Making the dialysis decision: What you need to know

Hundreds of thousands of Americans with kidney failure undergo dialysis treatments to keep them alive. While their reasons for needing the treatment can vary widely, many patients with kidney failure ultimately face the same dialysis decision.

Here's what you need to know:

What is dialysis?

When your kidneys fail, your body cannot filter toxins, regulate body fluids, or sustain electrolyte balance vital to survival. Dialysis takes the place of kidney function by cleaning a person's blood.

The first successful dialysis machine, or “artificial kidney,” was invented in 1945 by Willem Johan Kolff, then a doctoral student at the University of Groningen in Holland. Today, about 450,000 Americans are on dialysis, according to the National Kidney Foundation.

Dialysis is used as a bridge to kidney transplant, in recovery from acute kidney failure, or for an end-of-life, life-sustaining purpose. In general, life expectancy after starting dialysis is five years.

Who gets dialysis treatment?

The No. 1 reason a person needs dialysis treatment is kidney failure due to diabetes. The disease is responsible for 44 percent of all dialysis patients’ kidney failure, according to the U.S. Renal Data System's 2013 Annual Data Report.

The report names the second-largest group of dialysis patients, at 28 percent, as people with kidney failure due to high blood pressure. Other conditions often leading to dialysis treatment are glomerulonephritis, polycystic disease, kidney inflammation, genetics, auto-immune disease, drug use, etc.

Signs and symptoms of kidney failure are often hard to pinpoint because they mimic multiple other medical conditions. For early detection, lab testing should be part of your yearly physical. By analyzing a person's blood urea nitrogen and creatinine levels, a doctor will be able to determine the level of kidney function.

Patients who have lost more than 75 percent of their kidney function are often referred for dialysis treatment. The worse your kidney function is, the more complications you will have.

The decision to undergo dialysis treatments is the first and most important discussion you will have to make with your health care provider, and you should understand doing so will complicate any other medical problems you have.

Realities of dialysis treatment

It’s important to note dialysis is not a cure for kidney failure. Dialysis is a life-support treatment — without functioning kidneys you cannot live.

Once the decision is made to move forward with dialysis, there are two types of treatments you can use: hemodialysis and peritoneal dialysis.

Hemodialysis is when an external machine attaches directly to your body through the blood stream. This is done at least three times a week at a dialysis facility, with the treatments usually lasting three to five hours, a WebMD article comparing the two types of dialysis explains.

Peritoneal dialysis is done at home but is more labor intensive. This type of dialysis "uses the lining of your belly, which is called the peritoneal membrane, to filter your blood," the WebMD article explains. A catheter is surgically implanted in your stomach, which becomes the access point for your daily "exchanges." These exchanges are done four to six times a day.

Dialysis treatments are very hard on the body and its organs. Complications from dialysis vary and are different for every patient.

Some complications include:

• Chronic anemia
• Life-threatening electrolyte imbalance
• Uremic syndrome (causing nausea, vomiting and frequent sleep disturbances)
• Heart disease
• Bone disease
• Fluid regulation problems
• Need for a multiple-medication regime

The younger you are when you undergo dialysis, the better your options and results are. No one over the age of 65 years old is eligible for transplant, and any dialysis patient over the age of 70 has a higher risk of death because of the treatments and frequent complications.

My mother died from kidney failure at the age of 70. She was on home dialysis prior to her death, and watching her go through her illness and multiple dialysis treatments each day was horrendous. It is something I would not wish on anyone.

When considering dialysis, please realize you are making a lifelong choice that will impact many people and change your level of independence.

Jordan Ormond contributed to this story.

Suzanne Carlile, “Nurse Suzy,” has been a nurse since 1982. Her main focus is critical care and nursing education.