Stages of Chronic Kidney Disease (CKD) | |||
---|---|---|---|
CKD stage | eGFR number | disease severity | degree of kidney function |
stage 1 | over 90 | mild kidney damage | More than 90% of normal capacity |
Step 2 | 60~89 | early kidney disease | 60-89% of normal capacity |
Step 3a | 45~59 | moderate kidney disease | 45-59% of normal capacity |
Step 3b | 30~44 | Moderate to severe kidney disease | 30-44% of normal dose |
Step 4 | 15~29 | serious kidney disease | 15-29% of normal dose |
Step 5 | 15 or less | end stage renal disease | Less than 15% of normal dose |
Home dialysis and hospital dialysis
People who can do dialysis at home are generally healthier than people who need dialysis in a hospital. Critically ill patients with acute kidney injury (AKI) often receive dialysis upon admission to a hospital intensive care unit (ICU). Very sick CKD patients with stage 5 kidney failure may receive dialysis in an intensive care unit.
Deciding not to have dialysis
For some people, the burdens of dialysis outweigh the benefits. Everyone has a choice when deciding whether to get dialysis or not. Some people decide not to do it. In fact, a VA study conducted over a 10-year period from 2000 to 2011 found that about 1 in 7 veterans with end-stage renal disease refuse dialysis.
After starting dialysis: What happens?
Although there are commonalities, responses to dialysis are diverse and heterogeneous. Everyone's experience will be unique. That said, here are some common features of starting central hemodialysis (ICHD):
from beginning to end
During dialysis, a dialysis nurse inserts a needle into a special catheter in the arm, called an arteriovenous fistula, to access the blood supply. The blood is then removed through a needle and filtered by a machine that acts as an artificial kidney, filtering waste and other harmful substances from the bloodstream. Typically, dialysis is performed three times a week.
It is common to feel exhausted after a dialysis session. Please consider this when planning transportation to and from the dialysis center. You may feel too tired or dizzy to drive immediately after your session. Recovery time varies from person to person, but some people feel refreshed within about 30 minutes and can safely drive a car once dizziness or blurred vision subsides.
Feeling bad after treatment is also called a “dialysis hangover.” Just as a hangover after drinking a lot of alcohol gradually disappears throughout the day, people who wake up with a hangover the morning after dialysis often feel much better by the early afternoon of the next day.
Symptoms and Side Effects You Should Know
Below is a list of common symptoms and side effects associated with dialysis.
Dialysis timing and frequency
Most people still receive HD treatment at the center during the day. However, some people choose to use a home machine that gives them nocturnal dialysis while they sleep in their own bed, or choose a long-term nocturnal dialysis center where they can do nocturnal dialysis for longer.
More and more people who are physically and cognitively able to perform peritoneal dialysis at home on their own are choosing this option. Home PD can be performed in short bursts of 30 to 40 minutes throughout the night, giving people more flexibility and control over their daily schedule.
Logistically, home PD becomes much more convenient and saves time as there is no need to drive to a dialysis center. For many people who live in rural areas, driving to and from a dialysis center can add an hour or two to the four-hour treatment time. Additionally, it often takes about 30 minutes to prepare and conclude a therapy session within each center.
Including transportation, daily in-center HD treatment can take six hours or more, well beyond the typical four hours on a dialysis machine.
People can receive dialysis for years. It is not uncommon for people waiting for a kidney transplant to be on dialysis for four years or more. Depending on the age at which you begin dialysis, you may receive this kidney replacement therapy for several years.
Survival rate and life expectancy
Life expectancy with dialysis depends on comorbidities (co-occurring health conditions), age, and response to treatment. The average life expectancy for people receiving dialysis is 5 to 10 years, but it is not uncommon for people to live more than 20 years on dialysis. For many people, dialysis is a lifeline that keeps them alive for years while waiting for a kidney transplant. Patients with kidney failure who are ineligible for a transplant or who come off dialysis may have a survival rate of only 7 to 10 days. However, some people who receive palliative care or hospice care survive for several weeks or months, depending on factors such as age or severity of the disease.
How to Manage Dialysis-Related Effects
Everyone experiences slightly different dialysis-related side effects. For example, some people may feel too cold during in-center hemodialysis and may bring extra blankets and wear hats to keep warm. Other people do not feel cold during ICHD.
Itchy skin is another side effect that many people experience. The causes of itching in dialysis patients can be complex and difficult to treat.
Having your nephrologist determine the optimal dialysis dose to adjust your dialysis dose and reduce itching may help you manage these side effects. Maintaining a healthy skin barrier with the right moisturizer can help relieve itching. In some cases, antihistamines relieve symptoms.
Some people may experience muscle cramps during hemodialysis if too much fluid is removed in the final hours of HD. In this case, you may want to talk to your nephrologist about ways to adjust your target dry weight (the patient's weight at the end of a dialysis session) and remove less water.
Dialysis before transplant
For people eligible for a kidney transplant on the waiting list, the median duration of dialysis is four years. The average wait time for a viable kidney in the United States is 3 to 5 years, depending on where you live.
In some parts of the country, waiting times are longer, meaning people with end-stage kidney disease will spend much longer on dialysis before treatment.
Adjusting to Life on Dialysis
A social worker can help you adjust to life on dialysis. Federal law requires every dialysis center in the United States to have a social worker on staff. Also known as kidney social workers, these professionals provide guidance as you navigate the uncharted physical and mental terrain associated with dialysis treatment.
Your social worker is an important part of your dialysis treatment team and has the knowledge to help you manage both the mental and physical side effects of your treatment. Kidney social workers also serve as administrative assistants who can help with financial and insurance-related issues.
summary
The kidneys filter and clean the blood. When the kidneys stop functioning, dialysis performs this function. Dialysis can add years to someone's life, but it's not easy. Some people choose not to get dialysis if they are older or ineligible for a kidney transplant. Ideally, dialysis is a way to extend the lives of people on the kidney transplant waiting list, which typically takes several years.
There are various types of dialysis and treatment methods. If you have advanced chronic kidney disease, it is wise to start deciding on dialysis before kidney failure occurs. It could take 3-6 months to get everything sorted out, and you want to have time to think about all your options.