- Insomnia
- Muscle cramps
- Blood pressure changes
- Fatigue, especially around dialysis days
What it means for daily life
Dialysis is a major change in your routine. Most people on haemodialysis have to go to a dialysis center three times a week, for three to five hours each time. During this time, you sit still while a machine cleans your blood. You may feel weak or uncomfortable, and you may be less available for work or family.
Your **diet** changes considerably. You will need to pay attention to:
- Fluid intake (this can be strict)
- Potassium-rich foods (bananas, oranges, tomatoes)
- Phosphorus (dairy, nuts, certain grains)
- Salt and protein
These restrictions are necessary to keep your blood electrolytes stable.
**Work** can become more difficult. Some people keep their job, but have to negotiate flexibility. Others can no longer work due to fatigue or dialysis schedules.
**Social life** can be affected. Traveling requires planning with dialysis clinics. Appointments and activities must be scheduled around dialysis days. Many people report that their quality of life deteriorates, although this varies greatly from person to person.
**Emotionally** this is also a change. You are dependent on a machine and on a medical team. Some feel sad, worried or demoralised. That is normal. Support from family, psychologists or patient groups can help.
**Access** is crucial. For haemodialysis you need a fistula (connection between vein and artery in your arm) or a catheter. This requires care and can have complications.
Peritoneal dialysis offers more flexibility—you can do it at home, sometimes at night—but requires a lot of self-discipline and cleanliness.
Outlook
This is complicated, and the answer depends heavily on your situation.
With modern dialysis and transplantation, many people live for years more. Yet kidney failure is a serious condition; people with end-stage kidney failure generally have a lower life expectancy than the general population. But many factors come into play: your age, other illnesses, how well your dialysis works, your adherence to diet and medication, and psychological factors.
A **kidney transplant** can open another perspective. If you receive a donor kidney (from a living donor or deceased person), you can sometimes come off dialysis. A transplant can last 10-20 years or longer. Not everyone can be transplanted, and the waiting time can be long.
**Research** is being conducted continuously to better understand and treat dialysis and kidney failure. New approaches around nutrition, inflammation, mental wellbeing and dialysis techniques are being researched.
The most important thing is: prospects are not the same for everyone. Your doctor knows your medical history and can speak more realistically about what your specific situation means.
Frequently asked questions
**Is dialysis permanent?**
For many people, dialysis is a long-term treatment, possibly for years. But if you receive a successful kidney transplant, you can become independent of dialysis. There are also cases where kidney function returns partially, although this is rare. It depends on what damaged your kidneys and how quickly that happened.
**Can you work and travel on dialysis?**
That varies. Some people maintain their job, especially if their employer is flexible. Travel is possible, but requires preparation—you need to arrange dialysis at your destination. Peritoneal dialysis offers more freedom, because you can do it at home. However, this requires a lot of self-discipline.
**What about pain and discomfort during dialysis?**
The needle in your arm can sting briefly, but many people do not experience this as serious pain once they get used to it. Headaches, low blood pressure or cramps can occur before, during or after dialysis. Your team can usually help with this. Itching and insomnia are common side effects you should definitely discuss with your care providers.
**Can I normalise my diet?**
Unfortunately not completely. You will likely always have restrictions on fluid, potassium, phosphorus and sometimes salt. This is necessary to keep your blood healthy and protect your heart. A dietician can help you find foods that meet the guidelines and that you enjoy.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._