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What is kidney failure?

 Kidney failure is where the kidneys are less able to remove toxic wastes, excess salt and water. The condition tends to get worse over a period of years. Chronic kidney failure can lead to End-Stage Renal Failure (ESRF) over time. ESRF can be treated by dialysis or by a kidney transplant. Whilst effective, these treatments are not a cure.

Why does blood pressure matter?

High blood pressure is very common in people with kidney failure. Kidney failure causes high blood pressure and high blood pressure causes kidney failure to progress. High blood pressure increases the likelihood of a stroke or a heart attack. It can be controlled by reducing salt intake, weight loss if you are overweight and by taking blood pressure tablets. In patients on dialysis, removing salt and water also helps blood pressure control.

Is anaemia linked to kidney failure?

The kidneys participate in many functions in the body including maintaining haemoglobin levels. Many patients with advanced kidney disease patients have anaemia (low haemoglobin levels), it makes them weak and tired. Anaemia is easy to treat with injections of erythropoietin (EPO). Patients on EPO treatment may need additional iron, either in the form of tablets or injections.

Do most patients with kidney failure suffer renal bone disease?

Renal bone disease is caused by low levels of calcium and vitamin D in the blood, and by high blood levels of phosphate. It is an important complication of kidney failure; without treatment it can cause bone pain and fractures. Although renal bone disease starts early in kidney failure, it does not usually cause problems until advanced kidney disease or after dialysis has begun. A combination of dialysis and tablets usually reverses these problems but in some cases an operation (called parathyroidectomy) may be necessary.

What is dialysis?

Dialysis is the removal of body wastes and water from the blood. There are two types: haemodialysis (HD) and peritoneal dialysis (PD). In the UK, approximately half of the patients on dialysis have PD and the other half have HD - most patients can have either type. Each method has two main processes: - Diffusion removes the body wastes and ultrafiltration removes the excess water.

What is the difference between the two dialysis systems?

• PERITONEAL DIALYSIS

In Peritoneal dialysis the process takes place inside the patients’ abdomen, it is suitable for most people with End-Stage Renal Failure (ESRF). The abdominal lining acts as the dialysis membrane. Dialysis fluid from a bag is drained into the peritoneal cavity in the abdomen, left there until dialysis has taken place, and then drained out. Patients are trained to do this themselves at home which gives them independence, although storage space is needed to accommodate bulky supplies of dialysis fluid. Peritonitis is the main problem with PD, but the risk can be reduced with careful hygiene.

• HAEMODIALYSIS

Haemodialysis is when the process takes place inside a machine, it is suitable for most people with kidney failure. Blood is taken from the body, pumped into the dialysis machine, cleaned and pumped back into the body. Although most patients have haemodialysis in a hospital dialysis unit, most centres not encourage patients to have it at home, to help preserve most of their daily routine. It is usually done three times a week, each session lasting 3 to 4 hours if in a hospital but more frequently if done at home. Access to the patient’s blood stream is usually by a dialysis catheter (plastic tube inserted into a large vein) or a fistula (made by joining a vein to an artery). Some patients may feel sick or dizzy during or immediately after the first few sessions. Patients on haemodialysis tend to have a stricter fluid intake restriction compared to those on PD.

Is a transplant operation possible?

For the right patient at the right time, a transplant is the best treatment for End-Stage Renal Failure. If it works well the patient will be totally free from dialysis. Many patients with kidney failure are suitable for a transplant. Suitability is more important than age. Transplants are matched to the patient in terms of blood group and tissue type.

There are three sources of transplant kidneys:- 

• • Cadaveric transplants
  • Living related transplants
  • Living unrelated transplants

The transplant waiting list works on the basis of finding the right kidney for the right person ie patients do not form a queue. The average waiting time in the UK is two years. Transplants do not last forever, transplants from living relatives last longest. If a transplant fails the patient can go back to dialysis or have another transplant. Patients have to take immuno-suppressant drugs daily, for life, to prevent their body rejecting a transplant. These drugs have side effects, including a small increased risk of developing some types of cancer.

Is diet important to a kidney patient?

Dietary advice differs according to the stage of kidney failure and the type of treatment given. Kidney patients should only alter their diet when advised to do so by their doctor or dietician. Malnutrition is the major problem for many patients on dialysis - both peritoneal dialysis and haemodialysis. So, high protein intakes are recommended. Potassium restriction may be recommended for dialysis patients. Salt intake generally needs to be restricted. Most transplant patients will not have any dietary restrictions.

What impact does kidney failure have?

Kidney failure has a major impact on the whole of a patient’s life, and affects the lives of people who live with the patient. People with kidney failure have to cope with extra stresses. Those diagnosed with kidney failure usually go through shock, grief, and denial before acceptance. Long term problems may involve non-compliance, anxiety, problems with body image, loss of self-confidence, depression, adapting to changes, and a loss of interest in sex. Some patients find that their ability to concentrate and think clearly is affected although efficient dialysis helps most people. Various coping strategies can help people deal with the psychological problems that often occur with kidney failure, including counselling and social worker support from your local kidney unit.

Are there sexual problems to face?

The majority of male and female dialysis patients have sexual difficulties. Impotence is the most common problem but treatment is usually successful. Kidney failure affects the periods. Pregnancy is less likely but contraception is still needed. If a woman with kidney failure gets pregnant, there are serious risks to both mother and baby. A successful pregnancy is sometimes possible. If a woman with kidney failure wants to get pregnant, it is best to do so either in the early stages of kidney failure or after a transplant. And always plan your pregnancy with the advice of your kidney team.

How good or bad is the situation in the United Kingdom?

There has been a serious shortfall in the provision of treatment for kidney failure in the UK. Some European countries treat a far higher proportion of their people who develop kidney failure than do others. In the UK, there were around 5800 patients waiting for kidney transplant at the end of the period 2023/2024. Around 4600 transplants were carried out, but 400 patients died in the year whilst on the organ transplant wait-list. The UK now has an ‘opt-out’ organ donation system, which means most people are considered willing to donate their organs when they die, unless they say otherwise. This may help more people get a transplant in the future. And the average wait-time for a cadaveric kidney transplant is around 2 to 3 years.

Without dialysis or a transplant, people die within a few weeks of developing end-stage renal failure. Successful treatment (by dialysis or transplant) can prolong life for many years. Average survival chances for people on dialysis (or after a transplant) are affected by age, sex, the underlying cause of kidney failure and various medical factors. Yet treatment (by dialysis or transplant) may not be suitable for some patients due to multiple factors such as their complex medical history, weakness due to older age or other advanced illness. They may choose conservative management to maintain their lifestyle with the support of medications and carers until a peaceful death.

Is there anything I can do to help?

Yes, there is. Get involved with the National Kidney Federation which is campaigning to improve the situation in the UK It also provides support for patients and carers as well. It is a charity run by kidney patients for kidney patients. Get involved. Take a lead. Make a difference.

Last reviewed July 2025
Next review July 2028

Reviewed by Dr Oshini Shivakumar 'Specialist Renal Registrar'

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The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.