Division of Nephrology
The Division of Nephrology, part of the Department of Medicine, offers world-class patient care, research programs, and education and training opportunities.
Dialysis & Kidney Failure
Compassionate care and comprehensive treatment when your kidneys no longer function correctly
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Your Treatment Options for the End Stages of Kidney Disease
Your kidneys are vital to keeping you healthy. They filter waste from your body, make hormones and maintain a healthy balance of water, salts and minerals in your blood. Sometimes, however, things happen that interfere with kidney function. That can be serious, and possibly lead to kidney failure. Our kidney care team at Beth Israel Deaconess Medical Center (BIDMC) offers a full range of treatments for kidney failure. When you need compassionate experts to guide you forward, you'll find them here.
Understanding Kidney Failure
Kidney failure occurs when your kidneys don't perform as they should. If your kidneys stop functioning temporarily or suddenly, it's known as acute kidney failure (or acute renal failure). This may happen after a kidney injury, for example. Chronic kidney disease (CKD) occurs when your kidneys slowly lose function over several years. This may result in permanent kidney failure. Both kidneys usually fail at the same rate.
When your kidneys don't maintain the right balance of minerals and chemicals, the rest of your body may not function correctly. Hormone-related problems can also lead to other conditions like anemia (decreased supply of red blood cells).
Kidney Failure Symptoms and Causes
Signs and symptoms of kidney failure include the following:
- Confused thinking
- Difficulty sleeping
- Dry, itchy skin
- Extra fluid retention
- Fatigue
- Metallic taste in the mouth
- Vomiting and nausea
Many different diseases can harm your kidneys and cause them to fail. Some of these diseases work quickly, in just days or weeks. Others take years to do damage. Causes may include:
- Infectious diseases.
- Long-standing high blood pressure.
- Severe high blood pressure (malignant hypertension).
Treating Severe, End-Stage Kidney Disease
At BIDMC, you benefit from state-of-the-art, evidence-based approaches to stop kidney disease or slow its progression. We also offer clinical trials that test new treatments for many kidney conditions.
At a certain point, however, some people may go on to develop kidney failure. If you’re one of them, you have two main treatment options: dialysis and kidney transplant. You may also wish to consider conservative kidney management.
Dialysis: A Substitute for Failing Kidneys
When your kidneys fail, dialysis acts as a kidney replacement. The treatment involves using a special fluid containing a mixture of pure water and electrolytes to carefully eliminate wastes, salt and extra water from the blood without removing substances the body needs. This process helps control blood pressure and keeps your body's electrolytes in balance.
There are two main types of dialysis: hemodialysis and peritoneal dialysis. Both require minor surgery — dialysis access surgery — to begin treatment.
Hemodialysis
During hemodialysis, your blood goes through a filter, called a dialyzer, outside your body. A dialyzer is sometimes referred to as an "artificial kidney.” You usually get treatment three times a week: Monday, Wednesday and Friday; or Tuesday, Thursday and Saturday. Each dialysis session lasts about four hours. For more information on hemodialysis, please watch this video from the National Kidney Foundation or visit the website of the National Institute of Diabetes and Digestive and Kidney Diseases.
Home Dialysis Options
Peritoneal dialysis uses the thin lining that surrounds your abdomen, called the peritoneum, as a filter. During treatments, you cycle a dialysate, a cleaning fluid, into your abdomen through a small, flexible tube called a catheter. The dialysate absorbs or pulls extra waste and fluids from blood vessels into your abdomen. The waste stays there for a specified amount of time (dwell time). A peritoneal dialysis machine then drains the fluid out of your abdomen and into a drain or waste bag. Then, you put fresh dialysate back into your peritoneum to clean your blood once more. This filling and draining process is called an exchange or a cycle.
One of the biggest benefits of this treatment is that you do it at home or work. But it's not for everyone. If you’ve had multiple abdominal surgeries, scar tissue may prevent you instilling an adequate amount of fluid into your peritoneal cavity. Without enough fluid, your treatment may not be effective.
For more information on peritoneal dialysis, please watch this video from the National Kidney Foundation or visit the website of the National Institute of Diabetes and Digestive and Kidney Diseases.
Home Hemodialysis
It may also be possible for you to do hemodialysis at home. This can mean a more flexible schedule for you. Usually, you have 4-5 treatments per week. Sessions may last from 2-4 hours but are done when you want to do them. Your doctor will decide how many treatments you need and see you in person once a month. Machines for home use are small enough to sit on an end table.
Outpatient Dialysis Locations and Inpatient Unit
BIDMC offers dialysis services as needed if you’re in the hospital through the acute dialysis services of DaVita. Our nephrologists staff the acute dialysis unit. If you begin hemodialysis in the hospital, you will transition to an outpatient unit of your choice. Outpatient dialysis units are located in many communities throughout the Boston area.
Kidney Transplant Program
Kidney transplantation is another treatment option for kidney failure. Dialysis can be a life-saving treatment. But it does only about 10% of the work that a functioning kidney does. Because of its impact on your body, dialysis can also cause other health problems. Your life expectancy is typically about 10 to 15 years longer with a kidney transplant than it would be if you stayed on dialysis. Compared to dialysis, a kidney transplant may also offer you a much better quality of life. Getting a transplant before you need dialysis can be beneficial. But sometimes you need dialysis as a bridge to transplantation. Our kidney transplant program includes dedicated medical and surgical experts designed to guide you through the process of evaluation, surgery and post-surgical care.
Supportive Kidney Management
In some cases, it may be worthwhile to consider supportive kidney management rather than dialysis — especially when a transplant isn't possible. Dialysis isn’t for everyone. It may help you live longer and feel better, but it doesn’t cure kidney failure. And the older and sicker you are, the less likely it is that dialysis will help you. It may even be a burden to you if you have other health problems that dialysis won't improve. Supportive care includes all the medications, treatments and control of symptoms that help manage kidney failure, but without dialysis. Treatment focuses on:
- Keeping your kidneys functioning for as long as possible.
- Maintaining your quality of life for as long as possible.
- Managing other health problems caused by kidney failure, such as anemia.
- Managing symptoms, such as nausea and poor appetite and your feelings.
- Preparing for end-of-life care.
Learn more about conservative kidney management.
