1. When is dialysis needed?

You need dialysis if your kidneys no longer remove enough wastes and fluid from your blood to keep you healthy. This usually happens when you have only 10 to 15 percent of your kidney function left. You may have symptoms such as nausea, vomiting, swelling and fatigue. However, even if you don't have these symptoms yet, you can still have a high level of wastes in your blood that may be toxic to your body. Your doctor is the best person to tell you when you should start dialysis.

2. What does dialysis do?

Like healthy kidneys, dialysis keeps your body in balance. Dialysis does the following:

• removes waste, salt and extra water to prevent them from building up in the body
• keeps a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate
• helps to control blood pressure

3. Are there different types of dialysis?

Yes, there are two types of dialysis --hemodialysis and peritoneal dialysis.

4. What is hemodialysis?

In hemodialysis, an artificial kidney (hemodialyzer) is used to remove waste and extra chemicals and fluid from your blood. To get your blood into the artificial kidney, the doctor needs to make an access (entrance) into your blood vessels. This is done by minor surgery to your arm or leg.

Sometimes, an access is made by joining an artery to a vein under your skin to make a bigger blood vessel called a fistula.

However, if your blood vessels are not adequate for a fistula, the doctor may use a soft plastic tube to join an artery and a vein under your skin. This is called a graft.

Occasionally, an access is made by means of a narrow plastic tube, called a catheter, which is inserted into a large vein in your neck. This type of access may be temporary, but is sometimes used for long-term treatment.

5. How long do hemodialysis treatments last?

The time needed for your dialysis depends on:

• how well your kidneys work
• how much fluid weight you gain between treatments
• how much waste you have in your body
• how big you are
• the type of artificial kidney used

Usually, each hemodialysis treatment lasts about four hours and is done three times per week.

6. What is peritoneal dialysis and how does it work?

In this type of dialysis, your blood is cleaned inside your body. The doctor will do surgery to place a plastic tube called a catheter into your abdomen (belly) to make an access. During the treatment, your abdominal area (called the peritoneal cavity) is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate. There are two major kinds of peritoneal dialysis.

7. What are the different kinds of peritoneal dialysis and how do they work?

There are several kinds of peritoneal dialysis but two major ones are: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD).

Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. You do this yourself, usually four or five times a day at home and/or at work. You put a bag of dialysate (about two quarts) into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange. You use a new bag of dialysate each time you do an exchange. While the dialysate is in your peritoneal cavity, you can go about your usual activities at work, at school or at home.

Continuous Cycling Peritoneal Dialysis (CCPD) usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2 hours and exchanges are done throughout the night while you sleep.

8. Can dialysis cure my kidney disease?

In some cases of sudden or acute kidney failure, dialysis may only be needed for a short time until the kidneys get better. However, when chronic kidney disease progresses to kidney failure over time, your kidneys do not get better and you will need dialysis for the rest of your life unless you are able to receive a kidney transplant.

9. Is dialysis uncomfortable?

You may have some discomfort when the needles are put into your fistula or graft, but most patients have no other problems. The dialysis treatment itself is painless. However, some patients may have a drop in their blood pressure. If this happens, you may feel sick to your stomach, vomit, have a headache or cramps. With frequent treatments, those problems usually go away.

10. Is dialysis expensive?

Yes. Dialysis costs a lot of money. However, the federal government pays 80 percent of all dialysis costs for most patients. Private health insurance or state medical aid also help with the costs.

11. Do dialysis patients feel normal?

Many patients live normal lives except for the time needed for treatments. Dialysis usually makes you feel better because it helps many of the problems caused by kidney failure. You and your family will need time to get used to dialysis.

12. Do dialysis patients have to control their diets?

Yes. You may be on a special diet. You may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis.

13. Can dialysis patients travel?

Yes. Dialysis centers are located in every part of the United States and in many foreign countries. The treatment is standardized. You must make an appointment for dialysis treatments at another center before you go. The staff at your center may help you make the appointment.

14. Can dialysis patients continue to work?

Many dialysis patients can go back to work after they have gotten used to dialysis. If your job has a lot of physical labor (heavy lifting, digging, etc.), you may need to get a different job.