Dialysis Essentials

Dialysis is a familiar term to anyone from the Kidney Community, right? It is one of the treatment options for Kidney Failure after all.

BUT DO YOU REALLY UNDERSTAND WHAT EXACTLY IS DIALYSIS ALL ABOUT?

Scroll down or click on the topic-link from the contents list below to learn about all that you must-know about Dialysis, its significance, types, complications, its impact on various facets of our daily life and relevant links to details where necessary.

CONTENTS:

1. What is Dialysis? 

2. When do you need Dialysis?

3. How does Dialysis help kidney patients?

4. Types of Dialysis

4i. Haemodialysis (HD)

4ia. Components necessary for Haemodialysis to work?

4ib. The Haemodialysis procedure

4ic. Duration of Haemodialysis

4ii. Peritoneal Dialysis (PD)

4iia. Peritoneal Dialysis procedure

4iib. Peritoneal Dialysis types

5. Complications of Dialysis

5i. Haemodialysis Complications

5ii. Peritoneal Dialysis Complications

6. Choosing the Dialysis type that suits you best: Haemodialysis vs Peritoneal Dialysis

7. Other FAQs on Dialysis

7i. Does Dialysis cure Kidney Failure?

7ii. Do you still need to follow a restricted diet (Renal Diet) after starting Dialysis?

7iii. Are medicines still necessary after you start Dialysis?

7iv. Is Dialysis expensive?

7v. Can you continue to work (employment) while on Dialysis?

7vi. Can you travel while on Dialysis?

7vii. Do all patients on Dialysis need a kidney transplant?

7viii. Could you not go for a Kidney Transplant directly?

“Dialysis” (pronounced as “dai-a-li-sis”) basically refers to a process in Chemistry where different particles dissolved in a liquid can be separated based on their ability to pass through tiny pores in a film/membrane.

The word is derived from combining two Greek words “Dia” meaning “apart” and “Luein” meaning “to set free”.

This basic chemical procedure finds its application in clinical medicine in the form of a complex machine called a “Dialyzer”.

This as an indispensable tool used to treat patients who are sick because of an excess accumulation of unwanted wastes or toxins in their bloodstream.

Dialysis helps to artificially remove the excess load of unwanted wastes or toxins in a patient’s bloodstream when their body is unable to do so by itself.

Normally, this task happens to be among the many functions carried out by our Kidneys (via urine) and our Intestines (via faeces).

Any medical condition that affects this waste-clearing mechanism either directly or indirectly results in the levels of unwanted blood wastes to go haywire!

Initially, the medical team will try to treat this with medication. These are usually a combination of medicines taken by mouth, injections & infusions directly into the bloodstream.

If patients do not respond to these medicines and continue to get more sick, patients are put on Dialysis as the last resort.

Such medical conditions include but are not limited to:

1. Kidney failure following Chronic Kidney Disease (Stage 5 CKD or ESRD after eGFR falls below 10%)

2. Acute Kidney Injury complicated with high blood Urea, high blood Potassium, high blood acidity or fluid overload not responding to medication

3. Heart diseases that may cause:

• • High blood potassium levels that do not respond to other medicines.
  • Excess fluid retention not responding to medication.
  • High blood acidity not responding to medicines

4. In some cases of Liver failure.

5. In Stroke patients who are in Coma and are on strong doses of medicines that have harmful side-effects on kidney function.

6. Blood poisoning with kidney-harming drugs/chemicals

Both Dialysis & Kidney Transplant are considered what we technically term Renal Replacement Therapy (RRT). Simply put, these therapies “assist with or take over” the compromised function of unwell kidneys for an overall better blood-component balancing capacity.

When your kidneys fail, dialysis helps restore balance in your blood components by:

1️⃣ Removing metabolic wastes, excess salts and extra water to prevent them from building up in the body

2️⃣ Keeping a safe level of certain minerals / chemicals in your blood, such as potassium, sodium and bicarbonate

3️⃣ Helping to control your blood pressure

However, please understand, Dialysis only helps cover for a fraction of all functions normally performed by kidneys in good health.

Hence, talking in the strictest sense, Dialysis is more of an Assistive Therapy rather than a true Replacement Therapy. As of today, Kidney Transplants are the only viable Renal Replacement Therapy and hence, the best treatment for Kidney failure from CKD.

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Broadly, there are two types of Dialysis:

Haemodialysis (pronounced as “hee-mow-dia-lisis”)

Peritoneal Dialysis (pronounced as “peri-tow-nial”)

Hemo = Blood ; Dialysis = Separating out excess wastes

Here, the patient’s blood is directly sent to a dialysis machine for the cleansing procedure.

In hemodialysis, the dialyzer is used to remove waste and excess minerals and fluid from your blood.

Dialysis machines in a hospital appear as a “tall, boxy contraption” with a monitor displaying some “numbers” and attached to numerous tubes. Some of these tubes “dock the patient” to the machine.

Let’s take you through “what’s inside the box” to help you appreciate how Dialysis works.

The following components are necessary for Hemo-Dialyzers to work:

1. TWO “PORTS OF ACCESS” (TUBES) TO THE PATIENT’S BLOODSTREAM:

• One to draw waste loaded blood / fluid and send it to the dialyzer.
• The other, to return cleansed blood/fluid back from the Dialyzer

To insert these ports, the doctor needs to make an entrance into your blood vessels.

Such an Access or Entrance could be a:

👉 SURGICALLY CREATED ACCESS

This is done by a minor surgery to join a suitable artery and a vein in your arm, wrist or leg:

If these blood vessels are joined directly to make a bigger, wider blood vessel, it is called a Fistula.

Alternatively, if your blood vessels are not found suitable for Fistula creation, doctors can use a separate soft plastic tube to join the artery and the vein under your skin. This is called a Graft.

Such a surgical access “designates” a spot for inserting the two ports for multiple dialysis sessions. It virtually eliminates the struggle to map-out appropriate zones and poke two separate needles each time you go for a session.

👉 NECKLINE / CENTRAL LINE / CENTRAL  VENOUS CATHETER

Some patients may need Dialysis only for a short time before a planned kidney transplant. In such cases, instead of creating a Fistula or a Graft, your doctor can insert a narrow plastic tube or a Catheter directly into a large vein in your neck under local anaesthesia.

2. A “DIALYZER TANK”

Such a “tank” provides space for the patient’s waste loaded blood to collect outside the body for necessary correction.

3. A SOLUTION CALLED THE “FRESH DIALYSATE”.

Your Dialysis nurse adjusts this Fresh Dialysate to contain minerals and blood proteins in quantities appropriate for restoring normal mineral, protein & fluid balance in the patient’s blood upon “contact”.

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4. A “BIO-COMPATIBLE” MEMBRANE / FILM WITH TINY PORES WITHIN THE TANK

• This membrane separates waste-loaded blood from the fresh dialysate and acts as the filter.
• It allows for “controlled exchange” of minerals & plasma protein between the patient’s blood & the Dialysate until “desired correction”.

Think of this membrane as an Immigration Officer at Passport control, you get the idea.

• Your Dialysis team can control this procedure by pre-setting the timer & expected blood correction to be achieved via Dialysis in the “monitor” on the machine.

From the outside, Haemodialysis looks simple. You send your blood to the machine for “servicing” and get the finished product back. But the procedure is far from lucid.

Let’s unravel the details of the valiant journey that your blood undertakes from your body to the Dialyzer and back, to help you appreciate all that goes into assisting your unwell kidneys via Haemodialysis.

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🔔 FROM THE PATIENT’S BODY TO THE DIALYZER TANK

1. One port (needle accessing the bloodstream) sends the patient’s waste-loaded blood into the Dialyzer Tank. (blue tubing)
2. On the way to the tank, there is a thick syringe pumping a chemical called Heparin into the patient’s blood. This is a “blood thinner” that keeps the patient’s blood from clotting during the Dialysis procedure.
3. In addition, there are two pressure valves along the way to the Dialyzer Tank:

• The First Pressure Valve helps control the rate at which blood flows out of the patient’s body.

It is crucial that the dialysis team adjusts this pressure to prevent sudden or too rapid outflow of the patient’s blood. Else, the patient stands a risk of losing consciousness & further damage to the kidneys, heart & brain.

• The Second Pressure Valve is located after the “Blood Thinner” Syringe. This valve helps to regulate the pressure at which the patient’s blood, now mixed with Heparin, enters the Dialyzer Tank.

Regulating the Pressure at this valve is essential to allow adequate correction of waste, mineral, protein & fluid levels within the patient’s blood.

Oh Yes, you read that right. Dialysis is all about “Pressure Tactics”!

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🔔 WITHIN THE DIALYZER TANK

The fresh dialysate is continuously pumped to the Dialyzer Tank (Yellow tubing in diagram towards tank):

1. To “interact & correct” the mineral, fluid & plasma protein content.
2. Rid the in the patient’s blood of accumulated metabolic wastes.

The special “bio-compatible porous membrane” within the tank allows for controlled crossing-over of “useful” components such as proteins in the patient’s blood in “adequate” quantities into the fresh dialysate area within the tank.

In return, the waste-load, excess minerals & fluids “stay below”. This fluid now becomes the “Used Dialysate’

Once the “exchange” of the Fresh Dialysate helps restore the balance in the patient’s blood:

• The used Dialysate returns to a separate collection area.
• The “clean” blood is pumped back into the patient’s bloodstream.

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🔔 FROM THE DIALYZER BACK TO THE PATIENT’S BODY

1. The cleansed & balanced blood flows back to the body through another Pressure Monitor. This prevents the blood from gushing back to the patient’s bloodstream with unnecessary force which could otherwise potentially injure the vein and scar it.

2. In addition, an Air trap & bubble detector monitors the inflowing blood for large air bubbles. This is necessary to prevent large air bubbles from potentially blocking your natural blood flow within the body. Such bubbles could otherwise cause heart attacks, strokes or even sudden death.

The time needed for your haemodialysis session depends on:

1️⃣ How well your kidneys work

2️⃣ The fluid weight you gain between treatments

3️⃣ The waste content you have in your blood

4️⃣ Your body surface area (how big you are)

5️⃣ The type of dialyzer used

6️⃣ A typical hemodialysis treatment course requires three days of your week and 4 hours per session.

7️⃣ High flux dialysis is a type of hemodialysis that may take less time. You can speak to your doctor to see if this is an appropriate treatment for you.

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Peritoneal = Of peritoneum; Peritoneum = A thin porous tissue-sheet covering our intestines with very rich blood supply.

Here, instead of sending the patient’s blood to the dialyzer tank outside the body, the patient’s abdomen acts as the “Dialysis Tank” itself.

The ability of the peritoneum to act as the dialysis membrane within the body itself forms the basis for this variation.

In this type of dialysis, the blood cleansing takes place inside your body, as shown in the Illustration below:

👉 The doctor will surgically place a plastic tube called a catheter into your abdomen (belly) to make a long-term access beforehand. This plastic tube stays in place even when the person is not undergoing dialysis.

👉 During the treatment, your abdominal area (called the peritoneal cavity) slowly fills up with dialysate through the catheter.

👉 Your blood continues to circulate within the blood vessels (arteries and veins) that line your peritoneal cavity as usual. The blood vessel walls and the tissue lining of peritoneum act as a “continuous exchange-filter space”.

👉 The blood within the arteries & veins normally circulates at a higher pressure than the dialysate fluid that is filled in the peritoneal space. This allows for the extra fluid & waste products in the blood to move out into the dialysate.

There are two major kinds of peritoneal dialysis:

1️⃣ Continuous Ambulatory Peritoneal Dialysis (CAPD)

2️⃣ Automated Peritoneal Dialysis (APD).

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🔔 Continuous Ambulatory Peritoneal Dialysis (CAPD)

This is the only type of peritoneal dialysis that does not require machines. Patients do this themselves, usually four or five times a day at home and/or at work.

The patient puts a bag of dialysate (about two quarts) into his/her peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before draining it back into the bag and disposing of it. The technical name for this procedure is an Exchange.

Everytime patients do an Exchange, they need a fresh, new bag of Dialysate.

While the dialysate is in their peritoneal cavity, patients can go about their usual activities at work, at school or at home.

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🔔 Automated Peritoneal Dialysis (APD)

APD usually is done at home using a special machine called a Cycler (image below).

APD 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 patients sleep.

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Despite being a life-saving intervention, we cannot deny the fact that both kinds of Dialysis are ultimately an “external interference” in the usual work-flow of the human body. This is bound to invite some complications related to the procedure, especially in the long run.

Both Haemodialysis & Peritoneal Dialysis efficiently cleanse blood of wastes to help unwell kidneys marred by CKD. This effectively prolongs patient survival as well. However, both these Dialysis types have their share of side effects as discussed below.

1. Port Access (Fistula/Graft/Neckline) Complications:

• Infection of the fistula site with subsequent spread into the bloodstream
• Clotting in and blockage of the operated blood vessels (fistula/graft site)
• Easy bleeding from minor trauma
• Aneurysm refers to excess bulging of fistula & weakening of vessel walls
• Poor Skin integrity at the site over the bulged fistula

2. Haemo-dynamic problems 

• Fluctuation in blood pressure

Sudden “correction” of fluid levels in the blood after a Haemodialysis session can frequently manifest as a sudden fall in Blood pressure & extreme tiredness.

• Occasional Chest pain

This is likely due to abrupt changes in body water content during Dialysis that “burdens” the heart. It could also result from disease of blood vessels to the heart that is common in CKD.

• Poor control over decline of blood Albumin levels

This reduces the “oncotic pressure” & promotes limb swelling due to fluid accumulation 

3. Blood mineral imbalance 

• Muscle cramps especially in the calves.

This is due to rapid changes in blood Sodium & Potassium levels during Dialysis cycles. It can be avoided by suitably adjusting the Fresh Dialysate within the Dialysis machine.

• Poor control of raised blood phosphate levels from CKD.

This worsens Bone pain & increases chance of getting Kidney Stones.

• Anaemia due to iron deficiency from loss of extra blood during each Haemodialysis session. This worsens the already anaemic state caused due to kidney failure.

4. Neurologic complications 

• Headache

Headaches are extremely common in all Haemodialysis patients due to abrupt & large changes in body fluid and mineral levels after every session.

• Dialysis associated Dementia (forgetfulness)

This is attributed to Aluminium toxicity in blood & low blood pressure in HD patients

This is treatable by making adjustments to Aluminium levels in the Dialysate fluid and with medication to “bind to” & reduce blood Aluminium levels.

• Wernicke’s Encephalopathy

This complication involves inflammation of brain tissue due to Vitamin B1 deficiency.

This condition manifests as difficulty in eye movements, imbalance in body movements & confusion.

It is reversible by treating with Vitamin B1 injections/infusion.

• Dialysis disequilibrium syndrome

This complication is rare and is seen in patients who are irregular with their Haemodialysis treatment  msessions.

It is a set of neurologic symptoms including but not limited to headache, nausea, blurred vision. It occurs due to excess fluid accumulation in the brain.

• Stroke

Stroke or “brain attack” presents as paralysis due to sudden, poor blood supply to a part of the brain.

In hemodialysis patients, this could occur because of increased chances of abnormal blood clotting and poor heart pumping as side effects of the dialysis procedure over time.

Peritoneal Dialysis invites fewer complications in the short term unlike Haemodialysis. This is because it is gentler and does not involve changing blood vessel dynamics through a Fistula or Graft creation as in Haemodialysis.

Short-term complications

• Catheter site infection

Poor hygiene of the site on your tummy where the catheter is inserted, could cause infections locally.

• Peritonitis

This refers to infection of the peritoneum (biological tissue bag within the abdomen) that acts as the “filter space” in Peritoneal Dialysis

The Catheter for Peritoneal Dialysis is basically a “foreign body” that stays put even when the patient is not getting dialysis. So, it can act as a “portal of entry” for infection causing germs into the otherwise sterile abdominal cavity as well.

Peritonitis is a dangerous & extremely painful complication. The good news is,it is entirely preventable by maintaining strict hygiene at all times, especially at the catheter site.

Although initially, Peritoneal Dialysis comes with a lot less complications than Haemodialysis, in the long run (think in terms of a decade), PD patients end up with many complications that are otherwise seen in HD patients initially.

Long-term Complications

• Weight Gain
• Heart enlargement and poor pumping
• Sustained increase in blood Phosphate levels that can worsen bone pain & cause kidney stones
• Poor control over decline of blood Albumin levels

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This is a frequent question in all kidney patient circles that we at Team ATK have come across.

Selecting which Dialysis modality to start a kidney patient on, is a crucial step in the treatment of kidney failure. It is your medical team that must take the final call on which Dialysis Type suits you best.

But as we, at Team ATK always say, knowing precisely as to what your medical condition is about, & how your medical team takes clinical decisions for you significantly helps you to adhere to your treatments & ensure favourable clinical outcomes for you. Add to that, the kind of control that you gain over your life, and proactively learning about your health turns simply empowering!

So, let’s learn about this topic.

There are various factors pertaining to both patients & physicians play a role in deciding which Dialysis type suits you.

Let us compare how the two types of Dialysis work on individual parameters that determine the overall clinical outcome in patients with kidney failure.

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With amply ambivalent outcomes, simply choosing one method of Dialysis when required, would be, as nephrologist Dr. Roger Rodby rightly says in this AJKD blog post, akin to “Dorothy asking for directions from the Scarecrow”.

Choosing an integrated care approach with a “healthy start” and a dynamic course is the most sensible approach. This means PD can make for a better option for the initial renal replacement therapy (unless the patient is clearly expected to fare better on HD). This can be followed by timely transfer to HD once PD starts showing complications that overtake those of HD in the longer run. Going by the present research evidence, such an integrated approach may improve the long-term survival of ESRD patients.

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Does dialysis cure kidney failure due to chronic kidney disease? No. Dialysis assists your unwell kidneys with clearing out wastes from your blood. And this is only a fraction of all the work that healthy kidneys do. Dialysis is simply a treatment. It does not cure your kidney disease.

In a nutshell, Dialysis is a kidney-supportive therapy that needs to be continued your whole life or up until you receive a kidney transplant.

When on Dialysis, our bodies undergo immense changes over a relatively short time frame. To better cope up with these changes, we require a special set of nutrients, at the same time keeping in mind the dietary restrictions that apply with Chronic Kidney Disease.

Your doctor will send you to a Renal Dietitian to get your Special Dialysis diet plan. This also includes guidelines on your daily liquid intake.

Another point to note is that your diet will depend on the type of Dialysis you are on and its resulting changes to blood components.

GENERAL POINTS ABOUT A DIALYSIS DIET:

1️⃣ Your choices about what to eat & drink while on Dialysis has an impact on how you feel.

When you stick to your Dialysis Diet plan you help make your kidney treatments work better for you.

2️⃣ Between Dialysis sessions, wastes can start building up in your blood again. You can significantly slow down such waste buildup by watching your Diet.

3️⃣ Your medical team would ask you to consult a Renal Dietitian to help you get a “Kidney-friendly Diet Plan” customised to your individual health status.

Consider limiting or avoiding foods and beverages that have high quantities of these three minerals:

▪️ SODIUM

Sodium is a part of salt that is found in many canned, packaged, frozen, and fast foods. It is also found in many condiments, seasonings, and meats. Too much sodium makes you thirsty, which makes you drink more liquid.

Get a comprehensive Sodium Guide here.

▪️ POTASSIUM

Potassium levels can rise between hemodialysis sessions and affect your heartbeat. Eating too much potassium can be dangerous to your heart rhythm and may even cause death.

Learn how to limit your Potassium intake here

▪️ PHOSPHORUS

Too much phosphorus in your blood makes your bones lose calcium. This may make your bones weak and likely to break easily.

Click here for a comprehensive Phosphorus Guide.

Protein is special when it comes to Dialysis.

▪️ PROTEIN

Renal dietitians encourage most people on hemodialysis to start protein supplementation. But aren’t you also asked to reduce protein intake in food during your CKD journey?

So what’s with Protein supplements?

Click here to learn & turn Protein-Smart

▪️ LIQUID

Also keep track of and limit how much liquid you eat and drink. This is important to stay as close to your “Dry Weight” and reduce burden on your already unwell kidneys.

Hemodialysis removes extra fluid from your body. However, there is a limit to how much excess fluid can be removed from your body at a time safely in a single Haemodialysis session.

If you come to your hemodialysis with too much fluid in your body, your treatment may make you feel ill. You may get muscle cramps or have a sudden drop in blood pressure that causes you to feel dizzy or sick to your stomach.

Further:

▪️ ENERGY

Everyone’s calorie (energy) requirements differ based on their age, daily activity levels & body dimensions.

You might need to cut down on calories if you are overweight, or you might need to find ways to add calories to your diet if you are losing weight without trying.

▪️ VITAMINS & OTHER MINERALS

Because Renal Diet has restrictions, your health care provider may prescribe a vitamin and mineral supplement designed specifically for people with kidney failure.

However NEVER start any supplement (herbal or otherwise) on your own without asking your doctor.

For safety reasons, ALWAYS talk with your health care provider before using probiotics, dietary supplements, or any other medicine together with or in place of the treatment your health care provider prescribes.

BUT THEN THAT’S ALL ABOUT RESTRICTIONS. SO, WHAT CAN YOU REALLY EAT WITH KIDNEY FAILURE?

Click on the image below for the complete “Kidney-friendly grocery list”

YES! Dialysis only helps cleanse the excess waste load of your blood and retain the necessary minerals in appropriate amounts. However, this is only a fraction of all the functions that kidneys perform functions that kidneys perform.

To compensate for all the other functions of a healthy kidney which remain compromised with kidney failure, it is imperative that you continue on all your Prescription medicines for kidney disease.

DO NOT START ANY NEW MEDICINE / HERBAL OR NATUROPATHIC THERAPY without consulting your medical team to avoid adverse drug reactions or add unnecessary burden to already unwell kidneys.

Dialysis is expensive. The overall cost per patient varies across countries based on drug/medical device/health service pricing policies set up by the respective Health Ministry.

However, in most countries, Kidney failure is recognized as a focus area of prime importance. Hence, the Government bears the major chunk of the treatment cost in every Government-operated health facility. The patient party pays for the remaining fraction either out of their own pocket or via health insurance plans.

For instance, the US federal government pays 80 percent of all dialysis costs for most patients. Private health insurance or state Medicaid programs also help with the costs.

Dialysis per se does not hinder you from continuing with your employment. If you are responding well to dialysis treatments, you can go back to work, especially after having gotten used to your dialysis routine. However, please note the following:

1. If your job involves physical labor (heavy lifting, digging, etc. ), you may need to get a different job. Avoid lifting heavy weight at all times.

2. Patients on Haemodialysis may either need to talk to the Dialysis center to adjust the timing of their thrice-weekly sessions outside of their work hours. Alternatively, if suitable, you may need talk to your employer for flexibility in work hours. In short, do not miss your Dialysis Sessions at any cost. Talk to your medical team if Home Dialysis could be a viable option for you.

3. Patients on Peritoneal Dialysis or with a Neckline must maintain proper Catheter hygiene. This is to prevent any potential infection from entering the bloodstream and causing serious complications.

Traveling while on Haemodialysis or Peritoneal Dialysis is NOT a risk till you meet the following criteria:

1. Your medical reports are stable

2. You do not lift heavy weight (luggage) or go for intense outdoor activities.

3. You do not miss your routine Dialysis sessions, else you stand the possibility of showing complications. Talk to your regular Dialysis Center to see if they could make arrangements to accommodate you at a reliable local Dialysis unit at the place where you are headed to.

As explained in this section, Dialysis is a method to help clear the blood of excess wastes and fluid which can be used in a number of medical conditions as listed here, and NOT JUST kidney failure due to Chronic Kidney Disease.

In all those cases that require Dialysis, except for Kidney Failure due to CKD, a kidney transplant is unlikely to be necessary.

In addition, if you are a CKD patient on Dialysis and are too unstable to undergo long surgeries like a Transplantation, you will be advised to stay on life-long Dialysis.

Yes. If you are diagnosed with chronic kidney disease before your kidney function or your GFR number falls below 10 ml/min, and you have potential, matched kidney donors who are willing to help, you can opt for what we call a Pre-emptive transplant.

In the clinic, the word “Pre-emptive” refers to any medical intervention taken in good time before an expected health complication sets-in. Because all patients with advanced Chronic Kidney Disease with GFR numbers less than 15 progress to a “point-of-no-return“, they are assessed if they are stable enough to undergo a transplant surgery even before starting them on any assistive therapy like Dialysis. This usually coincides the point when your Serum Creatinine values in your bloodwork cross 6 mg/dL.

Such kidney transplants that are conducted in patients with kidney failure, upon anticipating the “point-of-no-return” without starting the patient on Dialysis is termed Pre-emptive Kidney Transplant.

It is a good option especially with young patients under 30 years so as to avoid complications from Dialysis restricting the quality of life.

Obviously, pre-emptive transplant is only possible when you have a willing, matched & healthy kidney donor available at your side in good time.

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REFERENCES

1. Who needs Dialysis? ~ Medscape
2. Dialysis ~ BMJ
3. Complications of Dialysis ~ Medscape
4. Headache in Haemodialysis patients 
5. Dialysis associated Dementia
6. Wernicke’s Encephalopathy in Haemodialysis patients 
7. Disequilibrium Syndrome associated with Haemodialysis 
8. Haemodialysis & Stroke
9. Which road do we take? PD or HD ~ by Dr. Roger Rodby (AJKD Blog)
10. Choosing the Dialysis type 
11. Understanding KtV ~ Yale Coursepress