FAQ About Starting Dialysis

When will I need to start dialysis?

Patients usually begin dialysis when kidney function is 15% or less or when severe symptoms, such as nausea/vomiting, fatigue, and shortness of breath develop. If your kidneys are still functioning, it’s important to prepare and learn about dialysis early so you can make the choices that are right for you. If you are interested in a transplant, take a look at these frequently asked questions about getting a kidney transplant.

What are the different types of dialysis?

The two main types of dialysis are hemodialysis and peritoneal dialysis. Both hemodialysis and peritoneal dialysis require a surgical procedure to create an access point so that dialysis can be performed.

With hemodialysis, your blood is removed from your body, filtered and cleaned by a machine that acts as an artificial kidney, and returned to the body free of toxic wastes, salts, and excess fluid. Patients on hemodialysis follow a strict diet with limited liquids.

Most patients have hemodialysis in a center three days a week for around four hours per treatment. Hemodialysis can also be done in your home using a special machine. There are other less traditional in-center hemodialysis options that include:

Self Care Dialysis – You and perhaps a partner are trained to help administer your treatments.

Nocturnal Dialysis – Treatments are performed by professionals in the center while you sleep.

With peritoneal dialysis (PD), the peritoneum, a semi-permeable membrane in your abdomen, is used to filter the wastes, salts, and excess fluids from your bloodstream. A fluid called dialysate is inserted into the peritoneal cavity and draws wastes and excess fluid from your blood into the cavity.  After several hours, the used dialysate is removed and new dialysate is exchanged so the cleansing process can begin again. Four to five of these exchanges are performed per day. Patients receive several training sessions with a dialysis nurse before they perform PD on their own or with the help of a partner. Peritoneal dialysis can be done anywhere—at home, at work, on vacation. Not all patients are able to do PD because of health issues. If you are on PD, you may be able to take fewer medications and eat a less restrictive diet because of the more frequent cleansing of your blood.

How do I choose a dialysis center?

As a kidney patient, it’s important to take an active role in your healthcare. There are a number of things to consider when choosing a center. You will want to visit centers and consider the distance from your home, center cleanliness, center hours, flexible treatment scheduling, visitor policy, education programs, treatment offerings, availability of patient support groups, etc. Talk with the staff and ask questions. You’ll want to find caregivers who are friendly and willing to answer your questions and take the time to give you a tour of the center. Keep in mind that if you choose peritoneal or home hemodialysis, you’ll still visit the dialysis center about once a month to meet with your healthcare team and review your lab results.

Before visiting dialysis centers, you can print out a Dialysis Facility Comparison Checklist to help with your decision making process.

How do I pay for dialysis?

For the first 30 to 33 months, your private health insurance pays for dialysis. Medicare pays for some or all of the remainder that your primary insurance doesn’t cover. After 30 to 33 months, Medicare becomes your primary insurer and your private health insurance is secondary. If you don’t have health insurance, you can apply for Medicare or Medicaid coverage. You can talk to a dialysis or transplant social worker to get help with questions about how much your insurance covers and how much your copay will be.

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