As a nephrologist, it is not uncommon to open up the discussion on dialysis when a patient’s kidneys start to fail.  It is never easy, particularly for patients who hear about the severity of their condition for the first time.  Some come to me for a second opinion, or even a third. 

Simply put, our kidneys clean toxins from the blood and help make urine. If your kidneys no longer work properly to perform these functions and you progress to kidney failure, then the kidneys don’t filter blood the way they should. As a result, toxins and waste build up in your bloodstream. Dialysis does the work of your kidneys, removing waste products and excess fluid from the blood.

The most common negative response by someone hearing about dialysis for the first time is how they know someone who died a few months or years after starting dialysis. Dialysis is there to save your life -- because your kidneys no longer function at a level that can sustain you. Therefore, if none of those patients who needed dialysis actually had the benefit or capability to do so, then they may not have had even those few months or years after they started dialysis.

The most common form of dialysis is hemodialysis, where a machine removes blood from your body, filters it through a dialyzer that acts like an artificial kidney, then returns the cleaned blood to your body. This usually takes around three to five hours, either at a hospital or a dialysis center, three times a week. 

Before starting dialysis, patients need to undergo a minor surgical procedure to make it easier to access the bloodstream.  It can be an arteriovenous (AV) fistula or graft in the arm.  If dialysis is urgent, a catheter may be inserted in your neck, chest or leg temporarily.

Many often bargain to reduce the amount of time they get dialysis. When you think about it, functioning kidneys work 24/7.  The rule of thumb is that dialysis is close to about 20 percent kidney function. So, dialysis twice a week is close to 14 to 15 percent and once a week is about seven percent. That difference is thought to account for the major difference in life expectancy when comparing dialysis patients here in the Philippines (two years) and abroad (five to seven years).  I can’t medically tell patients that twice a week is the same as thrice a week, because if it were, then I wouldn’t even offer the latter.  But there are a lot of patients who do it twice a week for reasons outside of the medical, mainly financial and logistical.  Which brings us to my next point…

Financial hindrances

Be open with your physician about possible financial hindrances. Ask your doctor to review your medications because for kidney patients this can get really expensive really fast.  For my patients I remove what I know is unessential and I advise them to ask their other doctors if there are cheaper alternatives.  You may 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.

For the majority of patients, medically speaking, a kidney transplant will be the best option. The upfront costs for transplantation can be expensive, but remember 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. 

What patients should appreciate is that dialysis is a lifesaving treatment for people with kidney failure. Many people on dialysis continue to live active and productive lives. They can keep going to work and even travel.  When you travel, your doctor can help arrange for you to get dialysis at a center at your new location. Don’t be afraid to discuss your concerns and options with your doctor, so that you can get the appropriate treatment and start feeling better.