What are the important functions of the kidneys?
The kidneys are responsible for excreting toxins, waste, drugs, and various chemicals such as urea, creatinine, and uric acid, which are produced from the metabolism of proteins and other substances, out of the body through urine. In addition, the kidneys help regulate the balance of water, minerals, acid-base, and blood pressure, as well as produce the hormone erythropoietin, which plays a role in stimulating the production of red blood cells from the bone marrow.
Generally, after the age of 35-50 years, the kidneys naturally decline by about 1% per year. However, if there are additional risk factors such as diabetes, high blood pressure, or risky behaviors like frequent use of painkillers, the kidneys may deteriorate faster, leading to chronic kidney failure. In end-stage kidney failure, when kidney function is only 10-15% of normal, waste accumulates in the blood causing various symptoms such as swelling, nausea, vomiting, high blood pressure, and can be life-threatening.
What is dialysis? Why is it necessary?
Dialysis is a medical treatment process that uses machines or specialized equipment to filter the blood in place of the kidneys in patients with end-stage chronic kidney failure, where the kidneys cannot adequately remove waste, regulate water, minerals, and toxins in the body. Dialysis is therefore essential to prevent severe complications such as pulmonary edema, acidosis, pericarditis, and even death.
Types of dialysis
Generally, there are two main types of dialysis, each with different principles, advantages, and limitations as follows:
- Hemodialysis: This method uses a dialysis machine to draw blood through a filter (Dialyzer) to remove waste, excess water, and minerals from the blood. It requires preparation of blood vessels for dialysis by creating an AV fistula or graft. This method is suitable for those who cannot care for themselves or do not have a clean enough environment for home dialysis. It has the advantage of high filtration efficiency and medical team supervision, reducing the risk of infection.
- Peritoneal Dialysis: This method uses the peritoneal membrane as a filter by introducing dialysis fluid into the abdominal cavity through a catheter implanted in the abdomen, allowing waste to pass through the membrane before draining it out. It can be done manually (Continuous Ambulatory Peritoneal Dialysis; CAPD) 4-6 times a day or automatically at night (Automated Peritoneal Dialysis; APD). This method is suitable for those who can care for themselves and have a clean environment but must maintain strict hygiene due to the risk of peritonitis. It has the advantage of not requiring frequent hospital visits but is not suitable for those with abdominal adhesions, previous abdominal surgery, hernias, or frequent abdominal infections.
Preparation before starting dialysis
Comprehensive preparation before starting dialysis helps patients enter the dialysis process with confidence, allowing them to live as close to normal as possible. It also improves treatment effectiveness and reduces the risk of complications. Preparation should begin once the patient is diagnosed with end-stage chronic kidney failure and approaches the time to rely on dialysis to replace natural kidney function. Preparation includes:
- Planning with a specialist doctor Patients should receive care from a nephrologist to assess readiness and plan dialysis suitable for their physical condition, lifestyle, and limitations. The doctor will explain the methods, advantages, and limitations of both hemodialysis and peritoneal dialysis to involve patients and families in decision-making.
- Preparing blood vessels or inserting dialysis catheters depending on the chosen dialysis method:
- Hemodialysis requires surgery to create a dialysis blood vessel (AV Fistula or AV Graft), usually using veins in the arm, which is the best vascular access due to low infection rates and long usability. Generally, it takes about 6-8 weeks for the blood vessel to be ready, so planning and preparation in advance are necessary. While waiting for the access to mature, patients may need a temporary central venous catheter if urgent dialysis is required.
- Peritoneal Dialysis requires minor surgery to implant a permanent dialysis catheter in the abdomen. Patients will receive instructions on wound care and proper self-dialysis training before starting actual use.
- Physical examination to assess health, risks, and comorbidities that may affect dialysis, such as heart disease, anemia, or infections.
- Vaccinations such as hepatitis B vaccine, influenza vaccine, and pneumonia vaccine to prevent severe infections common in kidney patients.
- Nutrition planning for appropriate intake of protein, salt, water, and minerals according to the disease stage and chosen dialysis method.
- Monitoring for complications such as infections at the dialysis access or peritonitis in peritoneal dialysis patients.
- Mental preparation by consulting psychologists or multidisciplinary teams.
- Financial planning including benefits and long-term cost assessment.
Is dialysis required for life? What about quality of life?
Although dialysis must be done continuously and regularly for life, if patients follow medical advice, take care of their diet, prevent infections, continuously monitor treatment, and plan appropriately—such as scheduling dialysis sessions to fit their activities and preparing equipment for home dialysis or travel—they can live close to normal lives, including studying, working, or traveling. Therefore, dialysis is not the end of a good quality of life but an adaptation to living well with kidney disease.
How to take care of yourself when undergoing dialysis
Even with dialysis, quality of life can be good if self-care is well understood. Important practices for patients include:
- Control diet according to dietitian’s advice such as limiting sodium (salt) to reduce blood pressure and prevent swelling, controlling potassium and phosphorus to prevent complications like arrhythmia, bone loss, and itchy skin, and avoiding excessive protein intake to reduce kidney waste burden.
- Care for dialysis access or peritoneal dialysis catheter by avoiding pressure or heavy exertion and maintaining cleanliness regularly to prevent complications such as blockage, infection, or injury.
- Exercise at an appropriate level such as light walking, yoga, or stretching to improve circulation.
- Control weight to reduce risk of complications and get enough rest, avoiding stress which can affect the immune system.
- Avoid smoking to reduce the risk of vascular disease and complications.
- Avoid using medications and herbs without consulting a doctor.
- Control fluid intake appropriately according to urine output and swelling by weighing yourself daily at the same time, such as after waking up. If weight increases by more than 1 kilogram in one day or more than 3 kilograms in a short period, it may indicate fluid overload, risking swelling, high blood pressure, enlarged heart, and shortness of breath. Rapid weight loss may signal dehydration and should be reported to a doctor immediately without waiting for severe symptoms.
- Attend medical appointments to evaluate treatment results, check for complications such as anemia, osteoporosis, infections, and adjust treatment plans accordingly.
Although dialysis is a continuous treatment, with proper planning under specialist care and behavioral adjustments, patients can have a good quality of life. At Phyathai Phaholyothin Hospital, there is a Chronic Kidney Disease Care Center with a team of nephrologists, nurses, nutritionists, and multidisciplinary teams, equipped with standard dialysis technology to provide appropriate and safe care. Because dialysis is not just treatment but a journey together every step of the way.
Dialysis at the Dialysis Center
Phyathai Phaholyothin Hospital
| Entitlement | Service Fee |
| Government officer rights from the Comptroller General’s Department Bangkok Metropolitan Administration rights State enterprise employee rights |
2,000.-/ session **No extra charge |
| Social Security rights | Reimbursement 1,500.- Dialysis 2 times/week, pay extra 700.-/ session Dialysis 3 times/week, pay extra 500.-/ session |
| Self-pay / Cash payment | Dialysis 2 times/week 2,200.- Dialysis 3 times/week 2,000.- |
