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Preparing for Kidney Failure Treatment

As your kidney disease progresses, your health care provider may talk to you about preparing for kidney failure. Talking with your provider about your treatment options ahead of time helps you take charge of your care. Treatment will help you feel better and live longer. The more you know about the types of treatment, the better prepared you may be to make a choice. It's also important to give yourself time to get used to the big changes that will be happening in your life.

Learn about steps you can take ahead of time to have better success with dialysis or a kidney transplant.

Preparing for Hemodialysis: Vascular Access

If hemodialysis is the best option for your treatment, one important step before starting treatment is creating a vascular access. Vascular access is the term for how blood can be removed from your body and returned at the high rate that dialysis requires. The goal is to allow high blood flow during dialysis treatment so that the largest amount of blood can be passed through the dialyzer (artificial kidney). Your own veins are not large enough to be used for dialysis. The best kind of long-term vascular access for hemodialysis is an arteriovenous (AV) fistula. An AV fistula is created when a surgeon connects an artery to a vein, usually in the arm. The increased blood flow through the AV fistula causes the vein to grow large and strong allowing the needles used for dialysis to be easily placed in the blood vessels. The AV fistula is considered the best option because it:

  • provides adequate blood flow for dialysis,
  • lasts longer, and
  • has a lower complication rate than the other types.

If an AV fistula cannot be created, the two other kinds of vascular access that may be used are an AV graft or venous catheter. An AV graft is a connection from an artery to a vein using a synthetic tube. An AV graft can be used soon after it is inserted. However, an AV graft is more likely than a fistula to have problems with infection and clotting, and the repeated formation of blood clots can block the flow of blood through the graft.

Vascular access should be in place weeks or months before you start dialysis. Learn more about vascular access and fistulas.

A graphic of a hand and forearm showing a looped, synthetic tube connecting the artery running to the hand and the vein running back from the hand. An AV graft will work for hemodialysis. The graft takes less time to mature, but is more likely to become infected or to develop a clot.  

Preparing for Peritoneal Dialysis: Catheter Placement

If peritoneal dialysis is the best option for your treatment, you'll need to have a soft catheter placed in your abdomen. A catheter is a tube that carries dialysis solution into and out of your abdomen.

Placing a catheter is usually a simple procedure. Your provider will make a small cut, often below and a little to the side of your navel (belly button), and then guide the catheter through the slit into the peritoneal cavity.

As soon as the catheter is in place, you can start dialysis treatment through it, although you probably won't begin a full schedule of exchanges for 2 to 3 weeks.

Preparing for Kidney Transplant

Your health care provider will tell you if a kidney transplant is a good treatment option for you. Transplantation isn't for everyone. Your provider may say you have a condition that would make a transplant dangerous or unlikely to succeed. If kidney transplant is an option for you, you may begin the process right away.

  • Medical Evaluation: You will need a thorough medical evaluation at a transplant center. The pre-transplant evaluation may require several visits over the course of several weeks or even months. The medical team will want to see if you're healthy enough for surgery.

    If a family member or friend wants to donate a kidney, he or she will need to be evaluated for general health and to see whether the kidney is a good match.

  • Waiting List: If you're a good candidate for a transplant but you don't have a family member or friend who can donate a kidney, you'll be put on the waiting list to receive a kidney from a deceased donor - someone who has just died. How long you'll have to wait depends on many factors. Some people wait years for a good match, while others get matched within a few months.

Learn more about kidney transplants and organ donation.

Videos

Videos

Will I need dialysis? Approach 1
Will I need dialysis? Approach 1 (0:39)

"A doctor explains that with early identification of kidney disease and treatment, patients may be able to avoid dialysis."

Will I need dialysis? Approach 2
Will I need dialysis? Approach 2 (0:26)

A doctor explains how early detection and treatment may delay the need to go on dialysis.

I feel fine, why do I need to see a surgeon now? Approach 1
I feel fine, why do I need to see a surgeon now? Approach 1 (:51)

A provider explains to a patient why an AV fistula is needed several months prior to dialysis

I feel fine, why do I need to see a surgeon now? Approach 2
I feel fine, why do I need to see a surgeon now? Approach 2 (1:48)

A provider explains why an AV fistula is placed before hemodialysis begins and how hemodialysis treatment works

What is a fistula and how does it work?
What is a fistula and how does it work? (2:22)

A provider explains the purpose, process, and benefits of AV fistula surgery. 

What does a fistula look like?
What does a fistula look like? (1:02)

A provider explains the purpose of a fistula and describes its appearance.

Why is a fistula the best option? Approach 1
Why is a fistula the best option? Approach 1 (1:19)

A provider explains that AV fistula placement is better for dialysis, less likely to become infected, and less likely to clot than an AV graft

Why is a fistula the best option? Approach 2
Why is a fistula the best option? Approach 2 (1:00)

A provider explains why a patient should use an AV fistula rather than other methods to prepare for hemodialysis

What happens if I don't have fistula surgery now?
What happens if I don't have fistula surgery now? (1:10)

A provider explains the importance of AV fistula placement before dialysis to ensure proper preparation to avoid emergency procedures

What are the problems with a catheter?
What are the problems with a catheter? (1:08)

A provider explains the potential problems of using a catheter over an AV fistula.

What should I do to prepare for surgery?
What should I do to prepare for surgery? (1:17)

A provider offers advice on how to prepare for AV fistula surgery and provides tips on how to protect a patient's veins.

How soon after surgery can I use my arm?
How soon after surgery can I use my arm? (0:59)

A provider explains what to expect after surgery and offers advice on how to recover quickly and safely.

Will I have more energy after starting dialysis?
Will I have more energy after starting dialysis? (1:12)

A provider explains what to expect after dialysis and how the procedure will improve a patient's overall well-being.


This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

This information is not copyrighted. The NIDDK encourages people to share this content freely.


​​March 1, 2012​

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