# Symptoms and stages of kidney failure and dialysis
Kidney failure usually progresses in stages. The kidneys gradually lose their ability to filter waste products from the blood and retain fluid. Once the kidneys no longer work well enough, dialysis is needed — a treatment that partially takes over that filtering function. Below we describe what the progression looks like and what complaints occur per stage.
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Chronic kidney failure before dialysis begins (Stages 1-4)
In the years before dialysis is needed, many people notice little. Yet much happens in the body.
**Complaints in this stage:**
Most people in this period have no noticeable symptoms, especially in the early stages. This is often discovered by chance during blood or urine testing. As kidney function further declines, the following may occur:
- Fatigue and lack of energy (due to buildup of waste products and anemia)
- Swelling of hands, feet and sometimes face (because the kidneys no longer excrete fluid properly)
- Nighttime urination (more than three times per night)
- Nausea and loss of appetite
- Shortness of breath during exertion
- High blood pressure (difficult to control)
- Itching of the skin (due to accumulation of uremic substances)
- Muscle cramps, especially at night
- Concentration problems and poor memory
**Meaning for daily life:**
In the early stages, daily life is often barely limited. As kidney function worsens, fatigue may become more common and diet must be chosen more carefully (less salt, sometimes less fluid and potassium). Regular check-up visits become important. Many people feel better after therapy.
**Figures on duration and survival:**
The speed at which kidney failure progresses varies greatly. Some have stable residual function for decades, others deteriorate quickly. Population studies from 2025-2026 (KNOW-CKD, machine learning analyses) show that in older patients with primary glomerular diseases (kidney tubule inflammation) the disease course is highly heterogeneous. There is no fixed duration for this stage; this depends on cause, severity, treatment and individual factors.
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Start of dialysis treatment (Start of kidney function maintenance)
When the kidneys have been reduced to approximately 10-15% of their normal function, most patients begin dialysis. This can be hemodialysis (via artificial kidney treatment several times a week) or peritoneal dialysis (via the peritoneum).
**Complaints at the time of start:**
- Severe fatigue and concentration problems
- Severe nausea and vomiting
- Loss of appetite
- Swelling of legs and feet, sometimes also of the face
- Shortness of breath and chest pain (due to fluid overload)
- High blood pressure
- Itching (sometimes severe — research from September 2026 shows that kidney failure-related itching is a significant burden for many patients)
- Insomnia
- Possible vomiting or dialysis-related nausea in the first sessions
**Meaning for daily life:**
The start of dialysis is a major change. Hemodialysis requires three times a week approximately four hours at a dialysis clinic (though this varies). This affects work, leisure time and social activities. Many people feel better after the first sessions — toxic substances and excess fluid are removed. But dialysis comes with severe fatigue, fluid restrictions, and many medications. Research on quality of life (KDQOL-36, eQ-5D-5L, December 2026) points to considerable burden from medication intake (pills and infusions) and emotional challenges (anxiety, demoralization). Many patients on maintenance dialysis experience depression; mindfulness intervention studies (August 2026) show that psychological support helps.
**Figures on duration and survival:**
This is related to the cause of kidney failure and age. In adults without transplantation, median survival on dialysis ranges from a few years to several decades. A meta-analysis from 2026 based on observations in large cohorts (KNOW-CKD, KoreaN cohort studies) shows that long-term survival is strongly influenced by age, diabetes, cardiovascular disease, and other conditions. For older patients (75+), median survival on dialysis may be 3-5 years; for younger patients without additional conditions, 10-20 years or more. **Important:** these are population averages. Individual differences are large — some people live much shorter, others much longer. Nobody can predict to an individual how much time someone has.
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Maintenance dialysis — hemodialysis
This is the phase in which someone undergoes hemodialysis long-term, usually 3 times a week, 4 hours each time.
**Complaints in this stage:**
- **Directly after dialysis:** sometimes people suddenly feel weak, dizzy, or experience headaches (dialysis-related symptoms)
- **Chronic, between dialysis sessions:** progressive fluid overload, swelling, shortness of breath, blood pressure fluctuations
- **Itching:** sometimes persistent, especially in the evenings and at night (research from 2026 confirms this as common)
- **Fatigue:** ongoing, both from kidney failure itself and from the physical strain of dialysis
- **Decreased appetite and nausea**
- **Muscle cramps**, especially at night
- **Restless legs** (involuntary leg movement)
- **Sleep disturbances**
- **Bone and joint pain** (due to mineral metabolism disorders)
- **Sexual dysfunction and loss of interest** (result of fatigue and anemia)
- **Fluid restriction** can lead to thirst and dry mouth
**Meaning for daily life:**
Maintenance dialysis structures life around three fixed moments per week. Many people experience this as a heavy burden. Fatigue limits work and leisure activities. Fluid restriction — often 1-1.5 liters per day — requires constant awareness. Salt, potassium, and certain other nutrients must be avoided. Many people feel socially isolated or ashamed of their kidney disease. The medication burden is large (blood pressure medications, medications for anemia, bone mineral management, etc.) — research from December 2026 shows that this together with the physical strain of dialysis itself noticeably affects quality of life. Yet many people can work, though often part-time, and maintain a social life.
**Figures on duration and survival:**
Median survival for adults starting maintenance dialysis is on average 5-10 years in many Western countries (American and European registries). For dialysis patients in general, first-year mortality rates are around 10-20% — so approximately 80-90% of dialysis patients reach the first year. After the first year, this stabilizes. Older patients have lower survival rates; younger patients without additional conditions much higher. **Never applies to one person:** the survival of a population says nothing about an individual. Many factors determine how long someone lives — the degree of residual kidney function, comorbidities, treatment adherence, access to transplantation, etc.
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Maintenance dialysis — peritoneal dialysis
Peritoneal dialysis (PD) is an alternative with which many people can be treated at home.
**Complaints in this stage:**
- **Abdominal conditions:** abdominal pain, especially in the first weeks; sometimes fluid leakage around the catheter (the tube in the abdomen)
- **Infection risk:** peritonitis (abdominal inflammation) can occur, with abdominal pain, fever, cloudy dialysate
- **Weight:** many people gain weight from sugar in dialysis fluids; this can worsen diabetes
- **Fatigue:** less pronounced than with hemodialysis, but present
- **Itching**
- **Hernias** (weak spots in the abdominal wall)
- **Fluid overload and pressure** on the lungs (because the dialysate in the abdomen creates pressure)
- The same chronic complaints as with hemodialysis: sleep problems, restless legs, bone and joint pain
**Meaning for daily life:**
Peritoneal dialysis can offer more freedom — some variants run throughout the day in small amounts, others happen at night. Many patients experience this as less burdensome than hemodialysis on machines. However: working at home requires good hygiene and training. Infection risks are real. Some patients can restrict fluid intake somewhat less strictly. Overall, many patients report that PD adapts better to their daily life than hemodialysis, although this does not apply to everyone.
**Figures on duration and survival:**
Median survival on peritoneal dialysis is comparable to hemodialysis (approximately 5-10 years), but survival depends heavily on how well the treatment responds and whether infections are managed well. After 3-5 years, many PD patients switch to hemodialysis because efficiency decreases (hardening of the peritoneum, peritonitis). First-year mortality rates are comparable to hemodialysis.
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Dialysis-refractory phases — serious complications
Sometimes serious problems arise despite dialysis.
**Symptoms that can occur:**
- **Sepsis:** infection that spreads through the bloodstream (via dialysis catheter or peritonitis)
- **Heart failure:** dialysis removes fluid, but the heart sometimes cannot pump well anymore; this leads to shortness of breath, chest pain
- **Brain inflammation or severe confusion** (sometimes due to imbalance in dialysis or infection)
- **Bleeding:** due to anticoagulants or uremic substances that promote bleeding
- **Severe itching** that cannot be treated with standard medications
- **Severe joint pain and bone inflammation** (dialysis-associated amyloidosis)
This phase is medically very complex and requires much attention in the hospital.
**Meaning for daily life:**
In this phase, staying at home and self-care become difficult or impossible. Many people stay partially or fully in the hospital. Well-being decreases noticeably. Decisions about treatment intensity become very important.
**Numbers:**
Patients who develop sepsis have a mortality of 30-50% during that event. This phase typically lasts weeks to months.
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Preparation for kidney transplantation
For many patients, transplantation is the goal; for others, dialysis remains the long-term solution.
**How this can change the symptoms:**
Patients who are candidates for transplantation can receive more intensive support. If a donor is found, dialysis stops and immunosuppression begins (medications to prevent rejection). This can greatly reduce many dialysis symptoms — more freedom, less fluid restriction, less fatigue —