Your doctor will help determine when you should start hemodialysis, based on several factors — your overall health, kidney function, signs and symptoms, quality of life, and personal preferences.

You might notice signs and symptoms of kidney failure (uremia), such as nausea, vomiting, swelling or fatigue. Your doctor uses your estimated glomerular filtration rate (eGFR) to measure your level of kidney function. Your eGFR is calculated using your blood creatinine test results, sex, age and other factors. A normal value varies with age. This measure of your kidney function can help to plan your treatment, including when to start hemodialysis.

Hemodialysis can help your body control blood pressure and maintain the proper balance of fluid and various minerals — such as potassium and sodium — in your body. Normally, hemodialysis begins well before your kidneys have shut down to the point of causing life-threatening complications.

Common causes of kidney failure include:

  • Diabetes
  • High blood pressure (hypertension)
  • Kidney inflammation (glomerulonephritis)
  • Blood vessel inflammation (vasculitis)
  • Kidney cysts (polycystic kidney disease)

However, your kidneys may shut down suddenly (acute kidney injury) after a severe illness, complicated surgery, heart attack or other serious problem. Certain medications can also cause kidney injury.

Some people with severe long-standing (chronic) kidney failure may opt for a different path, choosing maximal medical therapy, also called maximum conservative management, instead of dialysis. This therapy involves active management of complications of advanced chronic kidney disease, such as fluid overload, high blood pressure, and anemia, with a focus on supportive management of symptoms that affect quality of life. Ask your health care team for more information about your options. This is an individualized decision because benefits of dialysis may vary, depending on your particular health issues.

Jul. 10, 2013