Having chronic kidney disease means that for some time your kidneys have not been working the way they should. Your kidneys have the important job of filtering your blood. They remove waste products and extra fluid and flush them from your body as urine. When your kidneys don't work right, wastes build up in your blood and make you sick. When kidney function falls below a certain point, it is called kidney failure.

A measure of your kidney function (estimated glomerular filtration rate, or eGFR) is used to show how well your kidneys work. (The eGFR is calculated from the results of a creatinine test.) An eGFR of 15 milliliters per minute (mL/min) or less shows that you have kidney failure.

As your kidney function gets worse, you may:

• Feel very tired.
• Feel nauseated or vomit.
• Have swelling from fluid building up in your body.
• Not feel hungry. You may lose weight.
• Have trouble thinking.
• Have a metallic taste in your mouth.
• Have severe itching.

Kidney failure can cause serious heart, bone, and brain problems.

When you get close to kidney failure, your doctor will likely talk to you about your options. You may choose to treat your kidney failure with dialysis, to have a kidney transplant, or to have no treatment.

Dialysis is a process that filters your blood when your kidneys no longer can. It isn't a cure, but it can help you feel better and live longer. You can choose from two types of dialysis : hemodialysis (say "HEE-moh-dy-AL-uh-sus") and peritoneal dialysis (say "pair-uh-tuh-NEE-uhl dy-AL-uh-sus"):

A kidney transplant may be the best choice if you are otherwise healthy. With a new kidney, you would feel much better and be able to live a more normal life. But you may have to wait for a kidney that is a good match for your blood and tissue type. After the transplant, you would need to take medicines to keep your body from rejecting the new kidney. And you would need to see your doctor often and have blood tests to check how you're doing.

Not having dialysis or a transplant also is an option for people with kidney failure. Older adults or those with other serious health problems may decide instead to take medicines and make changes to their diet as their doctor recommends. Whatever you decide, discuss it with your family, friends, and medical team.

Deciding when to start dialysis can be confusing. Even the experts don't always agree on the best time to start or how long to wait. Waiting usually means 6 months to a year. But how long you can wait depends on several things, including your age and overall health aside from your kidneys.

Most people go on dialysis or get a kidney transplant when they have symptoms of kidney failure or when the main measure of their kidney function (estimated glomerular filtration rate, or eGFR) is less than 10 milliliters per minute (mL/min).

Guidelines for doctors about when to start dialysis include kidney failure symptoms, problems controlling blood pressure, problems controlling fluid, and problems with nutrition. The guidelines suggest these problems happen when the eGFR is between 5 to 10 mL/min. ^{footnote 1} These are just guidelines. You and your doctor may decide to start dialysis before these problems are happening to you.

Many things to consider

Your eGFR isn't the only thing you and your doctor will look at in deciding when you should start dialysis. You will also consider:

• Whether you have swelling, nausea, or other symptoms of kidney failure.
• Your age.
• Your health aside from your kidney failure.
• How you feel—if you have the energy to do your daily activities.
• Your ability to make lifestyle changes and to commit time to dialysis.

Dialysis can help you feel better before you start to have bad symptoms. It may improve your ability to get good nutrition and reduce the chances of going into the hospital from complications of kidney failure. It also may lower blood pressure in people who have high blood pressure.

Many experts recommend starting dialysis before you have any complications of kidney failure. That's because many of the complications can be deadly, such as not getting good nutrition, having too much fluid, or having too many wastes building up in your body.

Even if you don't start dialysis, you may want to plan for dialysis if your kidney function is getting worse. You could have surgery months ahead of time to create a place, called an access, to take the blood from your body to the dialysis machine.

Dialysis—whenever it's started—can cause side effects. The longer you have dialysis, the longer you expose yourself to the chance of side effects. Hemodialysis can cause low blood pressure and heart problems, such as sudden cardiac arrest. Peritoneal dialysis increases the risk of infection in the lining of your belly (peritonitis).

If you wait, you won't have as many limits on your time and lifestyle. Hemodialysis takes about 12 or more hours a week, usually in a dialysis center. Peritoneal dialysis needs to be done about 4 times a day, although it often can be done while you sleep.

If you decide to start dialysis, it may help to know that it's common to feel a little overwhelmed and even scared at first. It's a big change in your life. But if you choose to start dialysis, you can make good choices in your lifestyle to help you get the most from it.

• Be careful about what you eat and drink when you're on dialysis. Your doctor will tell you how much fluid, protein, and salt (sodium) you can have. A dietitian can work with you to help you plan your meals.
• Exercise to help improve your energy. Work with your doctor to make sure that you are getting the right amount of exercise.
• Avoid substances that can harm your kidneys, such as alcohol, any kind of tobacco, or illegal drugs.
• Tell your doctor about all prescription medicines, over-the-counter medicines, and herbs that you are taking.