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HEMODIALYSIS OVERVIEW
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Dialysis is a treatment for severe kidney failure (also called renal failure, stage 5 chronic kidney disease, and end-stage renal disease). When the kidneys are no longer working effectively, waste products and fluid build up in the blood. Dialysis take over a portion of the function of the failing kidneys to remove the fluid and waste.
   
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Dialysis is typically needed when about 90 percent or more of kidney function is lost. This usually takes many months or years after kidney disease is first discovered. Early in the course of kidney disease, other treatments are used to help preserve kidney function and delay the need for replacement therapy.
   
WHICH TYPE OF DIALYSIS IS BEST?
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Once dialysis becomes necessary, you (along with your physicians) should consider the advantages and disadvantages of the two types of dialysis:
* Hemodialysis
* Peritoneal dialysis
 
The choice between hemodialysis and peritoneal dialysis is influenced by a number of issues such as availability, convenience, underlying medical problems, home situation, and age. This choice is best made by discussing the risks and benefits of each type of dialysis with a healthcare provider.
   
WHEN TO START DIALYSIS
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You and your doctor will make the decision about when to start dialysis as your kidney disease progresses. Your kidney function (as measured by blood and urine tests), overall health, nutritional status, symptoms, quality of life, personal preferences, and other factors impact the decision. Healthcare providers recommend that dialysis begin well before kidney disease has advanced to the point where life threatening complications can occur.

It is generally possible to be put on a kidney transplant waiting list when kidney function is about 20 percent of normal. Many patients will need to start dialysis when their kidney function is about 8 to 12 percent of normal, although this is variable.

In certain situation, dialysis must be started immediately. If blood tests indicate the kidneys are working very poorly or not at all, or if there are symptoms such as confusion or bleeding that is related to kidney disease, dialysis should be started at once.