What is Dialysis?: Everything You Need To Know

• Dialysis is a common treatment option for end-stage renal disease (ESRD) and acute kidney failure. 
• There are two main types of dialysis. Each comes with its own set of pros and cons, as well as a distinct process for dialysis sessions. 
• When dialysis is medically required, Medicare, Medicaid, and most private insurance plans will cover treatment. 

Our kidneys help filter waste and excess fluids. If kidney function slows down, someone may be diagnosed with chronic kidney disease. Chronic kidney disease affects more than 1 in 7 U.S. adults, according to the National Institute of Diabetes and Digestive and Kidney Diseases. The right treatment option depends on the stage of kidney disease (there are five in total). If the kidneys have reached the end stage, dialysis may be addressed as a potential treatment option. 

Dialysis is a safe, effective treatment for end-stage kidney disease and acute kidney failure. It can add up to 20 years of life while also improving a patient’s quality of life. Continue reading to learn everything you need to know about dialysis, including the different types, a step-by-step guide to this procedure, and if your private or public insurance covers this treatment. 

The kidney is a bean-shaped organ that’s about as big as your fist. Most people have two kidneys that filter excess water and waste from the blood, turning it into urine. When kidneys are damaged, their ability to remove waste products from the blood is impaired, which can lead to a kidney disease diagnosis.

Symptoms of Kidney Disease & Failure

Should kidney activity drop below 15% of normal functioning, someone will be diagnosed with kidney failure (otherwise known as end-stage renal disease (ESRD)). 

Symptoms of kidney failure include:

• Swelling, often in the feet, ankles, or legs
• Headaches
• Fatigue during the day
• Trouble sleeping at night
• Feeling nauseous 
• Lost sense of taste
• Little to no urine
• Muscle cramps, weakness, or numbness
• Confusion or memory problems

Stages of Kidney Disease

End-stage kidney disease is the last stage, meaning the treatment focus shifts to keeping the patient alive, and the only stage when dialysis is used. However, there are four prior stages to be aware of: 

• Stage 1: There is some kidney damage, but they still work well.
• Stage 2: Mildly reduced kidney function.
• Stage 3: Moderately reduced kidney function. 
• Stage 4: Severe reduced function; kidneys have stopped working or are close to failing. 

Tips to Maintain Healthy Kidneys

In the earlier stages of kidney disease, there are steps to maintain kidney health, such as:

• Monitoring blood pressure
• Watching cholesterol levels
• Eating a nutrient-rich diet
• Staying active
• Taking medications, especially kidney-protective drugs, as prescribed

If someone already has kidney problems, such as chronic kidney disease or ESRD, these steps can slow the progression, but any current damage to the kidneys is irreversible. Early detection and appropriate management not only slow the disease’s progression but also improve quality of life. 

While kidney failure is the last stage of kidney disease, there are lifesaving treatment options — mainly a kidney transplant or dialysis. Dialysis filters your blood through a machine outside the body, removing excess water, salt, and other waste products. It’s similar to what normal kidney function looks like. 

Types of Dialysis

There are two main types of dialysis, peritoneal and hemodialysis. Both accomplish the same goal in different ways:

• Peritoneal dialysis filters the blood with the help of the peritoneum, a lining in your belly. A few weeks before you start peritoneal dialysis, a surgeon places a tube called a catheter into the belly. Once treatment starts, a dialysis solution (a cleansing fluid made of water with salt and other additives), is slowly filled into the bag, through the tube, and into the belly. Once the bag is empty, someone can resume everyday life. In the background, the solution absorbs waste and extra fluids from your blood. This option is typically continued at home after the first treatment and the supplies to complete exchanges are delivered to a patient’s home, usually once a month.
• Hemodialysis uses a dialysis machine to accomplish the same goal. This machine is sometimes referred to as an artificial kidney because your blood passes through a dialyzer (a filter) outside your body. The machine also checks blood pressure, controls how fast blood flows through the body, and may help balance important minerals. 

Choosing the Right Type of Dialysis

A healthcare provider will help you decide which type of dialysis is right for you. based on your medical condition, kidney function, and your personal preferences. Both have their pros and cons, though peritoneal dialysis may better stabilize ESRD and reduce or control blood pressure. 

By contrast, hemodialysis disease may better improve overall quality of life. Hemodialysis is also a great option for those who can’t do peritoneal dialysis themselves, as the peritoneal is usually done at home. If someone, for example, is visually impaired or has Alzheimer’s disease, hemodialysis in a dialysis clinic is probably a better option. 

Who needs dialysis?

Dialysis treatment isn’t for all digestive and kidney diseases. Instead, it’s reserved for those at the end stage of gradual kidney failure or acute kidney failure, when the kidney fails suddenly. It can be used in place of a kidney transplant or while someone is on the waiting list for one. 

Dialysis is a complicated process that can be completed in a dialysis center, at home, or in any clean place (like a sanitary hotel room on vacation). The locations where it can be completed and the dialysis process vary depending on which type is chosen. 

In both cases, the first step for dialysis is to create an access point so that the machine can make contact with your bloodstream. This is typically done through a minor surgery, usually by connecting an artery to a vein. An access point is often created in the arm or wrist.

Peritoneal Dialysis

When starting dialysis, a surgeon will prepare the equipment in advance. Usually, a surgeon will complete the first round of peritoneal dialysis, though a patient or loved one can complete it at home with proper training. For peritoneal dialysis, this process includes the following:

 

• A healthcare provider places the catheter in the lining of the patient’s belly a few weeks before treatment starts. This lining is referred to as the peritoneum and it contains tiny blood vessels similar to the kidney.
• Right before treatment starts, your provider will connect the tube to a bag with dialysis solution.
• The dialysis solution flows from the bag to the catheter to the belly.
• Once inside the belly, the solution absorbs any extra fluid.
• The solution with excess fluid and waste is filtered back into the bag.
• Once the bag is full of excess waste and fluids, the healthcare provider or patient can disconnect it from the catheter. 
• The bag with waste products is then thrown into a waste bin or tub.

There are two subtypes of peritoneal dialysis, automated peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). The main difference lies in the method of fluid exchange. APD utilizes a machine to automatically cycle dialysis fluid into and out of the abdomen, typically overnight while the patient sleeps. In contrast, CAPD involves manual exchanges of dialysis fluid (by hand), performed several times throughout the day, with each exchange typically lasting 30–40 minutes. 

In-Center Hemodialysis

While peritoneal dialysis is usually completed at home, hemodialysis is often conducted in a dialysis clinic. During this type of dialysis session:

• A healthcare provider at the dialysis center will place two needles on the patient’s arm. These needles are connected to a soft tube that runs back to a dialysis machine. 
• The patient’s blood enters the machine, which contains a dialysis solution.
• The machine removes unwanted fluid from the blood, placing them in the dialysis solution.
• Filtered blood then returns to the patient’s body.

When this process is completed in a clinic, a nephrologist (a doctor who specializes in kidney health) and their team will complete the dialysis. A patient may be able to stick the needles into their own arm with time, should they have a desire to do so. 

With in-center dialysis, patients have fixed time slots, usually three times a week lasting for about four hours each session. Some dialysis centers offer nighttime treatments, which may be a better treatment schedule for those who work.

At-Home Hemodialysis

At-home hemodialysis follows the same steps, except hemodialysis treatments occur in the patient’s home or another clean space. When someone chooses this option, they have more flexibility about when dialysis takes place and can choose between three schedules:

• Standard home hemodialysis: occurs three times a week or every other day. Treatment lasts three to five hours.
• Short daily hemodialysis: occurs five to seven days per week. Each time it lasts two to four hours. 
• Nightly home hemodialysis: occurs three to six times per week while asleep. 

A doctor can help decide which of the three types is best should someone opt for at-home hemodialysis. While at-home treatment is convenient and flexible, most clinics require both the patient and a loved one to go through training beforehand. This training typically takes three to eight weeks, lasting four and a half to six hours each weekday.

A healthcare provider will recommend dialysis when it’s necessary. According to the guidelines by the National Kidney Foundation, it’s recommended to start dialysis once kidney function goes below 15%, or if you have severe symptoms caused by kidney disease. Prior to starting treatment, you may want to ask the following questions: 

• What type of dialysis is right for me?
• Can I complete dialysis at home?
• Do you have any recommendations for a dialysis center to work with?
• How can I lower my risk of dialysis side effects?
• Do we need to adjust any medications I’m currently on once starting dialysis?
• Can I get on the waiting list for a kidney transplant?

They may also recommend a meal plan to follow while on dialysis. This meal plan is individualized and formulated based on a urine analysis, lab test results, how much kidney function remains, and a patient’s nutritional status. 

Other than dietary restrictions, most people can live a normal life while on dialysis. Some, however, report feeling fatigued right after a dialysis session, and it may be a good idea to reserve time to rest after. In between sessions, it’s encouraged to monitor your sodium, potassium, and phosphorus, and fluid intake as well to avoid fluid overload.

Dialysis Outcomes

Dialysis is a life-preserving treatment option for those with kidney disease, but it can’t do everything a kidney can and you can’t be on dialysis indefinitely. Most people will need to continue taking kidney medications while on dialysis and change their lifestyle to better support kidney health.

When medication, lifestyle changes, and dialysis are combined, it’s possible to live a long, healthy life. Many people often live 5–20 years or longer after starting dialysis. The exact life expectancy varies depending on the disease’s progression, someone’s age, and their overall health. 

Dialysis Risks

While dialysis works for many, it’s not without its risks. Side effects and risks associated with dialysis include:

• Fatigue: any form of dialysis can make someone feel low on energy or tired more often.
• Low blood pressure: Because fluid levels drop during dialysis, patients may experience low blood pressure.
• Sepsis: A type of blood poisoning that can develop if a dialysis exchange accidentally includes harmful bacteria.
• Muscle cramps: The loss of fluids during dialysis can cause muscle cramps, especially in the lower body
• Itchy skin: Many patients report itchy skin between dialysis sessions

There are also some unique side effects to each type. For hemodialysis, additional side effects include:

• Difficulties sleeping
• Erectile dysfunction
• Loss of libido
• Anxiety
• Dry mouth

Peritoneal-specific side effects include:

• Stomach pain
• High body temperature
• Nausea
• Chills
• Developing a hernia in the peritoneal cavity, the place where the catheter is connected to the belly
• Developing peritonitis, an infection of the lining of your abdomen.

Many of these side effects can be managed with supervision from a medical team and by completing dialysis in a clean environment. With home dialysis, proper training by all who are assisting with the dialysis procedure can help mitigate risks as well. 

Most health insurance plans will cover some or all of your sessions if they are deemed ​“medically necessary.” The amount covered depends on your plan type.

Private Insurance and Dialysis 

With a private insurance plan, either through an employer or the healthcare marketplace, some dialysis costs should be covered. However, dialysis is expensive, and many patients on these plans pay significant amounts out of pocket.

Medicaid and Dialysis 

Medicaid should cover some costs associated with dialysis, though coverage varies by state.

Medicare and Dialysis 

If diagnosed with ESRD, the best option is to enroll in Medicare because dialysis treatment will be covered. Typically, someone is eligible for Medicare once they reach the age of 65 and have worked the time required by Social Security. However, those with ESRD can enroll in Medicare at any age and receive dialysis coverage. 93% of applicants qualify for Medicare when needing dialysis.

Typically, Medicare covers three dialysis treatments per week, though different costs are covered by Part A, Part B, and Part D. Many Medicare Advantage plans cover costs too. Most likely, someone on Medicare will pay 20% of the dialysis costs, with Medicare footing 80% of the bill. It may be possible to get a Medigap plan to cover the remaining 20%.