Preparing for Dialysis

Dialysis replaces some of the work of failing kidneys: removing waste products, balancing electrolytes, and removing excess fluid. It does not cure kidney disease, and it does not replace all kidney functions — hormone production (erythropoietin, active vitamin D) still needs medication. The decision to start dialysis is based on symptoms and blood tests, not eGFR alone. Some people feel well even with very low eGFR and may delay dialysis if safe. Others need to start earlier because of complications. Your nephrologist will review your symptoms, blood tests (potassium, bicarbonate, phosphate), fluid status, and nutritional state at every appointment.

For haemodialysis, the best access is an arteriovenous fistula (AVF). A surgeon connects an artery to a vein, usually in your non-dominant forearm. Over weeks to months, the vein enlarges (matures) and becomes strong enough for repeated needle insertions. A fistula has the lowest infection rate and lasts longest. If your veins are too small or fragile, an AV graft (synthetic tube) may be used. For urgent starts or while a fistula matures, a central venous catheter (temporary line in the neck or chest) may be placed. For peritoneal dialysis, a soft PD catheter is placed in your abdomen under local or general anaesthetic, with a 2-week healing period before use.

Haemodialysis is efficient but requires either regular trips to a unit or significant home setup (home HD). It offers a fixed schedule and direct medical supervision. Peritoneal dialysis offers more independence and flexibility, preserves residual kidney function longer, and has gentler fluid shifts. However, PD requires good hand hygiene, space for supplies, and carries a risk of peritonitis (infection of the peritoneum). Some people switch between modalities over time — for example, starting on PD and moving to HD if peritonitis recurs or if abdominal surgery is needed. Your renal team will discuss your home situation, support network, manual dexterity, vision, and preferences.

The dialysis diet is stricter than the pre-dialysis diet. Potassium restriction becomes more important because dialysis removes potassium intermittently; between sessions, levels can rise dangerously. Phosphate restriction is essential — most dialysis patients need phosphate binders with every meal. Fluid restriction is typically 500–1000 ml per day above your urine output; this includes all drinks, soups, ice cream, and foods with high water content like melon. Sodium restriction helps control thirst and fluid gain. On the positive side, protein needs increase: haemodialysis patients lose amino acids during treatment, and peritoneal dialysis patients lose protein in the dialysate. Aim for 1.0–1.2 g protein per kg body weight daily, unless your team advises otherwise.

Medical: arrange fistula or PD catheter surgery 3–6 months ahead; get hepatitis B vaccination (recommended for dialysis patients); review and optimise heart and blood pressure medications. Home: for home HD or PD, arrange space for equipment and supplies; plan for delivery of dialysis fluids (heavy boxes). Work: talk to your employer about flexible hours; explore Access to Work grants for travel or equipment. Finance: check eligibility for benefits (Personal Independence Payment, Employment and Support Allowance); ensure travel insurance covers dialysis. Emotional: attend pre-dialysis education classes; consider joining a local Kidney Care UK support group; talk to the renal counsellor or social worker.

Most people settle into a routine within 2–3 months. Centre-based haemodialysis becomes a regular part of the week — bring books, headphones, a tablet, or use the time to rest. Many patients report improved energy, appetite and sleep once uraemia is controlled. Relationships, hobbies and travel are still possible — they just require planning. Some people feel down or anxious about dialysis; this is normal and treatable. Talk to your renal counsellor, GP, or a kidney charity support line. If you are considering a kidney transplant, your team will begin evaluation around the time dialysis starts or even before. A successful transplant frees you from dialysis and offers the best quality of life for suitable candidates.