NHS A-Z Condition - Dialysis

Dialysis

Dialysis

Dialysis is a form of treatment that replicates many of the kidney’s functions. It is often used to treat advanced chronic kidney disease, where the kidneys have lost most or all of their function. This is known as kidney failure or end stage renal disease.

The kidneys

The kidneys are two bean-shaped organs that are located at the back of the abdomen, behind the liver and intestines.

Every day the kidneys filter your blood, removing waste products collected as part of normal bodily functions, along with any excess fluid. The waste products and excess fluid become urine, which is stored in the bladder until you go to the toilet.

Why do I need dialysis?

If your kidneys stop working properly, waste products build up and cause symptoms including:

  • vomiting
  • itchy skin
  • fatigue (extreme tiredness)
  • blood in the urine (haematuria)
  • swollen feet, hands and ankles

Without necessary treatment such as dialysis, kidney failure will eventually prove fatal. 

How long is a person on dialysis?

Many people will remain on dialysis on a long-term basis (possibly for the rest of their lives) but for a significant minority the goal will be a kidney transplant. 

A person who is a suitable candidate for a kidney donation only has to be on dialysis until a donated kidney becomes available. This can range from a few months for people who have a relative willing to provide a living donation, to around three years for people waiting for a deceased kidney donation to become available.

For people who are not suitable for a kidney transplant because of another serious health condition, such as cancer or severe heart disease, will need to be on dialysis for the rest of their lives. Often this is a safer option than a transplant.

Types of dialysis

There are two types of dialysis:

  • haemodialysis
  • peritoneal dialysis

Haemodialysis

Haemodialysis is the type of dialysis that most people are aware of. It involves inserting a needle, which is attached by a tube to a dialysis machine, into a blood vessel.

Blood is transferred from your body into the machine, which filters out waste products and excess fluids. The filtered blood is then passed back into your body.

Most people require three sessions a week, each lasting four hours.

Peritoneal dialysis

Peritoneal dialysis is a less well known type of dialysis, but it's becoming more common. It involves using the peritoneum as a filter.

The peritoneum is a thin membrane that lines the inside of the abdomen and surrounds and supports the abdominal organs, such as the stomach and liver. Like the kidneys, the peritoneum contains thousands of tiny blood vessels, making it useful as a filtering device.

During peritoneal dialysis, a small flexible tube, known as a catheter, is attached to an incision in your abdomen. A special fluid called dialysis fluid is pumped into the space that surrounds your peritoneum (the peritoneal cavity).

As blood moves through the peritoneum, waste products and excess fluid are moved out of the blood and into the dialysis fluid. The dialysis fluid is then drained from the cavity.

The process of peritoneal dialysis lasts roughly 30 to 40 minutes and is repeated around four times a day. Alternatively, you can run it overnight.  

Which type of dialysis?

In many instances the choice of which type of dialysis you use is up to you. However, there are some medical problems that can mean a method is unsuitable or less suitable (for example, a previous major operation on your abdomen).

There are usually no right or wrong answers when it comes to choosing between haemodialysis and peritoneal dialysis, and it is possible to change from one type of treatment to another. You can discuss this with your care team.

Both haemodialysis and peritoneal dialysis achieve similar results. However, there are some situations where a particular technique would be recommended.

For example, peritoneal dialysis is usually recommended for adults who are otherwise healthy apart from having kidney disease. Haemodialysis is usually recommended for older adults whose health is poor. 

Both types of dialysis can be carried out at home, which means you don't have to visit hospital or a dialysis unit. Some people feel that this is a big advantage while others find the prospect daunting and prefer the regular contact they have with staff at the dialysis unit or at hospital.

Read more about the advantages and disadvantages of both types of dialysis.

Side effects

There are different side effects for haemodialysis and peritoneal dialysis but they can both make you feel exhausted.

Haemodialysis can also cause itchy skin and muscle cramps while a common side effect of peritoneal dialysis is infection of the peritoneum with bacteria, known as peritonitis.

Who uses dialysis?

Dialysis is a relatively common type of treatment. Each year, in England, around 5,500 people experience kidney failure and there are currently around 41,000 people receiving treatment for kidney failure. Of those affected:

  • around half are treated with a kidney transplant
  • around 4 out of 10 are treated with haemodialysis
  • around 1 out of 10 are treated with peritoneal dialysis

Most people who have dialysis are over 65 years of age.

NHS availability

Most major cities have dedicated dialysis units that can provide haemodialysis. There are also many smaller dialysis units based in hospitals and clinics across England. You can find a renal unit near you using our service search.

Results

Dialysis is a potentially life-saving treatment for people who would otherwise experience significant disability, pain and eventually death. However, how successful the results of dialysis are depends on a number of factors. 

Although dialysis is a demanding treatment, which requires considerable personal discipline, many patients achieve a good quality of life and some carry on in full or part-time employment.

In the past, people on dialysis did have a limited life expectancy. However, due to advancements in treatment the average life expectancy of people on dialysis has increased and is expected to continue to increase in the future.

The average life expectancy of younger people who are in their twenties is 20 years and this should improve in the future. Some people have been on dialysis for more than 30 years.

Why

The kidneys contain millions of tiny filters called nephrons. As blood passes through the kidneys, nephrons filter out any excess fluid and waste products that are released from the body as urine. However, if the nephrons become damaged, the kidneys can lose their ability to filter and dangerous levels of fluid and waste products can build up.

Kidney failure occurs when the kidneys have lost around 90% of their filtering ability. Left untreated, the amount of waste products in the blood will build up to a dangerous level, resulting in coma and then death.

A kidney transplant is the ideal treatment for kidney failure. However, many people have to wait several months or years before a suitable donated kidney becomes available so dialysis is used.

Some people are not suitable for a kidney transplant because they have another serious health condition, such as heart failure or cancer. This usually means that it is unlikely they will survive the transplant procedure.

People who aren't suitable for a kidney transplant will require dialysis treatment for the rest of their lives.

Common causes of kidney failure

Common causes of kidney failure include:

  • diabetes
  • chronic inflammation of the kidneys (glomerulonephritis)
  • high blood pressure (hypertension)

These are described below.

Diabetes

Diabetes is a condition where the body either does not produce enough insulin (type 1 diabetes), or does not make effective use of it (type 2 diabetes).

Insulin is vital because it breaks down the glucose in the blood to produce carbohydrate, which provides energy.

If you have diabetes that is not properly controlled, too much glucose can build up in your blood. The excess glucose can damage the tiny filters (nephrons) inside your kidneys.

The damaged nephrons can disrupt your kidney’s ability to filter out waste products and fluids from your blood.

Glomerulonephritis

Glomerulonephritis is a condition where tiny structures inside the kidneys, known as the glomeruli, become inflamed.

The glomeruli are an important part of the nephrons and persistent inflammation of the glomeruli will lead to them scarring. This can disrupt your kidney’s ability to filter and clean the blood of waste products.

Glomerulonephritis can be caused by the immune system (the body’s natural defence against infection and illness) mistaking harmless proteins inside the kidneys as a threat and, as a result, attacking the kidneys, leading to inflammation.

In many cases there is no obvious reason why glomerulonephritis occurs.

High blood pressure

Blood pressure is a measurement of how much pressure is required by your heart to pump blood around your veins and arteries. Too much pressure is known as high blood pressure or hypertension and can damage your body's organs and lead to heart disease.

Hypertension also causes kidney damage by putting strain on the small blood vessels in the kidneys. This prevents the filtering process from working properly.

In 90% of cases of high blood pressure, the causes are unknown. However, there appears to be a strong link between the condition and lifestyle factors, such as being overweight, having a diet that is high in salt, smoking and drinking too much alcohol.

Other causes

Other, less common causes of kidney failure include:

  • polycystic kidney disease: a genetic (inherited) condition where cysts (fluid-filled sacs) develop inside the kidneys
  • repeated kidney infections
  • renal artery disease: a condition where the arteries that supply blood to the kidneys become clogged up with fatty substances known as plaques; a reduced blood supply can damage the kidney’s tissues

When

Dialysis will usually be recommended if you have symptoms that suggest that your kidneys have lost most of their ability to filter and the levels of waste products in your blood are dangerously high. The medical term for this situation is uremia.

Uremia

Uremia is where your blood contains many of the waste products that are usually passed out of your body when you urinate.

The initial symptoms of uremia are prolonged fatigue (tiredness) and drowsiness. You may then experience symptoms such as itchy, dry or flaky skin.

Other symptoms of uremia include:

  • an unpleasant metallic taste in your mouth
  • an unpleasant ammonia smell on your breath (ammonia is a chemical that smells like stale urine)
  • loss of appetite
  • feeling sick
  • being sick
  • muscle cramps
  • problems sleeping (insomnia)
  • mental confusion
  • seizures (fits)

Filtration rate

In some cases, if tests shows that your kidneys have lost much of their filtering ability, dialysis may be recommended, regardless of whether you have started to experience the symptoms of uremia.

Dialysis is often recommended for people with diabetes, as the combination of diabetes and uremia could lead to serious complications developing, such as nerve damage or malnutrition.

Diagnosing chronic kidney disease is done by assessing the filtering ability of the kidneys using a measurement called the glomerular filtration rate (GFR). The GFR measures how many millilitres of blood your kidneys are able to filter over a given time.

Using a blood test, GFR can be estimated to a reasonably high degree of accuracy. A person with healthy kidneys would have a GFR of 90 or above.

A GFR of below 15 would indicate kidney failure or near kidney failure and dialysis treatment will probably be recommended.

How it is performed

Haemodialysis

If you decide to have haemodialysis, the first step usually involves creating an arteriovenous fistula (AV fistula). This is a surgically modified blood vessel that is created by connecting an artery to a vein. The fistula is usually created in your wrist and upper arm.

Creating a fistula by joining a vein and artery together makes the blood vessel larger and stronger. This makes it easier to transfer your blood into the dialysis machine and then back again.

The operation to create the AV fistula is usually carried out six weeks before haemodialysis begins because this allows the tissue and skin surrounding the fistula to heal.

If your blood vessels are too narrow to create an AV fistula, an alternative operation known as an AV graft may be recommended. This involves using a piece of synthetic tubing, known as a graft, to connect an artery to a vein.

As a short-term measure, or if haemodialysis is suddenly required due to a medical emergency, you may be given a neck line. This is where a small tube is inserted into a vein in your neck. Once the AV fistula has been created and has had time to heal, the neck line can be removed.

The haemodialysis process

Most people require three sessions of haemodialysis a week with each session lasting for four hours. A dialysis session takes at least four hours to complete because your blood needs to be removed and then replaced slowly.

At the start of the session, your blood pressure, skin temperature and pulse will be measured. If you decide to have dialysis at home, you will be trained to take these measurements yourself.

Two thin needles will be inserted into your AV fistula or graft and taped into place. One needle will slowly remove blood and transfer it to a machine known as a dialyser or dialysis machine. The dialysis machine contains a series of membranes that act as filters and a special liquid called dialysate.

The membranes filter out waste products from your blood, which are passed out into the dialysate fluid. The ‘dirty’ dialysate fluid is pumped out of the dialyser and the ‘clean’ blood is passed back into your body through the second needle. It would be too dangerous to remove large amounts of blood in one go, so only 40-50ml (two fluid ounces) of blood is removed at any one time.

During your dialysis sessions, you will sit or lie on a couch, recliner or bed. You will be able to read, listen to music, use your mobile phone or sleep. Children who have haemodialysis often find that playing on a mobile games console is an enjoyable way to pass the time.

Haemodialysis is not painful, although some people experience symptoms of nausea, dizziness and muscle cramps during dialysis. This is due to the rapid changes in blood fluid levels that occur during dialysis.

After the dialysis session has been completed, the needles are removed and a plaster is applied to prevent bleeding.

Haemodialysis and fluid intake

If you are having haemodialysis, the amount of fluid that you can drink will be severely restricted.

This is because your kidneys are not working properly. The haemodialysis process itself also limits the amount of fluid you can drink.

Over the course of a day, healthy kidneys constantly remove excess fluid from the body. However, during the haemodialysis process, two to three days' worth of fluid is removed over the course of four hours.

If you drink too much, the dialyser will be unable to remove all of the fluid and excess fluid will build up in your blood, tissues and lungs. This can be serious and lead to:

The amount of fluid that you are allowed to drink will depend on your weight and your body size. Most people are only allowed to drink between 1,000-1,500ml (two to three pints) of fluid a day.

You will also need to avoid eating foods that have a high fluid content such as:

  • soup
  • ice cream
  • melons
  • oranges
  • tomatoes

Many people who are having haemodialysis find that the restriction on drinking fluids is one of the most challenging aspects of living with dialysis. You may find that chewing gum or sucking an ice cube can help to alleviate your symptoms of thirst.

Haemodialysis and diet

As well as removing waste products, your kidneys help to regulate the amount of minerals that are in the body including:

  • sodium (salt)
  • potassium
  • phosphorus

These minerals are removed during haemodialysis. However, the levels of each mineral can build up rapidly between dialysis sessions, particularly if you eat foods that are high in potassium, phosphorus or sodium.

Excess levels of any of these minerals can be dangerous and lead to:

  • seizures and coma
  • osteoporosis (weakness of the bones)
  • an irregular heart beat (arrhythmia) and, in the most serious cases, sudden death 

Before having haemodialysis you will be referred to a dietitian so that a suitable diet plan can be drawn up for you. Diet plans will differ from person to person, but it is likely that you will be asked to avoid foods that are high in potassium and phosphorus and cut down the amount of salt you eat.

Foods that are high in salt include:

  • ready-to-eat meals (including ready-to-eat sandwiches)
  • bacon
  • ham
  • smoked fish
  • cheese

Foods that are high in potassium include:

  • bananas
  • baked potatoes
  • oranges
  • chocolate

Foods that are high in phosphorus include:

  • dairy products, such as cheese
  • yoghurt
  • baked beans
  • lentils
  • sardines
  • bran cereals

Peritoneal dialysis

As with haemodialysis, the first stage in peritoneal dialysis is to create an access point. This is so that the dialysate fluid can pass through your peritoneal cavity.

To create an access point, an incision will be made in your abdomen, usually just below your navel (belly button). A piece of equipment called a Tenckhoff catheter will be inserted into the incision.

A Tenckhoff catheter is a thin piece of tube that is about 10cm (four inches) long. The dialysate fluid is passed through the catheter and into the peritoneal cavity. After a dialysis session is finished, the end of the catheter will be sealed. You will be shown how to keep the catheter clean to prevent peritonitis (infection of the peritoneum) occurring.

The Tenckhoff catheter is permanently attached to your abdomen which many people find upsetting. If you are unable to get used to the catheter, you can have it removed and you can switch to haemodialysis.

Types of peritoneal dialysis

There are two main types of peritoneal dialysis:

  • continuous ambulatory peritoneal dialysis (CAPD): where your blood is filtered several times during the day
  • automated peritoneal dialysis (APD): where a machine filters your blood during the night as you sleep

Continuous ambulatory peritoneal dialysis

 The equipment that is used to perform CAPD consists of:

  • a bag containing the dialysate fluid
  • an empty bag that is used to collect waste products
  • a series of tubing and clips used to secure both bags to the catheter
  • a wheeled stand that you can hang both bags from

CAPD involves exchanging old dialysate fluid that contains waste products and excess fluids with new dialysate fluid.

An exchange begins by draining out the old fluid into the waste bag. The new fluid is then drained into your peritoneal cavity. The process is painless and takes around 30 to 40 minutes to complete.

The new fluid is left in the peritoneal cavity for a number of hours (you will be advised about what the best length of time for you is).

As blood passes through the peritoneum, special chemicals in the dialysate fluid draw out waste products and excess fluid from the blood into the fluid. After the set number of hours has passed, you will begin the process again, exchanging the old fluid for the new fluid. Most people who use CAPD require four exchanges a day.

You will be given full training in how to perform both types of draining, as well as detailed instructions about how to keep all of the equipment clean to prevent peritonitis (infection of the peritoneum).

Automated peritoneal dialysis (APD)

Automated peritoneal dialysis (APD) works on the same principles as CAPD, except that a machine is used to control the drainage of fluid. You fill the APD machine with fluid before you go to bed. As you sleep, the machine automatically performs a number of exchanges.

You usually have to be attached to the APD machine for eight to 10 hours. You then usually have one last fill of fluid that you keep in your cavity all day before it is drained away the following evening. An exchange can be temporarily interrupted if, for example, you need to get up to go to the toilet.

Some people who have APD worry that a power cut or other technical problem could be  dangerous. However, it is usually safe to miss one night’s worth of exchanges as long as you resume treatment within 24 hours.

You will be given the telephone number of a 24-hour hotline that you can use if you experience technical problems. 

Dialysis and pregnancy

If you become pregnant while having dialysis, it is usually recommended that you are treated with haemodialysis at a dialysis unit (if you're not being treated already). This will enable your condition to be regularly monitored.

Research has found that pregnant women who are treated with haemodialysis have a healthier pregnancy than women who are treated with peritoneal dialysis.

It is likely that the number of haemodialysis sessions will need to be increased as a precaution to protect the baby from any waste products in your blood. Most pregnant women require five to six sessions a week rather than the three sessions that most people have.

Equipment

If you are having home haemodialysis or peritoneal dialysis, it's important that you keep additional supplies of equipment in case an emergency or adverse weather conditions mean that you are unable to obtain supplies.

Many experts recommend that you keep a week’s worth of equipment as an emergency backup supply. You should also let your electrical company know if you're using home haemodialysis or automated peritoneal dialysis. This is so they can treat you as a priority in the event that your electrical supply is disrupted.

Pros and cons

Deciding on a dialysis plan

If dialysis is recommended to you, you will have to decide whether you want haemodialysis or peritoneal dialysis. Both methods have the same levels of effectiveness, so the choice is usually a case of personal preference.

However, there may be some circumstances where a particular type of dialysis is recommended.

For example, peritoneal dialysis is usually recommended as the first form of treatment for:

  • children who are two years of age or above
  • people who still have some limited kidney function
  • adults who do not have other serious health conditions, such as heart disease or cancer

Haemodialysis is usually recommended for people who can't cope with carrying out peritoneal dialysis, such as those who:

If you choose to have haemodialysis, you then will have to decide whether you want to receive treatment at home or visit a local hospital or dialysis unit for treatment.

If you choose to have peritoneal dialysis, you will have to decide whether you want continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD).

Any decision you make about which treatment method to have will not be final and it's possible to move from one treatment option to another. Also, depending on your health, you may have to be treated with haemodialysis at some point in the future because peritoneal dialysis may no longer be a safe or suitable treatment for you.

Haemodialysis

The main advantage of haemodialysis is that you have four dialysis-free days a week.

Haemodialysis usually involves using the dialysis machine three times a week, with each dialysis session usually lasting for about four hours. Therefore, you will have to plan your life around your dialysis sessions.

If you travel to another country, you will have to pre-arrange access to dialysis facilities. If you are planning to travel, you should inform the staff at your dialysis centre well in advance as they may be able to arrange for you to be referred to a dialysis unit at your destination.

The Global Dialysis website has a database of dialysis units across the world. However, many of these units may charge a fee.

Another disadvantage of haemodialysis is that your diet and the amount of fluid that you drink needs to be restricted. For example, many people receiving haemodialysis have to avoid foods that are high in potassium, such as bananas, chocolate and crisps, and they are usually advised not to drink more than a couple of cups of fluid a day.

Read more about how dialysis is performed for more information and advice regarding diet and fluid intake.

Peritoneal dialysis

Unlike haemodialysis, the obvious advantage of peritoneal dialysis is that regular visits to a dialysis unit are not required and, in the case of home haemodialysis, there is no need to have a bulky machine installed in your house.

As the equipment that is used for peritoneal dialysis is portable, you have more freedom to travel compared with haemodialysis patients.

CAPD equipment is roughly the size of a hat stand on wheels. The equipment used for APD is the size and weight of a small suitcase.

Another advantage of peritoneal dialysis is that there are fewer restrictions on diet and fluid intake compared with haemodialys where there are strict limits on the amount of fluids that you can drink.

One of the main disadvantages of peritoneal dialysis is that you need to perform it every day, whereas haemodialysis is usually only performed three days a week.

Another major disadvantage of peritoneal dialysis is that your risk of developing peritonitis (infection of the peritoneum) is increased.

Peritonitis causes symptoms that include:

  • abdominal pain
  • vomiting
  • chills (episodes of shivering and cold)

Repeated episodes of peritonitis can damage the peritoneum and surgery may be required to repair it.

Another drawback of peritoneal dialysis is that the dialysis fluid used can cause a reduction in protein levels, which can lead to a lack of energy and in some cases malnutrition.

Weight gain is another possible side effect of peritoneal dialysis that affects some people.

Continuous and automated peritoneal dialysis

The two types of peritoneal dialysis are continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD).

CAPD does not involve using a machine. Instead, portable equipment is used, which includes a dialysis bag that contains fluid and a number of tubes.

With CAPD, you carry out regular dialysis sessions during the day. The sessions are known as exchanges because clean fluid is exchanged with fluid that contains waste products. Most people using CAPD have four exchanges a day, with each exchange lasting between 30 and 40 minutes.

APD involves using a dialysis machine, although it is much smaller than the one used in haemodialysis. Dialysis is performed during the night as you sleep, with a session lasting between eight and 10 hours.

The main advantage of using CAPD is that the equipment is portable. This gives you more freedom to travel away from your house. For example, you may be able to take your CAPD equipment to your workplace. However, you will need to spend at least two hours a day performing dialysis.

The main advantage of using APD is that your days are dialysis-free. However, you need to keep and maintain a dialysis machine (and the associated equipment) in your house which does not suit some people. 

Side effects

Both haemodialysis and peritoneal dialysis cause side effects. This is due to the way that dialysis is carried out and the fact that dialysis can only compensate for the loss of kidney function to a certain extent.

Fatigue

Fatigue, where you feel tired and exhausted all the time, is a common side effect in people who have used both haemodialysis and peritoneal dialysis on a long-term basis. Fatigue is thought to be caused by a combination of:

  • the loss of normal kidney function
  • the effects that dialysis can have on the body
  • the dietary restrictions associated with dialysis
  • the overall stress and anxiety that many people with kidney failure experience

There are several treatment options that may be of some use in helping to improve the symptoms of fatigue.

Firstly, you may want to consult your dietitian because your diet may need to be adjusted in order to boost your energy levels. Secondly, research has shown that regular aerobic exercise can improve the symptoms of fatigue.

It can be challenging to start a programme of regular exercise if you are fatigued and many people who are on dialysis complain of feeling out of breath. However, if you persevere with regular exercise, it should become easier with time. Low-to-moderate aerobic exercise is recommended such as:

  • cycling
  • jogging
  • walking
  • swimming

Your dialysis care team or your GP can advise you about the type of exercise that is most suitable for you.

Haemodialysis

Low blood pressure

Low blood pressure (hypotension) is one of the most common side effects of haemodialysis. It can be caused by the drop in fluid levels that occurs during dialysis. Low blood pressure can cause nausea and dizziness.

The best way to minimise the symptoms of low blood pressure is to ensure that you keep to your daily fluid intake recommendations. If symptoms of low blood pressure persist, you should consult your dialysis care team because the amount of fluid used during dialysis may need to be adjusted.

Invasive staphylococcal infections

People having haemodialysis have an increased risk of developing an invasive staphylococcal infection. These infections are caused by staphylococcus aureus bacteria. This type of bacteria are usually responsible for minor skin infections such as boils.

However, the haemodialysis process can allow the bacteria to enter the body where they can cause a more serious invasive infection that can spread through the blood, leading to multiple organ failure. This is known as sepsis or blood poisoning.

Sepsis that is associated with an invasive staphylococcus infection is the second most common cause of death, after heart disease, in people having haemodialysis.

The first symptoms of an invasive staphylococcal infection include:

  • a high temperature (fever) of 38C (100.4F) or above
  • dizziness, which is related to a decrease in blood pressure, or a worsening of low blood pressure if you already have it

If you have a high temperature, you should contact your dialysis unit immediately for advice. If this is not possible, call NHS Direct on 0845 46 47 or your local out-of-hours service.

If you develop an invasive infection, you will need to be admitted to hospital and treated with injections of antibiotics.

Read more about treating staphylococcal infections.

Muscle cramps

During a haemodialysis session, some people experience muscle cramps, usually in their lower legs. This is thought to be caused by the muscles reacting to the fluid loss that occurs during haemodialysis.

You should consult your dialysis care team if you have muscle cramps that become particularly painful. Medication may be available that can help you to cope better with the symptoms.

Itchy skin

Many people who receive haemodialysis experience itchy skin. This is thought to be due to a build-up of potassium in the body. Avoiding potassium-rich food can help reduce the frequency and severity of this symptom. Some people have also found that using moisturising cream can minimise the discomfort caused by itching.

Other side effects

Other side effects of haemodialysis include:

Peritoneal dialysis

Peritonitis

A common side effect of peritoneal dialysis is that the peritoneum becomes infected with bacteria (peritonitis). Peritonitis can occur if the dialysis equipment is not kept properly sterilised (free of germs). If bacteria is present on the equipment it can be passed into the peritoneum.

Lack of appetite and nausea are the initial symptoms of peritonitis. These are quickly followed by abdominal pain, which usually begins as a dull ache in your abdomen before progressing to a steady, severe pain.

Other symptoms of peritonitis include:

  • being sick
  • chills (episodes of shivering and cold)
  • a high temperature (fever) of 38C (100.4F) or above
  • rapid heartbeat (tachycardia)
  • feeling thirsty
  • not passing any urine, or passing much less than normal

Peritonitis is treated with injections of antibiotics (intravenous antibiotics). The antibiotics are usually injected directly into the tissue of the peritoneum.

The most effective way to prevent peritonitis is to keep your dialysis equipment clean. You will be given training in how to do this. If you have repeated episodes of peritonitis, it may be that you are not a suitable candidate for peritoneal dialysis and you should change to haemodialysis.

Hernia

A hernia occurs when an internal part of your body, such as an organ, pushes through a weakness in the muscle or surrounding tissue wall. People having peritoneal dialysis are at increased risk of developing a hernia because holding fluid inside the peritoneal cavity for many hours places strain on the muscles of the abdomen.

The main symptom of a hernia is the appearance of a lump in your abdomen. The lump may be painless and may only be discovered during a check-up. In some people, certain activities can cause a hernia to become painful. These include:

  • bending over
  • lifting heavy objects
  • coughing
  • having sex

Surgery is usually needed to repair a hernia. During surgery, the surgeon will place the protruding intestine or tissue back inside your abdominal wall. The muscles of the abdominal wall will be strengthened using a synthetic mesh.

Weight gain

The dialysate fluid that is used during peritoneal dialysis contains sugar molecules, some of which are absorbed into your body. This can increase your daily calorie consumption by up to several hundred calories a day.

If you do not compensate for these extra calories by reducing the amount of calories that you eat and by taking regular exercise, it is likely that you will experience weight gain. In a minority of cases, the weight gain can be excessive.

One study found that around 7% of people having peritoneal dialysis will gain around 10kg (two stone) over the course of two years.

If you are concerned that you're gaining too much weight, you should talk to your dialysis team who can recommend a diet and exercise plan that can help you lose weight.

Avoid using fad diets that claim to be able to help you lose a lot of weight quickly. This type of extreme dieting could upset your body’s chemistry and make you feel very ill.

Results

How successful dialysis proves to be in treating kidney failure depends on a number of factors including:

Unfortunately, dialysis can only compensate for the loss of kidney function to a certain extent, and having kidneys that do not work properly can place a tremendous strain on the body. In addition, many people who require dialysis are already in a poor state of health.

However, it should be stressed that the survival rates of people who are on dialysis have improved over the past decade and they are expected to continue to improve in the future.

One of the biggest influences on expected survival rates is the age at which a person started the dialysis; the younger the better.

People who begin dialysis when they are in their late twenties have an average life expectancy of 20 years, while older adults who are over 75 years of age have an average life expectancy of four years.

The underlying cause of kidney failure also has an influence on survival rates. People who have kidney failure as a result of polycystic kidney disease and glomerulonephritis tend to have much better long-term survival rates compared with those who have kidney failure as a result of high blood pressure or diabetes.

The one, five and 10 year survival rates (the amount of people you would expect to still be alive one, five and then 10 years after the start of dialysis) for each of the four conditions are as follows:

Though as these survival rates are based on people who started dialysis in the past, they probably do not reflect the current picture today.