Kidney Failure Treatment

How is Kidney Failure treated?

Being told that your kidneys are failing can feel overwhelming. It is natural to worry about what this means for your health, your work, and your family. The reassuring news is that kidney failure is treatable, and there are several well-established ways to replace the work of your kidneys and to help you feel well again.

With the right treatment and support, many people with kidney failure continue to lead full, active lives. Your kidney specialist will help you choose the approach that best fits your health, your lifestyle, and your wishes.

Understanding Kidney Failure

Your kidneys are two bean-shaped organs, each about the size of a fist, located in the abdomen on either side of the spine. Every day they filter waste and extra fluid out of your blood and turn it into urine. They also help to control blood pressure, keep the body’s salts and minerals in balance, make a hormone that supports red blood cell production, and keep bones strong.

Kidney failure occurs when the kidneys lose their ability to do these jobs well enough to keep you healthy. It can happen in two ways:

• Acute kidney failure: The kidneys stop working suddenly, often because of severe illness, dehydration, infection, or certain medications. Some people recover kidney function, although temporary dialysis may be needed while the kidneys heal.
• Chronic kidney failure: Kidney function declines gradually over months or years, most commonly because of diabetes or high blood pressure. When it reaches an advanced stage, often called end-stage kidney disease, treatment is needed to replace the kidneys’ work.

Kidney failure is a significant health concern in Singapore. Around six people here are diagnosed with kidney failure every day, and more than 9,000 people are on dialysis. Diabetes is the leading cause, followed by high blood pressure. The good news is that treatment options continue to improve, and early planning makes the journey smoother.

Your Treatment Options

There are several treatments for kidney failure, and the right choice depends on the type of kidney failure you have, your overall health, and your personal preferences. These options are not always an either-or decision. Many people use more than one over the course of their illness, for example starting with dialysis while waiting for a kidney transplant

• Haemodialysis: Your blood is passed through a filter outside your body, cleaned, and returned. It is carried out at a dialysis facility under the care of trained nurses, usually several times a week.
• Peritoneal Dialysis: The lining of your abdomen acts as a natural filter, using a special cleansing fluid that is placed into and drained from your abdomen. It can often be done at home. Your doctor will advise whether it is suitable for you.
• Kidney Transplant: A healthy kidney from a living or deceased donor is surgically placed in your body. It is often considered the best long-term treatment, as it can restore normal kidney function and remove the need for dialysis.
• Medications and Supportive Care: Medicines and careful monitoring to control blood pressure, anaemia, bone health, and fluid balance. They are important alongside dialysis, and while waiting for a transplant.
• Conservative Kidney Management: For some people, particularly those who are older or have other serious illnesses, focusing on symptom control and quality of life without dialysis may be the choice that best reflects their wishes.

Understanding Dialysis

Dialysis is a treatment that replaces your kidney functions when they stop working. It removes waste products and excess fluid from your blood, helps to keep the levels of salts and minerals balanced, and helps to control your blood pressure. Dialysis does not cure kidney failure, but it keeps you well by doing the work that your kidneys can no longer do.

Haemodialysis is done at a dialysis facility, where your blood is put through a filter outside your body, cleaned, and then returned to you. Farrer Park Hospital’s Dialysis Centre provides haemodialysis in a comfortable setting, supported by experienced dialysis nurses and kidney specialists.

You may feel dizziness and muscle cramps during dialysis caused by the rapid changes in blood fluid levels that occur during the treatment.

Before Your Haemodialysis Treatment

To carry out haemodialysis, the dialysis machine needs a reliable way to draw blood from your body and return it. For most people, this is done by creating a connection called an arteriovenous (AV) fistula in the arm. In a short procedure, a surgeon joins an artery to a vein, usually in your forearm or upper arm. This makes the vein stronger and larger over time so that it can handle the repeated needle insertions and high blood flow that dialysis needs.

The tissue and skin surrounding the fistula need to heal and mature for several weeks before haemodialysis can begin, which is why it is best to plan ahead rather than wait until dialysis is urgent. Your doctor may also advise you to protect the arm that will be used, for example by avoiding blood draws, drips, or blood pressure checks on that arm. In some situations, where a fistula is not possible or there is not time to wait, your doctor may suggest an alternative form of access, such as a graft or a temporary catheter.

What Happens During Haemodialysis

When you arrive for your session, a nurse will check your weight and blood pressure and will help you get comfortable on a couch, recliner, or bed. Two thin needles are then inserted into your fistula and taped securely in place. One needle slowly carries blood from your body to the dialysis machine, where it passes through a filter. On the other side of the filter is a liquid called dialysate, which draws waste products and extra fluid out of your blood. The used dialysate is pumped away, and your cleaned blood is returned to your body through the second needle.

A session typically lasts around four hours, and many people have sessions three times a week, although your schedule will be tailored to your needs. Most people read, watch something, listen to music, or rest during treatment, and nurses stay close by to monitor you throughout.

Because fluid and waste are removed relatively quickly, you may feel dizzy or get muscle cramps during dialysis. This is caused by rapid changes in the level of fluid in your blood. Please let your nurse know if you feel unwell during treatment, as small adjustments can often make you more comfortable.

What Happens After Haemodialysis

Once your session is complete, the needles are removed, and a plaster is applied to your arm to prevent bleeding. After a short period of monitoring, you will be able to leave the dialysis facility and go home. It is common to feel a little tired or washed out after treatment, and many people find it helpful to rest, have a light meal, and take it easy for the remainder of the day.

Caring for Your Fistula

Your fistula is your lifeline for dialysis, so a little daily care goes a long way.

• Check it daily: Gently feel for the vibration, sometimes called a thrill, over the fistula. If it feels different or disappears, tell your dialysis team.
• Keep it clean: Wash your arm with soap and water before each dialysis session, and keep the area clean and dry.
• Protect the arm: Avoid tight clothing, jewellery, or watches on the fistula arm, do not carry heavy loads on it, and avoid sleeping on it.
• Avoid blood tests and injections on that arm: Remind healthcare staff that you have a fistula so that blood pressure checks, blood draws, and drips are done on the other arm.
• Look after the needle sites: Follow your nurse’s advice on caring for the plaster and the needle sites after each session.

Kidney Transplant

A kidney transplant involves surgically placing a healthy kidney from a donor into your body. The new kidney can take over the work of your failed kidneys, and for many people a successful transplant offers a better quality of life and more freedom than dialysis. The donated kidney may come from a living donor, such as a family member or friend, or from a deceased donor.

Not everyone is suitable for a transplant. Your team will carry out a thorough assessment of your overall health, including your heart, lungs, and general fitness, to decide whether the benefits outweigh the risks. If you are suitable, you may be placed on a waiting list for a deceased donor kidney or evaluated for a living donor transplant. Organ donation and transplantation in Singapore are regulated by law, and living donors are carefully assessed to make sure that donating is safe for them. While you wait for a transplant, you will usually continue on dialysis.

After a transplant, you will need to take anti-rejection (immunosuppressant) medication regularly for as long as the kidney is working, along with regular check-ups to monitor how the new kidney is doing.

The needles are removed and a plaster is applied to your arm to prevent bleeding. You will be able to leave the dialysis facility and go home.

Medications and Supportive Care

Even with dialysis, or while waiting for a transplant, medications play an important role in keeping you well and in managing the complications of kidney failure. Your doctor may prescribe medicines to:

• Control blood pressure: High blood pressure is common in kidney failure, and keeping it in check protects your heart and blood vessels.
• Treat anaemia: Failing kidneys make less of the hormone that stimulates red blood cell production, which can cause tiredness and breathlessness. Injections and iron supplements can help.
• Protect your bones: Kidney failure upsets the balance of calcium, phosphate, and vitamin D, and can weaken the bones. Medicines such as phosphate binders and vitamin D may be prescribed.
• Manage fluid: Diuretics, sometimes called water tablets, help to remove excess fluid, particularly in people who still pass some urine.

Please take your medications exactly as prescribed, and check with your doctor or pharmacist before taking any over-the-counter painkillers, herbal remedies, or supplements, as some of these can be harmful to people with kidney disease.

Possible Side Effects and Challenges

Dialysis is a life-sustaining treatment, and most people adapt well to it, but it can come with some challenges. Besides dizziness and muscle cramps during a session, some people experience low blood pressure, tiredness, headaches, nausea, or itchy skin. The fistula and needle sites can occasionally become infected, bruised, or blocked, which is why daily care and checking your fistula matter. Your dialysis team will monitor you closely and adjust your treatment to help reduce these effects. Do tell them about anything that troubles you, no matter how small it seems.

Living with kidney failure can also take an emotional toll. It is common to feel anxious, low, or overwhelmed, particularly in the early days. Talking with your care team, family, or others in a similar situation can help.

Living Well on Treatment

What you do outside of your dialysis sessions matters just as much as the treatment itself. A few habits can help you feel your best.

• Follow your dietary advice: Your dietitian will tailor your diet to your needs and to your blood results. In general, this involves limiting salt, and often potassium and phosphate, while making sure you still get enough protein. Salty soups, gravies, sauces, and preserved foods are high in sodium, and fruits such as bananas, oranges, and durian, as well as coconut water, are high in potassium. Star fruit (carambola) can be dangerous for people with kidney failure and should be avoided entirely.
• Watch your fluids: Your doctor may set a daily fluid allowance. Remember that soups, drinks like coffee and tea, ice kacang, and even fruits count towards your intake. Fluid builds up between sessions, so sticking to the allowance helps you feel comfortable and protects your heart.
• Keep to your schedule: Attending every dialysis session and arriving on time, are among the most important things you can do for your health.
• Stay active: Gentle exercise such as walking, tai chi, or stretching can boost energy, mood, and strength. Ask your team what is suitable for you.
• Keep working and doing what you love: Many people continue to work, travel, and enjoy time with their families. Dialysis schedules can often be planned around your commitments, so speak to your team about what works best for you.
• Control your blood sugar and blood pressure: If you have diabetes or high blood pressure, keeping them under control protects your heart, eyes, and nerves.
• Look after your mind: Reach out for support from your care team, a counsellor, or a patient support group if you are finding things difficult.

Support Along the Way

You do not have to go through this alone. Your care is delivered by a team that may include kidney specialists, dialysis nurses, dietitians, pharmacists, and medical social workers, who work together to support you and your family. Our medical social workers can also guide you on the practical side of long-term treatment, including understanding your options for financing care through Medisave, MediShield Life, and insurance, as well as available subsidies and support schemes for eligible patients. Dietetics and Nutrition support is available to help you eat well on dialysis.

Should you feel unwell after the procedure, contact your doctor immediately or call our 24-HR Medical Urgency Clinic (65) 6705 2999.