End-stage kidney disease (ESKD) is the final stage of chronic kidney disease, occurring when the kidneys function at less than 15% of their normal capacity. When the kidneys fail, they can no longer remove waste products, balance electrolytes, or regulate fluid levels in the body. Dialysis is a procedure designed to take over these life-sustaining functions, filtering the blood to prevent the toxic buildup of waste and maintaining a stable internal chemical environment. This treatment is a form of renal replacement therapy that allows individuals to continue living, though it is not a cure for ESKD.
The Two Primary Types of Dialysis
The two main methods used to replace kidney function are Hemodialysis (HD) and Peritoneal Dialysis (PD), which differ significantly in their mechanism and delivery schedule. Hemodialysis involves circulating the patient’s blood outside the body through a specialized machine called a dialyzer, or artificial kidney. This process uses a semipermeable membrane to clean the blood before returning it to the patient.
Hemodialysis is typically performed at a clinic three times per week, with each session lasting around four hours, though home hemodialysis offers more flexible schedules. Peritoneal Dialysis (PD), by contrast, uses the patient’s own abdominal lining, the peritoneal membrane, as the filter. A sterile fluid, called dialysate, is introduced into the abdominal cavity through a permanent catheter, drawing out waste and excess fluid from the surrounding blood vessels.
Peritoneal Dialysis is a home-based treatment that offers greater independence and flexibility. Patients can perform exchanges manually several times a day (Continuous Ambulatory Peritoneal Dialysis) or use a cycler machine to perform the exchanges automatically overnight (Automated Peritoneal Dialysis). The choice between HD and PD often depends on the patient’s lifestyle, physical condition, and personal preferences.
Understanding Average Life Expectancy on Dialysis
While dialysis is a life-saving treatment, life expectancy for patients with ESKD is not uniform and depends heavily on individual health circumstances. The current average life expectancy for a person starting dialysis is approximately five to ten years. This figure represents a wide range, as many patients live for twenty years or more while others survive for only a few years.
This wide variability means that statistics must be viewed as broad averages rather than personal predictions. For the entire dialysis population, the five-year survival rate is cited to be between 35% and 55%. Younger patients consistently show much better outcomes; for those starting treatment under the age of 50, the five-year survival rate can exceed 80%.
In contrast, patients over the age of 80 face a much shorter prognosis, with five-year survival rates often falling below 35%. Overall, the one-year survival rate for all individuals initiating dialysis is high, often around 88%, demonstrating the immediate life-preserving capability of the treatment.
Key Factors Influencing Patient Longevity
The most significant factors determining a patient’s long-term survival are medical conditions that exist before or alongside kidney failure. The presence and severity of comorbidities profoundly affect patient longevity. Cardiovascular disease is particularly harmful, as it is the most common cause of death in dialysis patients, who face a risk of cardiovascular mortality ten to thirty times higher than the general population.
Uncontrolled diabetes is another negative predictor, as it not only causes kidney failure but also accelerates damage to the heart and blood vessels. Patients with a higher comorbidity burden face a significantly shorter life expectancy. Conversely, starting dialysis at a younger age correlates with a much longer survival time due to a lower burden of co-existing diseases.
Retaining some measure of native kidney function, known as residual renal function, acts as a protective factor for survival. Even minimal urine output helps clear toxins and control fluid balance between dialysis sessions, reducing stress on the cardiovascular system.
Maintaining good nutritional status is paramount, as malnutrition is strongly linked to poorer outcomes and increased mortality, particularly in older patients.
Quality of Life and Treatment Adherence
Beyond clinical factors, a patient’s commitment to their treatment regimen plays a substantial role in long-term survival and quality of life. Strict adherence to the prescribed dialysis schedule is foundational, as missing sessions allows dangerous amounts of fluid and waste products to accumulate, increasing the risk of hospitalization and death. Non-adherence to fluid restrictions can lead to hypervolemia, which places excessive strain on the heart, potentially causing fatal arrhythmias.
Dietary restrictions are equally important, requiring patients to limit intake of sodium, potassium, and phosphorus to prevent dangerous electrolyte imbalances. Sodium restriction helps control fluid retention, while limiting potassium prevents cardiac complications. Adherence to prescribed medications, including phosphate binders and blood pressure medications, is a constant requirement for managing the systemic effects of ESKD.
The psychological impact of living with a chronic illness affects adherence and overall well-being. Depression and anxiety are common among dialysis patients and can negatively influence their ability to follow complex treatment plans, underscoring the need for mental health support.
Actively managing psychological health and maintaining a positive outlook are non-clinical elements that allow patients to maximize their time and live more fulfilling lives on dialysis.