Tuesday, May 19, 2015

What Is Dialysis and When Do I Start

In the early stages of chronic kidney disease (CKD), you do not need dialysis. The stages of chronic kidney disease can last for many years. But if your kidneys fail, you will need dialysis or a kidney transplant to keep you alive.

National Kidney Foundation guidelines recommend you start dialysis when your kidney function drops to 15% or less — or if you have severe symptoms caused by your kidney disease, such as: shortness of breath, fatigue, muscle cramps, nausea or vomiting. Your doctor will help you decide when to start dialysis, based on results of lab tests that measure how much kidney function you have left and on your symptoms.

Private insurance generally covers treatment for kidney failure whenever your doctor says it is needed. If you don’t have private insurance, you may be able to get coverage through federal or state funded health care programs, such as Medicare or Medicaid.

Most people (about 93% of those who apply) qualify for Medicare when they need dialysis or a transplant, even if they are under age 65. Medicare pays for 80% of treatment costs of kidney disease when kidney function has dropped to 10 – 15%, or when your doctor justifies it.

If you are not having symptoms, you may be able to wait a bit longer before you begin dialysis. However, some doctors believe that starting dialysis as soon as Medicare or insurance covers it is wise, since it can take a long time to recover if you let yourself get very ill. Since chronic kidney failure often happens slowly, sometimes people do not even know how bad they feel, until they start dialysis and begin to feel much better.

It is important to start getting ready for dialysis or a transplant well in advance — when your kidney disease reaches Stage 4 (severe, with glomerular filtration rate, or GFR, less than 30 mL/min). Learning about the types of dialysis and transplant options will help you make a choice that is best for you. Any type of dialysis will require surgery — usually outpatient — to allow access for your treatments, and this should be done well in advance to allow time for healing.

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