Who needs to have dialysis?
A patient on haemodialysis
Most people with CKD, AKI and other kidney diseases do not need dialysis. A few do. Dialysis is an artificial way of carrying out the work of a normal kidney (i.e. to remove excess wastes and water from the body).
There are two main forms of dialysis: haemodialysis (HD) and peritoneal dialysis (PD). HD is usually used for severe AKI.
These are the 5 indications for someone to need dialysis.
- Chronic Kidney Disease (CKD) Stage 5 (kidney failure). This is the most advanced stage of kidney disease, where the kidneys are no longer able to filter waste and excess fluids from the blood effectively. It’s characterized by an estimated glomerular filtration rate (eGFR) of less than 15 ml/min
Note. Only 1% of people with CKD ever need dialysis - Acute Kidney Injury (severe). Dialysis may be necessary for individuals whose kidneys have rapidly failed
- Fluid overload. Excess fluid in the body, particularly in the lungs (pulmonary oedema), can be a sign that dialysis is necessary
- Electrolyte imbalances
- High levels of certain electrolytes, such as potassium (and sometimes calcium), can be life-threatening and may require dialysis to remove them. A potassium level in the blood of >6.5 mmol (normal is 3.5-5.3), unresponsive to other drugs, is usually taken as an indication to start dialysis. For calcium, the dialysis treatment level is >4.0 mmol/L (2.2-2.6) – again unresponsive to other drugs
- High acid levels in the blood (acidosis).
- High toxin levels. A few individuals with high levels of certain drugs or toxins – e.g. salicylates (aspirin), lithium, barbiturates; as well as certain alcohols like ethylene glycol and methanol) – in their blood, may require dialysis to remove them.
Decision to Start Dialysis
- The decision to start dialysis is typically made by a kidney doctor (nephrologist); and is based on various factors, including the severity of kidney disease, symptoms, and overall health
- Some people may choose to start dialysis earlier, while others may opt to delay treatment until symptoms become more severe.
