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Dialysis & Kidney Failure

When the kidneys fail, dialysis or a kidney transplant takes over part of their work — and some people choose supportive care instead. This guide explains the choices, how to protect your access, eating and drinking on dialysis, living well, and how Medicare helps pay.

Call 911 for chest pain, severe trouble breathing, fainting, or a heartbeat that is racing, pounding or irregular. In someone with kidney failure these can be signs of a dangerously high potassium level, which can stop the heart, or of fluid building up in the lungs (National Kidney Foundation, MedlinePlus, NIDDK). Sudden confusion or any sudden, unexplained change in alertness is also an emergency (MedlinePlus).

Call your dialysis unit right away for fever or chills; redness, warmth, swelling, pain or pus at your access or around your peritoneal dialysis (PD) catheter; or cloudy or unusually colored used PD fluid, belly pain, nausea or vomiting, which can mean peritonitis, a serious infection inside the belly (NKF, NIDDK, MedlinePlus). Also call if the buzzing (“thrill”) in your fistula or graft stops or feels weaker — don’t wait for your next treatment (NKF). Infections are common in people on dialysis and can be very serious (CDC).

Bleeding from your access that won’t stop: press firmly on the spot with clean gauze or a clean towel, and if the bleeding is heavy, spurting or won’t stop, call 911 (NKF).

Never skip or shorten a treatment. Complete your treatments on your prescribed schedule (NKF); skipping PD exchanges can be dangerous (MedlinePlus), and potassium and fluid build up between hemodialysis sessions (NIDDK). If something makes it hard to stay for your full time, tell your team so they can help.

What is kidney failure?

Healthy kidneys remove wastes and extra fluid, balance salts and minerals such as potassium, phosphorus and calcium, and make hormones that help control blood pressure, make red blood cells and keep bones strong. When kidney function drops below 15 percent of normal, it is called kidney failure; kidney failure treated with dialysis or a transplant is called end-stage renal disease (ESRD), also known as end-stage kidney disease (NIDDK). It usually develops slowly, after years of chronic kidney disease (MedlinePlus). (A separate Kidney guide is on the way.)

As kidney function falls, people may notice swelling in the legs, feet or ankles, itching, tiredness and poor sleep, nausea or loss of appetite, little or no urine, muscle cramps, and trouble focusing (NIDDK).

What dialysis does

Dialysis filters the blood to remove wastes and extra fluid, helps control blood pressure, and helps balance minerals such as potassium, sodium and calcium. It can help you feel better and live longer, but it is not a cure: even when done very well it replaces only part of what healthy kidneys do (NIDDK). There are two main kinds: hemodialysis, which cleans your blood in a filter outside your body, and peritoneal dialysis, which uses the lining of your belly as the filter (MedlinePlus).

How common is it?

According to the U.S. Renal Data System’s 2023 Annual Data Report, as summarized by NIDDK, more than 808,000 people in the United States are living with end-stage kidney disease — 68 percent on dialysis and 32 percent with a kidney transplant — or about 2 in every 1,000 Americans. At the end of 2021, 14.1 percent of people on dialysis did it at home (NIDDK). Black Americans are more than 4 times as likely as White Americans to develop end-stage kidney disease, and Hispanic and Native American people more than twice as likely (NIDDK).

What causes it?

The most common causes of chronic kidney disease in adults are diabetes and high blood pressure (NIDDK). About 1 in 3 people with diabetes and 1 in 5 people with high blood pressure have kidney disease (NIDDK). Other causes include immune diseases such as lupus, some cancers, and rare genetic conditions (NIDDK). See our Diabetes guide and Blood Pressure guide.

Your choices — and they are yours

There are four options: hemodialysis, peritoneal dialysis, a kidney transplant, or conservative management, which treats kidney failure without dialysis or a transplant and focuses on comfort and quality of life. None of them makes the kidneys better, but all can help you feel better. NIDDK advises learning about them early — before you need treatment — talking with people who live with each one, and sharing your thoughts with your family. You can change your mind later (NIDDK). A working transplant filters better than dialysis, but it is still a treatment, not a cure (NIDDK). The section Choosing a treatment below walks through the trade-offs.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Hemodialysis (in a center, at night, or at home) or peritoneal dialysis at home; a fistula as the preferred access; medicines such as phosphate binders, ESAs and iron for anemia, active vitamin D and calcimimetics; vaccines; evaluation for a kidney transplant; or conservative care with palliative and hospice support. Medicare covers people of any age with ESRD who qualify. Outpatient dialysis: 20% of the Medicare-approved amount after the Part B deductible. Living donor’s care: $0. Other costs vary with your coverage. Dialysis helps you feel better and live longer but is not a cure. A working transplant filters better than dialysis and is linked with longer life, but it needs lifelong anti-rejection medicines.
Chiropractic No role. We found no evidence that chiropractic care treats kidney failure or replaces any part of dialysis. Not recommended for kidney failure, so no cost estimate is given. Not a treatment for kidney failure. Kidney failure can weaken bones, so talk with your kidney team before any spinal manipulation.
Acupuncture Studied as an add-on for the itching of kidney failure (uremic pruritus); acupressure has been studied for fatigue on hemodialysis. Cost estimate being researched. Small, mostly lower-quality trials suggest possible relief of itch or fatigue; an earlier review called the itch evidence insufficient. Never place needles in, or press on, your access arm.
Herbal medicine Not a treatment. Many herbs and supplements are dangerous in kidney failure: some are high in potassium or phosphorus, some damage kidneys (aristolochic acid), and star fruit can be toxic. Not applicable — don’t buy supplements without your kidney team. Possible harm, including dangerous potassium levels, interactions and, after a transplant, risk to the new kidney. Take only vitamins your kidney team prescribes.
Massage therapy Gentle massage for comfort, relaxation and restless legs — never on, or with pressure over, your access arm or PD catheter. Cost estimate being researched. Small trials suggest massage may ease restless legs on hemodialysis. Comfort, not a treatment for kidney failure.
MBHA Wellness Coach Working with your renal dietitian on fluid, sodium, potassium, phosphorus and protein; protecting your access; staying active; mood and support; work and travel planning; caregiver support; advance care planning. Renal dietitians and social workers are part of covered dialysis care. MBHA coaching: being researched. Supports — never replaces — your kidney team. Following your eating plan and treatment schedule helps you feel better between treatments.

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Conventional medicine (AMA)

Your kidney team usually includes a nephrologist (kidney doctor), dialysis nurses, a renal dietitian, a social worker and, if you are considering a transplant, a transplant coordinator (NIDDK). We name treatments but never doses — your team tailors them to your blood tests.

1. Hemodialysis

  • In a dialysis center: usually three times a week for about 4 hours, on a fixed schedule. Staff do the work and are with you the whole time, but the schedule is less flexible and the longer gaps between treatments mean the strictest limits on diet and fluids. Some centers offer longer overnight treatments while you sleep, which free your days and ease diet limits (NIDDK). Under Medicare rules you have the right to choose your dialysis center (NIDDK).
  • At home: shorter treatments most days or longer ones overnight while you sleep (MedlinePlus). More frequent dialysis comes closer to the work healthy kidneys do, with fewer diet and fluid limits and fewer “ups and downs” (NIDDK). Most centers require a trained partner; training typically takes 3 to 8 weeks, and the center provides 24-hour support (NIDDK). Not all centers offer it (MedlinePlus).
  • Common problems include muscle cramps and sudden drops in blood pressure that cause dizziness or nausea, usually from removing fluid quickly; your doctor can adjust your treatment (NIDDK). Keeping to your “dry weight” — your weight without extra fluid — helps control blood pressure (NIDDK).

2. Your vascular access: fistula first

Hemodialysis needs an access — your “lifeline” — made with minor surgery, ideally months before you need it (NIDDK).

  • Arteriovenous (AV) fistula — an artery joined to a vein, usually in the arm. It is the best long-term access because it gives the highest blood flow, is less likely to become infected or clot, and lasts longer (NIDDK). It needs weeks to months to mature (NKF).
  • AV graft — a soft tube joining an artery and a vein, used when a fistula isn’t possible. It can be used sooner but has more infections and clots (NIDDK).
  • Central venous catheter — a tube in a large vein in the neck, chest or groin. It can be used right away but carries the highest risk of infection and is meant for short-term use (CDC). If you have one, ask whether you can move to a fistula or graft (CDC).
  • Before surgery, “save” your arm: if your team asks you to protect one arm, don’t let anyone take blood pressure there, and don’t allow blood draws or IVs in it unless your team says it’s okay (NKF).

Day-to-day access care is covered in the Wellness Coach section below.

3. Peritoneal dialysis (PD)

  • A soft tube (catheter) is placed in your belly with minor surgery, ideally a few weeks before you start. Cleansing fluid flows in, soaks up wastes and extra fluid, and is drained after a few hours — an “exchange”. You can do exchanges by hand during the day (CAPD) or with a machine (cycler) at night while you sleep (NIDDK).
  • PD is done at home, at work or while traveling, without a partner once you’re trained; training usually takes 1 to 2 weeks (NIDDK).
  • The most serious risk is infection — at the catheter exit site or inside the belly (peritonitis). Wash your hands every time, wear a mask when connecting, check each bag for cloudiness, and clean the exit site daily as taught. Hernias and weight gain from the sugar in the fluid can also happen (NIDDK).

4. Medicines

Dialysis doesn’t replace every job the kidneys do, so most people also take medicines. Review all of them with your team at every visit (NIDDK).

  • Phosphate binders, taken with meals, keep phosphorus in food from entering the blood (NIDDK). Too much phosphorus pulls calcium from bones and can cause itching.
  • For bones and parathyroid hormone: active vitamin D (calcitriol), calcium and vitamin D, and calcimimetics; if these and dialysis can’t control the hormone, surgery to remove parathyroid glands may be considered (NIDDK).
  • For anemia: iron (which may be given through a vein during dialysis) and erythropoiesis-stimulating agents (ESAs), which signal the bone marrow to make red blood cells (NIDDK).
  • For high potassium: potassium binders, which attach to extra potassium in the gut so it leaves the body, along with diet changes (NKF).
  • Vitamins: your provider may prescribe a vitamin made for people with kidney failure; don’t take over-the-counter supplements on your own (NIDDK).
  • For itching: treatment starts with controlling phosphorus and parathyroid hormone and with moisturizers; other medicines, including one given during hemodialysis, may be tried (NKF).

5. Vaccines and infection prevention

  • CDC lists people on dialysis — in-center or home hemodialysis and peritoneal dialysis — and people preparing for dialysis among those at risk for hepatitis B, with a special vaccine series for dialysis patients (CDC). Ask your team about hepatitis B, flu, pneumonia, COVID-19 and other vaccines (MedlinePlus).
  • Make sure staff clean their hands before and after caring for you or your access (CDC).

6. Kidney transplant

  • Tell your doctor you’re interested; you’ll be referred to a transplant center for tests of your heart and other organs, your mental and emotional readiness, and tissue matching. Evaluation can take several visits over weeks to months (NIDDK).
  • A kidney may come from a living donor — a relative, spouse or friend — which lets you schedule the surgery, or from a deceased donor, which can mean a wait of months to years. You can be placed on the waiting list before you start dialysis once kidney function is low enough (NIDDK).
  • People with a transplant have a greater chance of living longer than those who stay on dialysis, with fewer diet limits — but surgery has risks, the kidney may be rejected, and anti-rejection medicines must be taken every day for as long as the kidney works (NIDDK). After a transplant, call your transplant center right away for fever, drainage from the scar, burning when you urinate, or a cold or cough that won’t go away (NIDDK).

7. Supportive care, palliative care and hospice

Palliative care eases pain, symptoms and stress and can be offered to anyone with kidney disease, alongside dialysis or a transplant; a palliative care team can also help you weigh whether to start or continue dialysis (NKF). If you choose not to start dialysis, or decide to stop, you still receive care focused on comfort, and hospice can help at the end of life (NIDDK, NIDDK). See Choosing a treatment.

What it costs

  • Medicare at any age: if you have ESRD, you can get Medicare no matter how old you are if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and you (or your spouse or parent) have worked the required time under Social Security, the Railroad Retirement Board or as a government employee, or already get or are eligible for Social Security or Railroad Retirement benefits (Medicare.gov). You need both Part A and Part B for the full ESRD benefits; sign up through Social Security (Medicare.gov).
  • When coverage starts: usually the first day of the fourth month of dialysis — or as early as the first month if you take part in home dialysis training in the first 3 months. For a transplant, it can start the month you’re admitted, if the transplant happens that month or within the next 2 months (Medicare.gov).
  • When it ends: if ESRD is your only reason for Medicare, coverage ends 12 months after you stop dialysis or 36 months after a transplant, and resumes if you restart dialysis or need another transplant within those periods (Medicare.gov).
  • Dialysis: Part B covers outpatient and home dialysis, home training for you and your helper, home equipment and supplies, and most dialysis drugs, including ESAs and phosphate binders. You usually pay 20 percent of the Medicare-approved amount after the Part B deductible. Medicare doesn’t pay for home dialysis aides or lost pay during training (Medicare.gov).
  • Transplant: Medicare covers the transplant and the living donor’s full care at no cost to you or your donor; you pay 20 percent for Part B doctor services after the deductible (Medicare.gov). If ESRD is your only reason for Medicare, a separate benefit can pay for anti-rejection drugs after the 36 months end — in 2026, a $121.60 monthly premium (higher for some incomes), a $283 yearly deductible and then 20 percent (Medicare.gov).
  • Other drugs: Part B doesn’t cover drugs for other conditions, such as blood pressure medicines; a Part D plan does (Medicare.gov). In 2026, out-of-pocket Part D drug costs are capped at $2,100 (Medicare.gov).
  • Choosing a plan: people with ESRD can pick Original Medicare or a Medicare Advantage Plan; check that your dialysis center, kidney doctor and any transplant center are in an Advantage plan’s network (Medicare.gov). If you’re under 65 and on dialysis, you may or may not be able to buy a Medigap policy, depending on your state (NIDDK).
  • Employer coverage: a group health plan pays first for the first 30 months of Medicare eligibility (the “coordination period”), then Medicare pays first (Medicare.gov).
  • More help: Medicaid, Medicare Savings Programs, state kidney programs, SSDI and SSI, and the National Kidney Foundation may help; your renal social worker can find options (NIDDK). Before kidney failure, Medicare Part B covers up to 6 kidney disease education sessions for people with stage 4 chronic kidney disease (Medicare.gov).
  • Problems with your care: your regional ESRD Network can help with complaints about a dialysis facility, and your facility can’t take action against you for complaining (Medicare.gov).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating kidney failure. We found no studies showing it can replace any of the work of the kidneys or of dialysis.

  • Kidney failure can weaken the bones: untreated mineral and bone disorder can make bones thin and weak and raise the risk of fractures (NIDDK). Serious side effects of spinal manipulation are very rare, but they may be more likely in people with underlying health problems that raise the risk of injury (NCCIH).
  • If back or neck pain is a problem, talk with your kidney team first. If you do see a chiropractor, tell them you have kidney failure and list every medicine and supplement you take (NCCIH), and don’t let anyone put pressure on your access arm or take blood pressure there (NKF).
  • Don’t accept supplements from any practitioner without your kidney team’s okay (see the Herbal medicine section).

Find a chiropractor in our directory

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Acupuncture

Acupuncture does not treat kidney failure. It has been studied as an add-on for two symptoms that trouble many people on dialysis: itching and tiredness. The research is small and mixed.

What the research says

  • Itching (uremic pruritus): a 2010 review found that all of the few trials reported benefits, but most had a high risk of bias, so the evidence was insufficient to show acupuncture works (systematic review, 2010). A 2023 review of 7 randomized trials (504 people on hemodialysis) reported that acupuncture eased itching more than usual care and was about as effective as medicines; only three of the trials reported on side effects (systematic review, 2023). Larger, well-designed trials are still needed.
  • Fatigue: a 2024 review of 8 randomized trials (725 people on hemodialysis) found that acupressure — pressing on points without needles — reduced fatigue compared with control groups (systematic review, 2024).

Safety

  • Complications are rare, but acupuncture done improperly can cause infections, punctured organs and nerve injury; needles must be sterile and single-use (NCCIH). People on dialysis are already at higher risk of serious infections (CDC).
  • Never allow needles or pressure on your access arm or near a catheter or PD exit site — your access should be used only for dialysis (MedlinePlus).
  • Tell your kidney team before starting. Itching deserves medical attention too — treatment options exist (NKF).

Find an acupuncturist in our directory

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Herbal medicine

Herbal medicine does not treat kidney failure — and for people on dialysis, many herbs and supplements are dangerous.

Don’t take any herb, supplement or over-the-counter vitamin without your kidney team. Over-the-counter supplements may contain vitamins or minerals that are harmful to you (NIDDK). Bring the bottle, or a photo of the label, to your appointment so your team can check it (NKF).

Why herbs are risky with kidney failure

  • Hidden potassium and phosphorus. Some herbal products are high in potassium (examples include alfalfa, dandelion, noni, nettle, turmeric and coconut water) or phosphorus (such as blue-green algae, seaweed and seed-based products). Labels promising “electrolyte support”, “high in minerals” or “superfood green powders” are warning signs (NKF). High potassium can affect your heartbeat and can even cause death (NIDDK).
  • Build-up in the body. Some herbs leave the body through the kidneys, so they can reach toxic levels when kidneys don’t work (NKF).
  • Kidney damage and cancer. Aristolochic acid, found in Aristolochia (birthwort) and some wild ginger plants, is still present in some traditional remedies (NKF). Cancers of the urinary tract have been reported in people whose kidneys were damaged by products containing it (National Cancer Institute).
  • High-risk herbs. NKF lists examples including aloe (by mouth), astragalus, cat’s claw, chaparral, comfrey, licorice root, St. John’s wort and yohimbe, as well as creatine supplements (NKF).
  • Interactions. Herbs can make prescription medicines weaker or too strong; after a transplant, an interaction with anti-rejection medicines can put the new kidney at risk (NKF). Some products contain contaminants such as heavy metals, or ingredients not on the label (NKF, NCCIH).
  • “Kidney detox” or “cleanse” products have little evidence behind them, and some ingredients can interact with medicines or damage kidneys; avoid them, and avoid “proprietary blends” (NKF).

Star fruit

Star fruit (carambola) can be poisonous for people with kidney disease. A review of published cases found 123 patients in eight countries, and 22 percent of them died (systematic review, 2017). Reported nervous-system effects range from hiccups to prolonged seizures (review, 2021). Avoid star fruit and star fruit juice, and ask your dietitian about any unfamiliar fruit or juice.

Some herbs, such as Asian ginseng, may also interact with blood pressure medicines or affect blood clotting (NCCIH). We don’t list doses here.

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Massage therapy

Massage is not a treatment for kidney failure, but gentle massage may help with comfort, relaxation and restless legs, which many people on dialysis live with.

What the research says

  • A 2022 analysis of 5 small randomized trials (369 people on hemodialysis with restless legs syndrome) found that massage reduced symptoms without more side effects; the authors called for larger studies (meta-analysis, 2022).
  • A 2025 review of 12 studies found massage and acupressure reduced restless legs severity, while reflexology did not, and none of them improved sleep quality (systematic review, 2025).
  • Palliative care teams may offer massage among other therapies to ease emotional stress (NKF).

Protect your access

  • Never massage, press on or put weight on your access arm. Don’t let anyone use a blood pressure cuff on it, and avoid tight sleeves, watches or jewelry over the access (NKF, MedlinePlus).
  • Keep a catheter dressing clean and dry, and never pull or tug on a catheter (NKF). Ask your PD nurse how to protect your belly catheter before any massage.

Other safety tips

Serious harm from massage is rare, but blood clots, nerve injury and broken bones have been reported, some after vigorous deep-tissue massage or in people at higher risk of injury (NCCIH). Because kidney failure can weaken bones (NIDDK), ask for gentle pressure, and choose lotions or oils your team approves. Tell the therapist about your access and your other health conditions.

Find a massage therapist in our directory

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MBHA Wellness Coach

Living with dialysis takes a lot of daily work. An MBHA Wellness Coach can help you build routines, prepare questions and look after yourself and your family — alongside, never instead of, your kidney team.

Food and fluid, with your renal dietitian

Your dialysis center has a renal dietitian with special training in kidney nutrition (NIDDK). A coach can help you keep a food and fluid log to take to them, find low-sodium recipes, and plan around your treatment days. The details are in Eating and drinking on dialysis below.

Protecting your access every day

  • Wash your hands and the access area before each treatment; check the “thrill” (buzzing) every day and look for redness, warmth, swelling, pain, drainage or bleeding (NKF).
  • Don’t sleep on your access arm, carry heavy bags with it, or wear tight sleeves, watches or jewelry over it; don’t let anyone take blood pressure, draw blood or start an IV in it (NKF, MedlinePlus).
  • With a catheter: keep the dressing clean and dry, never open the caps, and don’t swim or soak in a bath unless your team says it’s safe (NKF).

Staying active

  • Physical activity strengthens muscles, bones and heart, and can improve mood and sleep. Talk with your doctor first, start slowly with walking or gardening, and aim to be active on as many days as possible (NIDDK).
  • People on dialysis who exercise regularly report better sleep, more energy and strength, and easier daily tasks. Some units offer foot pedals or bikes to use during hemodialysis — ask. Also ask which activities are safe with your type of access and how much fluid you can have around exercise (NKF).

Mood, stress and support

  • Depression is common with long-term illness and can make kidney disease harder to manage. Ask for help if you feel down; your team, a support group, clergy, friends or family can help, and counseling can help with anxiety and depression (NIDDK).
  • Adjusting to dialysis can be hard on you and your family; a mental health counselor or social worker can help you cope (NIDDK). See our Depression guide.
  • If you are struggling or in crisis, call or text 988 (988 Lifeline).

Work

Many people with kidney failure keep working. Under the Americans with Disabilities Act, an employer can’t fire you just because you’re on dialysis or have had a transplant, and must make reasonable changes — such as scheduling work around dialysis, or giving PD users space and time for an exchange. Your renal social worker can help if your employer isn’t willing (NIDDK). The flexible schedule of home hemodialysis can make it easier to work outside the home (NIDDK).

Travel

Caregivers

Home dialysis partners take on real work, which can be stressful (NIDDK). Caregivers should look after their own health too — ask a doctor for a referral to a counselor if you feel anxious or depressed, and consider a caregiver support group (NIA).

Advance care planning

An advance directive lets you say in advance which treatments you would or wouldn’t want — including dialysis, CPR and breathing machines — and name a health care proxy (NIDDK). The two most common are a living will and a durable power of attorney for health care (NIA). A coach can help you start these conversations with your family.

Another approach

Choosing a treatment: dialysis, transplant or supportive care

Choosing a treatment for kidney failure is a big decision, and a personal one. Start early, think about how each option would affect your daily routine, and reflect on what matters most to you — work, time with family, travel, or feeling as well as possible (NIDDK).

Trade-offs at a glance

  • In-center hemodialysis: staff do the work, but the schedule is fixed and diet and fluid limits are strictest. Home hemodialysis: more control and fewer limits, but you need a partner, training and space for the machine. Peritoneal dialysis: done daily at home, work or while traveling, with no partner needed after training (NIDDK).
  • Kidney transplant: a greater chance of living longer than staying on dialysis and fewer diet limits, but it means surgery, extensive testing, possibly years of waiting and lifelong anti-rejection medicines, and one transplant may not last a lifetime (NIDDK).
  • Conservative management: also called supportive or comfort care, with palliative care as one part of it (NIDDK).

Conservative (supportive) care

  • For most people, dialysis may extend and improve life. For some — for example, people who are elderly and frail or have other serious illnesses such as dementia, heart failure or cancer — it may not lengthen life or may feel like an added burden (NIDDK).
  • Your team continues to treat symptoms such as nausea and poor appetite, and problems such as anemia, while avoiding treatments and hospital stays that would worsen quality of life (NIDDK).
  • How long a person lives without dialysis differs for each person, depending on their health and remaining kidney function — from weeks to several months (NIDDK). Ask your doctor honest questions: Will dialysis improve my quality of life? Will it prolong my life? Is there a downside to trying dialysis first? (NIDDK)
  • You can start dialysis later if you change your mind (NIDDK). Hospice care, at home or in a facility, focuses on comfort at the end of life (NIDDK); with Medicare, you pay nothing for covered hospice care from a Medicare-approved provider, except small drug copays (Medicare.gov).

Stopping dialysis

It is your right to decide how your kidney failure is treated (NIDDK). If you have been on dialysis and wish to stop, you will still receive supportive care, and the dialysis social worker can help you make an end-of-life care plan (NIDDK). Palliative care can start at any stage and can include advance care planning and support for your family (NIA).

Another approach

Eating and drinking on dialysis

What you eat and drink can change how you feel and how well your treatments work. Every plan is personal, so work out your own limits with your renal dietitian — this section explains the reasons (NIDDK).

  • Fluid. On hemodialysis, extra fluid builds up between treatments and can cause swelling, blood pressure changes, strain on the heart and fluid in the lungs; removing a lot at once can bring cramps or a sudden drop in blood pressure. Foods that are liquid at room temperature — soup, gelatin, ice cream — count as fluid, and many fruits and vegetables contain water (NIDDK). Fluid limits on PD may be less strict (NIDDK).
  • Sodium (salt). Salt makes you thirsty. Choose fresh foods, look for “low sodium” labels, and don’t use salt substitutes, which contain potassium (NIDDK).
  • Potassium. Levels can rise between hemodialysis sessions and affect your heartbeat. Your dietitian may suggest limiting foods such as avocados, bananas, kiwis and dried fruit; dicing or shredding potatoes and boiling them in plenty of water removes some potassium (NIDDK). PD removes potassium, so some people on PD need more potassium-rich foods — but not too much (NIDDK). Watch for potassium additives on labels (NKF).
  • Phosphorus. Too much pulls calcium from bones and can cause itching. Processed and packaged foods are especially high; it is also in dairy, beans, nuts, cola and tea. Take phosphate binders as prescribed (NIDDK).
  • Protein. Dialysis removes protein, so most people need high-quality protein such as meat, poultry, fish and eggs; PD removes even more (NIDDK). Avoid processed meats, which are high in sodium and phosphorus (NIDDK).
  • Calories. Many people on hemodialysis don’t feel like eating; your dietitian can suggest healthy ways to add calories (NIDDK). PD fluid contains sugar, so some people on PD need to limit calories (NIDDK). If you have diabetes, plan sweets with your dietitian (NIDDK).

After a transplant there are fewer limits, though sodium and calories may still need watching (NIDDK). Medicare covers dietitian services as part of dialysis care (Medicare.gov).

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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