It's often an uncomfortable discussion, and there is no easy way to tell a patient that his kidneys are failing and he needs to start dialysis. Some who have seen other doctors have an idea what is going on, while others are caught completely by surprise.

It really is a challenge even for the most empathetic of physicians. This is where not only patience, but the communication skills of any doctor can be put to the test.

Here are some things to know about dealing with advanced kidney disease.

1. First of all, the doctor who first tells you that you might need to prepare for or begin dialysis is never the bad guy. In fact, he may be the first one to have enough courage to tell you the truth.

2. Dialysis is not your enemy. Most patients are afraid because they know someone who died a few months or years after starting dialysis. Remember that dialysis is there to save your life. If patients who really need it do not start dialysis then they may not even have a few months.

3. For the majority of patients, medically speaking, a kidney transplant will be your best option. Yes, the upfront costs for transplantation can be expensive, but it is an elective procedure and there is time to prepare, if you are lucky enough to have been given a heads-up. Use this time wisely to prepare not only financially, but also logistically and emotionally.

4. "Can I do dialysis two times a week or once a week instead?" The short answer is no, at least medically. The rule of thumb is that dialysis is close to about 20 percent kidney function (in terms of cleaning your blood and removing excess waste and water). So twice a week is close to 14 to 15 percent and once a week is about seven percent. There are a lot of patients who only do it twice a week for reasons outside of the medical, mainly financial and logistical. Which brings us to my next point…

5. Be open with your physician about financial hindrances. Ask your doctor to review your medications because for kidney patients this can get really expensive really fast. Ask to remove what is unessential and if there are cheaper alternatives. Sometimes you'll be surprised to find out that you're really not giving up too much in the way of efficacy. Because let's face it, you'll probably live longer and do better by getting that third dialysis session each week than you will by taking more expensive versions of certain medications.

So, connect with your doctor. Communication is a two-way street and while patients may not understand medical jargon, doctors don't read minds either. Things will go a lot more smoothly if you were upfront with your entire medical history, as well as how all this makes you feel so that we can better understand what you need, not only from a medical perspective, but from an emotional one as well.