The Role of Dialysis in Kidney Failure: Types & Benefits

Understanding Kidney Failure and Dialysis

Kidney failure occurs when kidney function has declined to the point that the kidneys can no longer adequately maintain the body’s internal balance without additional treatment.

Kidney failure generally has two types:

• Acute kidney injury (AKI): a sudden decline in kidney function that may sometimes be reversible.
• Chronic kidney disease progressing to kidney failure: a long-term decline in kidney function that may eventually require kidney replacement therapy.

Not everyone with advanced CKD needs dialysis immediately.

When Is Dialysis Needed?

No single kidney-function percentage or eGFR value automatically means dialysis should begin. The KDIGO 2024 CKD guideline recommends considering a combination of symptoms, signs, quality of life, patient preferences, kidney function, and laboratory abnormalities when deciding when to start dialysis [1]. Situations that may prompt dialysis include symptoms or complications that cannot be adequately controlled with medical management.

In some patients, dialysis may be started at a relatively low level of kidney function because complications develop. In others, dialysis can be safely deferred while kidney function and symptoms are closely monitored. Planning for dialysis access or transplantation may begin before dialysis is actually required, allowing time for appropriate preparation.

The decision should therefore be individualised by a nephrologist and healthcare team.

What Is Dialysis? And Why It Matters

Dialysis is a form of kidney replacement therapy that helps perform some functions normally carried out by the kidneys.

Depending on the type of dialysis, treatment can help:

• Remove waste products from the blood
• Remove excess fluid
• Help control electrolyte levels
• Help maintain acid-base balance

Dialysis does not replace every function of healthy kidneys. Patients may also need medicines, dietary adjustments, fluid management, anaemia treatment, and monitoring of bone and mineral health as part of comprehensive kidney-failure care.

Key Types of Dialysis

The two main forms of dialysis are:

• Haemodialysis: It uses a dialysis machine and a specialised filter called a dialyser to remove waste products and excess fluid from the blood. Blood travels from the body to the dialyser, then returns to the patient. Home haemodialysis is a form of haemodialysis that can be performed at home after appropriate training and medical planning.
• Peritoneal dialysis: Peritoneal dialysis uses the peritoneum, the lining of the abdominal cavity, as a natural filtering membrane. A dialysis solution is introduced into the abdomen through a catheter. Waste products and excess fluid move into the dialysis solution, which is then drained and replaced.

The most suitable option depends on the person’s medical condition, home circumstances, preferences, treatment goals, and available support.

Research comparing haemodialysis and peritoneal dialysis has found differences in some quality-of-life measures, but findings are inconsistent across outcomes. A 2025 systematic review and meta-analysis involving 25 studies and 5,440 participants reported advantages for peritoneal dialysis in several quality-of-life domains, while finding no significant differences in several other domains. The authors also noted substantial heterogeneity between studies [2].

Therefore, no single dialysis modality is universally better for every patient.

Preparing for Dialysis – Steps Before Starting

Starting dialysis is a major change in daily life, so preparation is important.

Depending on the patient’s condition and the chosen modality, preparation may involve the following:

Step 1: Medical Assessment

The nephrology team evaluates kidney function, symptoms, fluid status, blood tests, other medical conditions, and nutritional status.

Step 2: Choosing the Dialysis Modality

Patients may discuss haemodialysis, peritoneal dialysis, home options, and other kidney replacement therapies with their healthcare team. The choice should consider medical suitability, lifestyle, treatment goals, home circumstances, and personal preferences.

Step 3: Preparing Vascular Access

Patients who are expected to receive haemodialysis may need an AV fistula or another suitable form of vascular access prepared in advance.

Step 4: Preparing for Peritoneal Dialysis

Patients choosing peritoneal dialysis need a peritoneal dialysis catheter placed and training in safe exchange procedures.

Step 5: Understanding Lifestyle Changes

Patients may need guidance regarding:

• Fluid intake
• Sodium and other dietary considerations
• Medicines
• Work and travel
• Physical activity
• Dialysis schedules
• Infection prevention

The exact recommendations vary between patients.

Benefits and Goals of Regular Dialysis

When dialysis is medically indicated, following the prescribed treatment schedule helps remove waste and excess fluid over time. Adequate dialysis can help manage complications associated with kidney failure and support overall health and day-to-day functioning. However, dialysis is not a cure for kidney failure and does not restore normal kidney function.

Missing or shortening prescribed dialysis sessions can allow fluid, electrolytes, and waste products to accumulate. Patients who have difficulty completing their scheduled treatment should discuss the situation with their dialysis team rather than changing the schedule themselves.

Does Dialysis Prevent Infections?

Dialysis does not make the body “cleaner” or eliminate infection risk. In fact, people receiving dialysis can face infection risks related to vascular access, dialysis catheters, peritoneal dialysis, and other factors. Good infection-control practices, recommended vaccinations, and attention to infection symptoms are important parts of dialysis care.