When kidney disease reaches stage 5, also called kidney failure, the kidneys can no longer keep you healthy on their own. There are several treatment options. Planning ahead, ideally during stage 4, gives you time to learn about each one and choose what fits your health and your life.
Kidney transplant
A transplant places a healthy kidney from a living or deceased donor into your body. For many people, a transplant offers the best quality of life and the longest survival. You may be referred for transplant evaluation before you need dialysis. Living donation can shorten the wait.
In-center hemodialysis
Hemodialysis uses a machine and filter to clean your blood. At a dialysis center, treatments usually take about three to four hours, three times a week, with nurses and technicians providing care.
Home hemodialysis
With training, you and a care partner can do hemodialysis at home. Treatments are often shorter and more frequent, and you have more control over your schedule.
Peritoneal dialysis (PD)
PD uses the lining of your belly as a natural filter. A cleansing fluid flows in and out through a soft tube called a catheter. PD is done at home every day, either by hand during the day or with a machine overnight while you sleep. It needs no needles and can make it easier to work and travel.
Comparing your options
| Option | Where | How often |
|---|---|---|
| Kidney transplant | Surgery at a transplant center | One surgery, then lifelong medicines and follow-up |
| In-center hemodialysis | Dialysis center | Usually 3 times a week, about 3 to 4 hours each |
| Home hemodialysis | Home, with a care partner | Often 4 to 6 shorter treatments a week |
| Peritoneal dialysis | Home | Every day, by hand or overnight by machine |
| Conservative care | Home and clinic | Regular visits focused on symptoms and comfort |
Conservative (supportive) care
Some people, especially those who are older or have other serious health problems, choose not to start dialysis. Conservative care focuses on managing symptoms, protecting remaining kidney function, and quality of life, with support for you and your family.
Preparing for dialysis
- Vascular access: hemodialysis works best with a fistula, a connection made between an artery and a vein in your arm. It takes a few months to be ready, so it is often placed well before dialysis starts. Protect that arm from blood draws and IV lines if your doctor asks you to.
- PD catheter: if you choose peritoneal dialysis, a catheter is placed in your belly a few weeks before you begin.
- Education: ask about kidney options classes and visiting a dialysis unit.
Questions to ask at your visit
- Which treatment options are right for me?
- When should I be referred for a transplant evaluation?
- When should I get a fistula or a PD catheter?
- Can I keep working and traveling on dialysis?
This guide is general education and is not a substitute for medical advice. Talk with Dr. Salim or your care team about your own situation. Informed by patient materials from the National Kidney Foundation; learn more at kidney.org.