Is this topic for you? This topic provides information about sudden kidney failure.

If you are looking for information about longterm kidney disease, see the topic Chronic Kidney Disease. What is acute renal failure? Acute renal failure (also called acute kidney injury) means that your kidneys have suddenly stopped working. Your kidneys remove waste products and help balance water and salt and other minerals (electrolytes) in your blood. When your kidneys stop working, waste products, fluids, and electrolytes build up in your body. This can cause problems that can be deadly. What causes acute renal failure? Acute renal failure has three main causes: A sudden, serious drop in blood flow to the kidneys. Heavy blood loss, an injury, or a bad infection called sepsis can reduce blood flow to the kidneys. Not enough fluid in the body (dehydration) also can harm the kidneys. Damage from some medicines, poisons, or infections. Most people don't have any kidney problems from taking medicines. But people who have serious, long-term health problems are more likely than other people to have a kidney problem from medicines. Examples of medicines that can sometimes harm the kidneys include: Antibiotics, such as gentamicin and streptomycin. Pain medicines, such as aspirin and ibuprofen. Some blood pressure medicines, such as ACE inhibitors. The dyes used in some X-ray tests. A sudden blockage that stops urine from flowing out of the kidneys. Kidney stones, a tumor, an injury, or an enlarged prostate gland can cause a blockage. You have a greater chance of getting acute renal failure if: You are an older adult. You have a long-term health problem such as kidney or liver disease, diabetes,high blood pressure, heart failure, or obesity. You are already very ill and are in the hospital or intensive care (ICU). Heart or belly surgery or a bone marrow transplant can make you more likely to havekidney failure. What are the symptoms? Symptoms of acute renal failure may include: Little or no urine when you urinate. Swelling, especially in your legs and feet. Not feeling like eating. Nausea and vomiting. Feeling confused, anxious and restless, or sleepy. Pain in the back just below the rib cage. This is called flank pain. Some people may not have any symptoms. And for people who are already quite ill, the problem that's causing the kidney failure may be causing other symptoms. How is acute renal failure diagnosed? Acute renal failure is most often diagnosed during a hospital stay for another cause. If you are already in the hospital, tests done for other problems may find your kidney failure.

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If you're not in the hospital but have symptoms of kidney failure, your doctor will ask about your symptoms, what medicines you take, and what tests you have had. Your symptoms can help point to the cause of your kidney problem.

http://www.webmd.com/a-to-z-guides/acute-renal-failure-topic-overview

Chronic kidney disease

Email this page to a friendShare on facebookShare on twitterBookmark & SharePrinter-friendly version Chronic kidney disease is the slow loss of kidney function over time. The main function of the kidneys is to remove wastes and excess water from the body. Causes Chronic kidney disease (CKD) slowly gets worse over time. In the early stages, there may be no symptoms. The loss of function usually takes months or years to occur. It may be so slow that symptoms do not appear until kidney function is less than one-tenth of normal. The final stage of chronic kidney disease is called end-stage renal disease (ESRD). At this stage, the kidneys are no longer able to remove enough wastes and excess fluids from the body. The patient needs dialysis or akidney transplant. Chronic kidney disease and ESRD affect more than 2 out of every 1,000 people in the United States. Diabetes and high blood pressure are the two most common causes and account for most cases. Many other diseases and conditions can damage the kidneys, including: Autoimmune disorders (such as systemic lupus erythematosus and scleroderma) Birth defects of the kidneys (such as polycystic kidney disease) Certain toxic chemicals Glomerulonephritis Injury or trauma Kidney stones and infection Problems with the arteries leading to or inside the kidneys Some pain medications and other drugs (such as cancer drugs) Reflux nephropathy (in which the kidneys are damaged by the backward flow of urine into the kidneys) Other kidney diseases

Chronic kidney disease leads to a buildup of fluid and waste products in the body. This condition affects most body systems and functions, including: Blood pressure control Red blood cell production

Vitamin D and bone health

Symptoms The early symptoms of chronic kidney disease are also symptoms of other illnesses. These symptoms may be the only signs of kidney disease until the condition is more advanced. Symptoms may include: Appetite loss General ill feeling and fatigue Headaches Itching (pruritus) and dry skin Nausea Weight loss without trying to lose weight

Other symptoms that may develop, especially when kidney function has gotten worse, include: Abnormally dark or light skin Bone pain Brain and nervous system symptoms: o Drowsiness and confusion o Problems concentrating or thinking o Numbness in the hands, feet, or other areas o Muscle twitching or cramps Breath odor Easy bruising, bleeding, or blood in the stool Excessive thirst Frequent hiccups Low level of sexual interest and impotence Menstrual periods stop (amenorrhea) Shortness of breath Sleep problems, such as insomnia, restless leg syndrome, and obstructive sleep apnea Swelling of the feet and hands (edema) Vomiting, typically in the morning

Exams and Tests High blood pressure is almost always present during all stages of chronic kidney disease. A nervous system exam may show signs of nerve damage. The health care provider may hear abnormal heart or lung sounds when listening with a stethoscope. A urinalysis may show protein or other changes. These changes may appear 6 months to 10 or more years before symptoms appear. Tests that check how well the kidneys are working include:

Creatinine clearance Creatinine levels BUN

Chronic kidney disease changes the results of several other tests. Every patient needs to have the following checked regularly, as often as every 2 - 3 months when kidney disease gets worse: Albumin Calcium Cholesterol Complete blood count (CBC) Electrolytes Magnesium Phosphorous Potassium Sodium

Causes of chronic kidney disease may be seen on: Abdominal CT scan Abdominal MRI Abdominal ultrasound Kidney biopsy Kidney scan Kidney ultrasound

This disease may also change the results of the following tests: Erythropoietin PTH Bone density test Vitamin D

Treatment Controlling blood pressure will slow further kidney damage. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used most often. The goal is to keep blood pressure at or below 130/80 mmHg

Other tips for protecting the kidneys and preventing heart disease and stroke: Do not smoke. Eat meals that are low in fat and cholesterol. Get regular exercise (talk to your doctor or nurse before starting to exercise).

Take drugs to lower your cholesterol, if needed. Keep your blood sugar under control. Avoid eating too much salt or potassium.

Always talk to your kidney doctor before taking any over-the-counter medicine, vitamin, or herbal supplement. Make sure all of the doctors you visit know you have chronic kidney disease. Other treatments may include: Special medicines called phosphate binders, to help prevent phosphorous levels from becoming too high Treatment for anemia, such as extra iron in the diet, iron pills, iron through a vein (intravenous iron) special shots of a medicine called erythropoietin, and blood transfusions Extra calcium and vitamin D (always talk to your doctor before taking)

You may need to make changes in your diet. See: Diet for chronic kidney disease for more details. You may need to limit fluids. Your health care provider may recommend a low-protein diet. You may have to restrict salt, potassium, phosphorous, and other electrolytes. It is important to get enough calories when you are losing weight.

Different treatments are available for problems with sleep or restless legs syndrome. Everyone with chronic kidney disease should be up-to-date on important vaccinations, including: H1N1 (swine flu) vaccine Hepatitis A vaccine Hepatitis B vaccine Influenza vaccine Pneumococcal polysaccharide vaccine (PPV)

When the loss of kidney function becomes more severe, you will need to prepare for dialysis or a kidney transplant. When you start dialysis depends on different factors, including your lab test results, severity of symptoms, and readiness. You should begin to prepare for dialysis before you need it. Learn about dialysis and the types of dialysis therapies, and how a dialysis access is placed. Even people who are candidates for a kidney transplant may need dialysis while waiting for a kidney to become available.

Support Groups See: Kidney disease - support group

Outlook (Prognosis) Many people are not diagnosed with chronic kidney disease until they have lost most of their kidney function. There is no cure for chronic kidney disease. Untreated, it usually worsens to end-stage renal disease. Lifelong treatment may control the symptoms of chronic kidney disease. Possible Complications Anemia Bleeding from the stomach or intestines Bone, joint, and muscle pain Changes in blood sugar Damage to nerves of the legs and arms (peripheral neuropathy) Dementia Fluid buildup around the lungs (pleural effusion) Heart and blood vessel complications o Congestive heart failure o Coronary artery disease o High blood pressure o Pericarditis o Stroke High phosphorous levels High potassium levels Hyperparathyroidism Increased risk of infections Liver damage or failure Malnutrition Miscarriages and infertility Seizures Swelling (edema) Weakening of the bones and increased risk of fractures

Prevention Treating the condition that is causing the problem may help prevent or delay chronic kidney disease. People who have diabetes should control their blood sugar and blood pressure levels and should not smoke. Alternative Names Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; Chronic kidney failure; Chronic renal failure

References Tonelli M, Pannu N, Manns B. Oral phosphate binders in patients with kidney failure. N Engl J Med. 2010;362:1312-1324. Abboud H, Henrich WL. Clinical practice. Stage IV chronic kidney disease. N Engl J Med. 2010;362:5665. Upadhyay A, Earley A, Haynes SM, Uhlig K. Systematic review: blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med. 2011;154:541-548. KDOQI. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007; 50:471-530. KDOQI; National Kidney Foundation II. Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease in adults. Am J Kidney Dis. 2006;47(5 Suppl 3):S16-S85. Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004; 43(5 Suppl 1):S1-S290.

http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm

Diet For Renal Patient

Fluid & Fluid Control Kidneys help control the amount of fluid that leaves your body. If your kidney disease progresses, your kidneys may be unable to regulate the removal of fluid from your body and as a result your doctor may ask you to limit your fluid intake. Too much fluid may cause swelling, shortness of breath, or high blood pressure. What exactly is a fluid? Fluids are any food that is liquid or anything that melts into a liquid. Examples of fluids include the following: Coffee Tea Sodas Soups Popsicles Ice cream, sherbet Ice cubes Gelatin Milk, liquid creamer Water Wine and beer

If your doctor advises you to decrease the amount of fluids you eat and drink each day these tips may help you.

 Drink only when thirsty. Do not drink out of habit or to be social Eat less salt so you will feel less thirsty Suck on ice chips. (Measure small units into a cup) Brush your teeth three to four times a day; this is to prevent your mouth from drying out Suck on a lemon wedge If you have diabetes, control your blood sugar Chew sugarless gum or suck on sugarless hard candy Take your medications with sips of fluid When dining out, ask your beverage to be served in a child-size glass Measure how much fluid your favorite cup or glass holds so you will be better able to monitor the amount of fluid you drink After measuring out the total amount of fluid you can drink for the day, place the water in a container. During the day drink only from this container so you can keep an eye on the amount of fluid you have consumed.

The Renal Diet- Phosphorus Before making any changes to your diet, make sure you discuss them with your doctor or dietitian. Phosphorus is a mineral that works with calcium to keep your bones healthy and strong. Phosphorus is needed by the body for building and maintaining bones and teeth and for normal nerve and muscle function. When kidney function declines, the body has a difficult time keeping phosphorus and calcium in balance. As a result of this imbalance, the body cannot get rid of excess phosphorus (phosphorus levels increase) and the body cannot take in enough calcium (calcium levels decrease). To try and correct this imbalance the body will steal calcium from the bones, which makes the bones weak. Problems associated with high phosphorus levels include itchy skin, bone and joint pain, and brittle bones. Foods that are high in phosphorus include: Cola Drinks Peanut Butter Cheese Sardines Chicken/beef liver Nuts Caramels Beer Ice Cream

Lower phosphorus food substitutes include: Broccoli Non-dairy milk substitute Sherbet Non-cola soda Zucchini squash Hard Candy

A large serving size of a low phosphorus food can become a high phosphorus food. If your phosphorus level remains high your doctor may prescribe a phosphate binder for you to take. This medication will bind with the phosphorus in the food you eat and prevent phosphorus from being absorbed in the body. It is important that you take this medication exactly as instructed by your doctor.

The Renal Diet- Potassium Before making any changes to your diet, make sure you discuss them with your doctor or dietitian. Potassium helps to keep your nerves and muscles, especially your heart, working properly. Potassium is a mineral and can be found in many foods. The kidneys are responsible for helping to keep the correct amount of potassium in your body. It can be very dangerous if your potassium level is too high. Too much potassium can make your hear beat irregularly or even stop without warning. Foods that are high in potassium include the following: Fruits Vegetables Other Food Bananas Broccoli Chocolate Oranges Potatoes Coffee (limit to 2 cups per day) Cantaloupe Tomatoes Salt Substitute Prunes Mushrooms Bran & bran products Raisins Greens (swiss chard, Nuts & dried fruit Collard, dandelion, Mustard, and beet) Apricots Low-potassium foods include the following: Fruits Vegetables Other Food Apples Beans (green or wax) Rice Grapes Cucumber Noodles Pears Onions Cake Watermelon Lettuce Cereal Cranberries Carrots Bread & bread products Cherries It is important to remember that almost all foods contain potassium. Serving size will determine whether foods are a low, moderate, or high potassium level. A large serving size of a low potassium food can become a high potassium food.

The Renal Diet- Protein Before making any changes to your diet, make sure you discuss them with your doctor or dietitian. Diet plays an important role in the management of kidney disease. The diet your physician will ask you to follow will be based upon your level of kidney function, your body size, and any other medical conditions you may have. Your diet may be helpful in delaying the need for dialysis. Protein is needed to maintain muscles, aid in building resistance to infections, and repair and replace body tissue. As your body breaks down protein foods, waste products called urea are formed. As kidney function declines, urea builds up in the bloodstream. Eating to much protein may cause urea to build up more quickly. This will make you feel sick. Eating less protein may be helpful in reducing your blood urea levels. Reducing protein intake must be monitored by your doctor and dietician. Examples of foods high in protein are: Meat

 Poultry Milk Products Eggs Foods low in protein includes the following: Fresh beans (pinto, kidney, navy) Grains Vegetables You need both high quality and low quality protein in your diet. Your physician will determine how much protein should be in your diet. The Renal Diet- Sodium Before making any changes to your diet, make sure you discuss them with your doctor or dietitian. Sodium is needed by the body for many functions such as controlling muscle contractions, balancing fluids, and controlling blood pressure. Healthy kidneys remove excess sodium in the urine. As kidney function declines, sodium and fluids may accumulate in your body. Fluid retention may cause swelling in your eyes, hands, and/or ankles. To keep your sodium level in balance, your doctor may ask you to limit the sodium in your diet. Foods high in sodium include the following: Table salt Bouillon cubes Potato chips Nuts Bacon Cold Cuts Cheese Canned, dehydrated, or instant soup Canned vegetables Processed dinner mixes (such as Hamburger Helper, Rice-a-Roni) Low sodium alternatives: Season with a variety of spices like garlic and oregano Use lemon

http://www.mcw.edu/Nephrology/ClinicalServices/DietforRenalPatient.htm

Peritoneal dialysis (per-ih-tuh-NEE-ul di-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can no longer do the job adequately. During peritoneal dialysis, blood vessels in your abdominal lining (peritoneum) fill in for your kidneys, with the help of a fluid (dialysate) that flows into and out of the peritoneal space. Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling. You may be able to use fewer medications and eat a less restrictive diet than you can with hemodialysis.

Why is it done Peritoneal dialysis isn't an option for everyone with kidney failure. You need manual dexterity (or a reliable caregiver) and the ability to care for yourself at home. Peritoneal dialysis is often done to manage kidney failure until a kidney transplant is possible. Kidney failure itself usually results from a long-term (chronic) disease that causes kidney damage over a number of years. Common causes of kidney failure include: Diabetes High blood pressure (hypertension) Kidney inflammation (glomerulonephritis) Blood vessel inflammation (vasculitis) Multiple cysts in the kidneys (polycystic kidney disease) Your doctor can help you decide which type of dialysis will work best for you and when you should start, based on several factors: Your overall health Your kidney function (as measured by blood and urine tests) Your personal preferences Your home situation Peritoneal dialysis may be the better option if: You can't tolerate the rapid changes of fluid balance associated with hemodialysis. During hemodialysis, your blood is pumped into a machine to be filtered and then returned to your body. You want to minimize the disruption of your daily activities and work or travel more easily. Peritoneal dialysis might not work for you if: You have extensive surgical scars in your abdomen You have a limited ability to care for yourself or lack caregiving support at home You have inflammatory bowel disease or frequent bouts of diverticulitis

risk
Most people who require dialysis face a variety of serious health problems, including diseases that cause kidney failure as well as kidney failure itself. Dialysis prolongs life for many people, but life expectancy for those who need the procedure is still lower than that of the general population. The main complications of peritoneal dialysis are: Infections. The most common problem for people receiving peritoneal dialysis is peritonitis, an infection of the lining of the abdominal cavity (peritoneum). An infection can also develop at the site where the tube (catheter) is inserted to carry the cleansing fluid into and out of your abdomen. Weight gain. The fluid used to clean your blood in peritoneal dialysis contains sugar (dextrose). You may take in several hundred calories each day by absorbing some of this fluid, known as dialysate. The extra calories can also lead to high blood sugar if you have diabetes. Weakening of the abdominal muscles (hernia). Holding fluid in your abdomen for long periods may strain your belly muscles.

How to prepare
Before you start peritoneal dialysis, you will receive training on what the procedure involves and how to use the equipment. You will need an operation to insert the catheter the thin, soft plastic tube that carries the dialysis solution in and out of your abdomen. You may receive local or general anesthetics for the insertion procedure. Usually the surgeon places the tube near your bellybutton. Your doctor will probably recommend waiting at least two weeks before starting treatment so that the catheter site has time to heal. What can you expect In peritoneal dialysis, a sterile cleansing solution (dialysate) flows through the catheter into your abdomen. The solution stays in your abdomen for a prescribed period of time, known as dwell time. During this dwell time, waste, chemicals and extra fluid in your blood pass from tiny blood vessels (capillaries) in the lining of your abdominal cavity (peritoneum) into the dialysis solution. The solution contains a sugar that draws wastes and extra fluid through the capillaries in your peritoneum into your abdomen. Your belly may feel fuller than usual while the dialysis solution is there, but it's generally not uncomfortable.

When the dwell time is over, the solution, along with waste products drawn from your blood and any excess fluid, drain into a sterile collection bag. The process of filling and draining your abdomen is called an exchange. Different methods of peritoneal dialysis have different schedules of daily exchanges. The two main schedules are continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). Some people use a combination of both methods. Continuous ambulatory peritoneal dialysis (CAPD) With this form of peritoneal dialysis, you fill your abdomen with dialysis solution and later drain the fluid. Gravity moves the fluid through the tube and into and out of your belly. Each exchange includes filling your abdomen with dialysate fluid, letting the fluid dwell in your abdomen, then draining the fluid. You may need three to four exchanges during the day and one with a longer dwell time while you sleep. You can do the exchanges at home, work or any clean place. You're free to go about your normal activities while the dialysis solution dwells in your abdomen between exchanges. Continuous cycling peritoneal dialysis (CCPD) With CCPD, a machine called an automated cycler performs three to five exchanges at night while you sleep. The cycler automatically fills your abdomen with dialysis solution, allows it to dwell there, and then drains it to a sterile drainage bag that you empty in the morning. This gives you more flexibility during the day, but you must remain attached to the machine for 10 to 12 hours at night. In the morning, you begin one exchange with a dwell time that lasts the entire day. You're not connected to the machine during the day. Which form of peritoneal dialysis is best for you depends on your lifestyle, personal preferences and medical condition. You may also customize your program by combining the two forms. For instance, if you are using CCPD, you may do one extra exchange in the afternoon to remove more waste and prevent absorption of too much fluid. Results Many factors affect how well peritoneal dialysis works in removing wastes and extra fluid from your blood. These factors include: Your size

How quickly your peritoneum filters waste (peritoneal transport rate) How much dialysis solution you use (fill volume) The number of daily exchanges Length of dwell times The concentration of sugar (dextrose) in the dialysis solution Your health care team will perform several tests to check if your dialysis is removing enough waste products. These tests are especially important during the first weeks of dialysis to determine whether you're receiving an adequate amount, or dose.

Peritoneal equilibration test (PET). This test measures how much sugar has been absorbed from a bag of used dialysis solution and how much of two waste products urea and creatinine have entered into the solution during a four-hour exchange.

Clearance test. Samples of used dialysis solution and venous blood are collected to compare the amount of urea in the used solution with the amount in the blood. If you still produce urine, your doctor may take a urine sample at the same time to measure its urea concentration. If the test results show that your dialysis schedule is not removing enough wastes, your doctor may change your dialysis routine. This might involve changing the number of exchanges, increasing the amount of solution you use for each exchange or using a dialysis solution with a higher concentration of dextrose. You can improve your dialysis results and your overall health by eating the right foods, including foods low in sodium and phosphorus. A dietitian can help you develop an individualized meal plan based on your weight, your personal preferences, your remaining kidney function and other medical conditions, such as diabetes or high blood pressure. Taking your medications as prescribed also is important for achieving the best possible results. While you're receiving peritoneal dialysis, you'll likely need various medications to control your blood pressure, stimulate production of red blood cells, control the levels of certain nutrients in your blood and prevent the buildup of phosphorus in your blood.

Dialysis: Questions and Answers

If you have chronic kidney disease (CKD) that progresses to end stage renal disease (ESRD), you will want to know all of the dialysis choices that are available to you. Below are some frequently asked questions pertaining to dialysis, such as when it is necessary, how long you can be on it and how often you would need to dialyze.

If I have kidney disease, will I need dialysis?

In the early stages of chronic kidney disease, you do not need dialysis. These early stages can last for many years. But if your kidneys fail, you will need dialysis or a kidney transplant to keep you alive.

If I have kidney disease, how long will it be before I need to start dialysis?
Depending what stage your chronic kidney disease is and how quickly it progresses, you may never need dialysis or you may need dialysis right away. Dialysis is usually recommended when your kidney function is about 10-15% of normal.

Can I take a tour of a dialysis center before I start dialysis?

Yes, that's a great idea. To arrange your tour at a DaVita dialysis center, please call DaVita Guest Services at 1800-244-0680. (Operating hours: 5:00 a.m. - 6:30 p.m. PT / 8:00 a.m. - 9:30 p.m. ET)

My doctor said I will need to go on dialysis in six months to a year. What does this mean?
It is time for you to learn about all the treatment options for kidney failure: peritoneal dialysis (PD), hemodialysis and kidney transplant. You have some choices to make. If you plan to do peritoneal dialysis, which is a home dialysis option, you will need to have a tube surgically placed in your abdomen. If you plan to do hemodialysis, whether in center or at home, you will need to have surgery soon to create a vascular access and allow it to heal. If you want a kidney transplant, you will need to talk with your nephrologist about how to get on the transplant list or ask a friend or family member to donate a kidney.

When should I start dialysis?

National Kidney Foundation guidelines recommend that you start dialysis when your kidney function drops to 15% or less or if you have severe symptoms caused by your kidney disease, like shortness of breath, fatigue, muscle cramps or nausea and vomiting. Your doctor will help you decide, based on lab tests that measure how much kidney function you have left and on your symptoms.

How is dialysis paid for?

Private insurance generally covers treatment for kidney failure whenever your doctor says it is needed. If you don't have private insurance, you may be able to get coverage through federal or state funded healthcare programs, such as Medicare or Medicaid. Most people (about 93% of those who apply) qualify for Medicare when they need dialysis or a transplant, even if they are under age 65. Medicare pays for 80% of treatment for kidney disease when kidney function has dropped to 10-15%, or when your doctor justifies it. If you are not having symptoms, you may be able to wait a bit longer for dialysis. However, some doctors believe that starting dialysis as soon as Medicare or insurance covers it is wise, since it can take a long time to recover if you let yourself get very ill. Since chronic kidney disease often happens slowly, sometimes people do not even know how bad they feel until they start dialysis and begin to feel much better. It is important to start getting ready for dialysis or a transplant well in advance when your kidney disease reaches Stage 4 chronic kidney disease (with glomerular filtration rate, or GFR, less than 30 mL/min). Any type of dialysis will require surgery usually outpatient to create an access for your treatments, and this should be done well in advance to allow time for healing. Learning about the types of dialysis and transplant options will help you make a choice that is best for you. Check out the rest of this website for educational resources from DaVita.

I am in Stage 4 kidney disease and can't have a transplant. Can I do dialysis for the rest of my life?
The questions "How long can someone live?" and "How well can someone live?" are very common when you need to go on dialysis and you're scared. Yes, dialysis is something you can do for the rest of your life. And, most people on dialysis enjoy a good quality of life. Some people have been on dialysis for 30 years or more without getting a transplant. How long you can live on dialysis, and how well you do, will depend on a number of things, including:

How healthy you are, other than kidney disease How positive your attitude is (optimists live longer, depression can be treated) Whether you receive good quality medical care and dialysis How much you learn about dialysis and take an active role in your care.

Nobody lives for 30 years or more on dialysis by accident it takes a lot of knowledge and effort. You are doing the right thing by visiting this website. Sign up for kidney classes. You may also want to check into joining a kidney patient organization, like a chapter of the National Kidney Foundation at: http://www.kidney.org, or the American Association of Kidney Patients at: http://www.aakp.org or learn more about kidney disease by visiting Kidney School at: http://www.kidneyschool.org.

If I start hemodialysis, how often will I have to get treatments?

The usual schedule for in-center hemodialysis treatments is three times a week, either Mon/Wed/Fri or Tues/Thurs/Sat. You will have the same morning or afternoon time for each treatment. The length of your treatment depends on what your doctor prescribes for you. Three to four hours is common, plus time to travel to and from the center, and often some waiting time when you arrive. If you don't like the treatment schedule you get, you can ask to be on a waiting list for a different time, or switch to a different center.

If I start PD, how often will I have to get treatments?

Peritoneal dialysis (PD) is most commonly done on a nightly basis using an automated cycler machine while a person sleeps. A patient will typically be connected to the cycler for 8 to 10 hours each night and be free of dialysis during the day. Some people will choose to do manual PD, which usually means doing four to five exchanges per day. Each exchange takes 20 to 30 minutes, and they need to be spread out over the whole day to clean the blood well. A common manual PD schedule might be to do one exchange upon waking, one at lunchtime, one at dinner, and one at bedtime. A cycler can be used together with a manual exchange. The cycler can be used at night with only one exchange during the day.

Summary
When chronic kidney disease progresses to kidney failure, dialysis is a treatment that replaces kidney function to help people live a quality life. There are several dialysis treatment options available. Talk to your doctor about the types of dialysis and which one would be best for your health and lifestyle needs.

A kidney transplant is an operation that places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, so you no longer need dialysis. During a transplant, the surgeon places the new kidney in your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Often, the new kidney will start making urine as soon as your blood starts flowing through it. But sometimes it takes a few weeks to start working. Many transplanted kidneys come from donors who have died. Some come from a living family member. The wait for a new kidney can be long. If you have a transplant, you must take drugs for the rest of your life, to keep your body from rejecting the new kidney.