Kidney failure is treated with dialysis, a kidney transplant, or conservative management focused on quality of life. The right approach depends on your overall health, how quickly your kidneys declined, and your personal priorities. Kidney failure is defined as a glomerular filtration rate (GFR) below 15, meaning your kidneys are filtering less than 15% of what healthy kidneys would.
What Kidney Failure Means
Chronic kidney disease is measured in stages based on how well your kidneys filter waste from your blood. Stage 4, with a GFR between 15 and 29, is considered severely decreased function. Stage 5, with a GFR below 15, is kidney failure. At this point, your kidneys can no longer sustain your body’s needs on their own, and waste products, excess fluid, and mineral imbalances start causing symptoms like nausea, swelling, fatigue, and confusion.
Not everyone with kidney failure needs treatment immediately. Some people live with a very low GFR for months before symptoms become unmanageable. But once they do, you’ll need to choose between three paths: dialysis, transplant, or conservative care without dialysis.
Dialysis: Three Ways to Do It
Dialysis takes over the filtering work your kidneys can no longer do. It removes waste, excess salt, and extra fluid from your blood. There are three main setups, each with a different daily reality.
In-Center Hemodialysis
This is what most people picture when they hear “dialysis.” You travel to a clinic at least three times a week, and trained staff connect you to a machine that cycles your blood through a filter. Sessions typically last about four hours. The schedule is fixed and requires consistent travel, which can be a significant time commitment once you factor in getting to and from the center, waiting, and recovery afterward.
Home Hemodialysis
Home hemodialysis uses the same filtering technology but on your own schedule, typically five to seven times a week in shorter sessions. You and a trained partner learn to run the treatments yourselves. It does require dedicating space in your home for the machine, a water system, and supplies. The tradeoff is more flexibility and fewer trips to a clinic.
Peritoneal Dialysis
Peritoneal dialysis works differently. Instead of filtering blood through a machine, a special fluid is placed into your abdominal cavity through a small, permanent catheter. The lining of your abdomen acts as the filter, drawing waste out of your blood and into the fluid, which you then drain. It’s done every day, with no days off, but it requires no machine and takes less total time than traveling to a center for hemodialysis. Many people do exchanges while sleeping or during quiet periods at home.
Kidney Transplant
A transplant is the closest thing to restoring normal kidney function. A healthy kidney from a living or deceased donor is surgically placed in your lower abdomen and connected to your blood vessels and bladder. Your original kidneys usually stay in place unless there’s a specific reason to remove them.
Transplant outcomes are strong. Five-year graft survival, meaning the transplanted kidney is still working five years later, is about 87% for kidneys from living donors and roughly 76% for deceased donor kidneys. Patient survival rates at five years are similar: 87% for living donor recipients and 77% for deceased donor recipients.
The major limitation is access. The median wait time for a deceased donor kidney in the United States is about four years, and that varies considerably based on your blood type, where you live, and whether you’re an adult or child. A living donor, such as a family member, friend, or even an altruistic stranger, can dramatically shorten that wait.
Who Qualifies for a Transplant
Not everyone with kidney failure is a candidate. Transplant centers evaluate whether the surgery will genuinely improve your life expectancy and quality of life. Conditions that may disqualify you include a life expectancy under five years even with a successful transplant, extreme obesity (BMI over 45), active substance use disorders, severe heart or lung disease, cancer likely to worsen after transplant, uncontrolled infections, or the inability to follow post-transplant care requirements. You also need a reliable support system to help during recovery.
Life After Transplant
A transplant isn’t a cure in the sense that you can forget about your kidneys afterward. You’ll take immune-suppressing medications for the rest of the transplanted kidney’s life to prevent your body from rejecting it. These medications are given in two phases: strong doses around the time of surgery to prepare your body, followed by lower maintenance doses long-term.
The common side effects of these medications include increased risk of infections, higher blood pressure, elevated cholesterol, higher risk of diabetes, stomach problems, and a modestly increased risk of certain cancers. Many people also experience cosmetic effects like acne, weight gain, or increased hair growth. The specifics depend on which combination of drugs your transplant team prescribes, and regimens are often adjusted over time to minimize side effects while keeping rejection risk low.
Despite these trade-offs, most transplant recipients report significantly better quality of life compared to dialysis. There are no recurring treatment sessions, fewer dietary restrictions, and more energy.
Diet Changes for Kidney Failure
Regardless of which treatment path you’re on, what you eat matters. Failing kidneys can’t regulate sodium, potassium, phosphorus, or protein the way healthy kidneys do, so your diet needs to compensate.
Sodium is the most universal restriction. General guidelines recommend no more than 2,300 milligrams per day, but many people with kidney failure need to go lower than that. Excess sodium causes fluid retention, raises blood pressure, and makes dialysis less effective. In practice, this means cooking from scratch more often and avoiding processed and restaurant foods, which account for most sodium in the typical diet.
Potassium and phosphorus limits are more individual. Your levels depend on how much kidney function you still have, what medications you take, and whether you’re on dialysis. There’s no single number that applies to everyone. A renal dietitian can review your bloodwork and help you identify which foods to limit and which are safe. If you’re on dialysis, you may actually need more protein than before, since dialysis removes protein from your blood during treatment.
Managing Complications
Kidney failure doesn’t just mean waste buildup. It triggers a cascade of other problems that need their own management.
Anemia is one of the most common. Healthy kidneys produce a hormone that signals your bone marrow to make red blood cells. When your kidneys fail, that signal weakens, and your red blood cell count drops. This causes fatigue, weakness, and shortness of breath. Treatment involves medications that mimic that hormone, sometimes combined with iron supplements to give your body the raw materials it needs to produce new blood cells.
Bone and mineral disorders are another major concern. When your kidneys can’t filter phosphorus properly, it builds up in your blood and pulls calcium from your bones, weakening them over time. Phosphate binders are medications taken with meals that grab phosphorus from your food before it enters your bloodstream. Depending on the type, you chew or swallow them right before, during, or immediately after eating. The timing matters because they only work when there’s food in your stomach to bind to.
Fluid overload, high blood pressure, and heart disease are also closely tied to kidney failure and require ongoing attention. Most people with kidney failure take multiple medications to manage these overlapping issues.
Conservative Management Without Dialysis
Some people choose not to pursue dialysis or transplant. This is called conservative management, and it’s a legitimate medical path, not a refusal of care. The focus shifts entirely to quality of life and symptom control rather than replacing kidney function.
Conservative management includes preserving whatever kidney function remains for as long as possible, managing symptoms like nausea and poor appetite, treating complications like anemia, and addressing emotional and spiritual needs through palliative care. The goal is to maintain the best possible quality of life while avoiding treatments and hospital stays that may do more harm than good. This often means fewer medical appointments, fewer blood draws, and fewer medications.
This choice is most common among older adults or people with serious additional health conditions where dialysis would be unlikely to extend life meaningfully, or where the burden of treatment would outweigh the benefit. It includes planning for end-of-life care, and palliative care teams work alongside your regular doctors to manage pain, discomfort, and emotional wellbeing.
Choosing Between Treatments
There’s no single best treatment for kidney failure. The decision depends on your age, other health conditions, lifestyle priorities, and support system. Someone who is otherwise healthy and under 60 may benefit most from pursuing a transplant while using dialysis as a bridge during the wait. Someone in their 80s with advanced heart disease might find conservative management offers better day-to-day life than the demands of dialysis three times a week.
If you’re weighing options, the most important step is an honest conversation with your kidney care team about what each path looks like in practice: how much time it takes, how you’ll feel, what the realistic outcomes are for someone in your specific situation, and what matters most to you. Many kidney centers have social workers and patient navigators who can help you think through logistics like transportation, insurance, and caregiver support.