Why Is Chronic Kidney Disease (CKD) on the Rise? 6 Things to Know > News > Yale Medicine


It depends. Having CKD doesn’t always mean the disease will progress to ESKD and require dialysis or a kidney transplant. “As kidney specialists, we try to establish the cause of the disease, treat it, and determine if a patient will require dialysis in the future,” Dr. Luciano says. “Sometimes, the last part is difficult because we don’t know how they’re going to respond to treatment, how their kidney disease is going to progress over time, and what other circumstances can develop in their life that can impact the disease.”

If, however, you progress to ESKD and your kidneys fail, you will need either dialysis or a kidney transplant to replace the work of the kidneys.

Out of almost 808,000 people in the U.S. who have ESKD, 69% are on dialysis, which was once done only in a health care setting. Now, many people choose types of dialysis that can be performed at home.

There are two types of dialysis treatment, both of which involve several treatments a week.

  • Peritoneal dialysis: In a surgical procedure, a catheter (or plastic tube) is placed in the patient’s belly. The patient hooks up a plastic bag of cleansing fluid to the tube, which transports the fluid to the abdomen, and is then used to drain it. Treatment can be continuous, as the person goes about their normal activities, or automated, in which the cleansing fluid is delivered and drained while the person sleeps.
  • Hemodialysis: Blood is pumped out of the body through a tube and into an artificial kidney machine, which removes the waste and extra fluid before it’s sent back to the body. This is done three or four times a week, often in a health care setting, but it can sometimes be done at home.

“For those who can do it, we often recommend home dialysis,” Dr. Luciano says. “It tends to be easier for people, gives them more flexibility with their schedule, and is gentler on the body.”

Still, a kidney transplant is often the best solution—preferably before a patient reaches the point of requiring dialysis, Dr. Luciano says. That’s because while dialysis can take over the function of cleaning waste and excess water from the body, treatments can be time-consuming and cause such side effects as skin infections, low blood pressure, muscle cramps, weakness, and fatigue. It can also have a major impact on a person’s life, both emotionally and physically.

“The hope is that some of the newer medications will allow patients to stay on the waiting list longer without needing dialysis,” Dr. Luciano says.

In 2020, the remaining 31% of the almost 808,000 people in the U.S. with ESKD had kidney transplants, according to the CDC. People wait three to five years, more or less, for an organ from a deceased donor, depending on such factors as geographic location and blood type. “But if you have a living donor—either someone you know or a stranger willing to donate a kidney—and everything works out, you may get a kidney within three to six months,” Dr. Luciano says.

There are also kidney registries that can help match people with a living donor who is not a relative.


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