Questions

Advanced chronic kidney disease usually means kidney function is severely reduced or there is a high risk of further progression. The kidneys may be less able to remove waste and fluid or help control blood pressure, support red blood cell production, maintain acid balance, and keep bones healthy.

eGFR stands for estimated glomerular filtration rate. It is calculated from a blood creatinine result together with factors such as age and sex, and gives an estimate of how well your kidneys filter blood. It is most useful when followed over time and interpreted together with your symptoms, urine tests, and other results.

Not always. Your symptoms, examination findings, quality of life, kidney function, and laboratory results are all considered together when deciding whether dialysis is needed—not an eGFR value alone.

The rate varies considerably. Your kidney care team reviews the cause of kidney disease, changes in eGFR over time, urine protein, other health conditions, and a validated kidney-failure risk estimate where appropriate.

Kidney function can improve if a reversible problem is found and treated, and some people remain stable for a long time. Established chronic damage often does not fully recover, so repeated results and the overall trend are more useful than one test.

Take prescribed medicines consistently, manage blood pressure and diabetes where relevant, remain physically active within your ability, avoid smoking, and check over-the-counter medicines or herbal products with your kidney care team before taking them.

Your monitoring will be planned according to your individual needs. It commonly includes symptoms, blood pressure, weight and fluid status, eGFR, potassium, bicarbonate, haemoglobin, urine protein, nutrition, and markers of bone and mineral health.

The kidney care team looks for problems attributable to kidney failure, such as difficult-to-control fluid overload or blood pressure, persistent laboratory abnormalities, worsening nutrition, or symptoms affecting daily life. The decision is based on the complete clinical picture.

Transplant assessment and preparation for dialysis access can take time. Planning early allows questions to be answered, avoids rushed decisions, and increases the chance that the agreed plan is ready when it is needed.

The main choices are kidney transplantation, peritoneal dialysis, haemodialysis, and conservative kidney management. Suitability depends on your health, circumstances, available services, and clinical assessment.

Some suitable patients can receive a pre-emptive transplant before dialysis. Because evaluation and donor planning take time, the possibility should be discussed early with your kidney care team.

Peritoneal dialysis uses the lining of the abdomen as a filter and requires a catheter placed into the abdomen. Haemodialysis filters blood through a machine in a dialysis centre.

It is active, planned care without dialysis or transplantation. Treatment focuses on symptom control, quality of life, medical management of kidney complications, and support for the patient and family.

Choices can be reviewed when your health, circumstances, or preferences change. Some changes require further assessment or preparation and may not be possible immediately, so speak with your kidney care team early.

There is no single kidney diet or fluid limit for everyone. Advice about salt, protein, potassium, phosphate, and fluids should be based on your results, symptoms, urine output, nutrition, and treatment plan—preferably with a renal dietitian.

Many people can, although symptoms and treatment schedules may require adjustments. Discuss work, study, caregiving, and travel plans early so they can be considered when care is planned.

Pregnancy is possible for some people with advanced kidney disease, but the risks are higher and depend on your kidney function, blood pressure, urine protein, the cause of your kidney disease, and other health conditions.

If you are considering pregnancy, talk to your kidney care team before trying to conceive. They can discuss your individual risks, review your medicines, and arrange specialist pregnancy care if needed.

Please tell your kidney care team as soon as possible. Pregnancy with advanced kidney disease needs closer monitoring for both you and your baby.

Your kidney care team will work closely with a specialist obstetric team to monitor your kidney function, blood pressure and medicines, as well as your baby’s growth and wellbeing.

Do not stop or change any of your medicines without medical advice.

Some medicines used for kidney disease or high blood pressure may not be safe during pregnancy and may need to be changed before pregnancy or as soon as pregnancy is recognised. Many other medicines can be continued safely.

If you are planning a pregnancy or think you may be pregnant, contact your kidney care team promptly so that your medicines can be reviewed.

Do not stop any prescribed medicine on your own.

If dialysis becomes necessary during pregnancy, haemodialysis is usually used. Dialysis often needs to be given more frequently and for longer than usual during pregnancy to provide the best possible environment for you and your baby.

If you are already receiving peritoneal dialysis when you become pregnant, your kidney care team will usually discuss changing to haemodialysis.

Your kidney and obstetric teams will work together to decide when dialysis should start and plan the treatment according to your individual needs.

Most people with kidney disease have safe and effective contraception options. The most suitable method depends on your kidney disease, blood pressure, other health conditions, medicines, and your individual preferences.

Reliable contraception is particularly important if you are taking medicines that may not be safe during pregnancy.

Talk to your kidney care team or family planning team about the safest and most suitable option for you.

The kidney care team reviews your kidney health and likely course, explains the relevant care choices, discusses preparation, and answers questions. The aim is to develop a clear plan through discussion with you and your family.

We encourage you to bring family members with you. They can hear the same information, raise questions, help remember the discussion, and understand how they may support the agreed plan.

Bring an up-to-date medicine list, available medical records or results that the clinic may not already have, and a written list of your main questions or concerns.

The kidney care team reviews your overall health, other medical conditions, medicines, infections, and ability to manage surgery and long-term anti-rejection treatment. Tests are arranged before a decision is made.

A healthy adult may freely offer to be assessed as a living donor. The donor is assessed separately and confidentially to protect their health. Offering to be assessed does not guarantee that donation will be possible.

No.

• If your blood group is O: you can receive a kidney from blood group O.
• If your blood group is A: you can receive a kidney from blood group A or O.
• If your blood group is B: you can receive a kidney from blood group B or O.
• If your blood group is AB: you can receive a kidney from blood group A, B, AB or O.

Waiting time cannot be predicted. It depends on donor availability, blood group, matching, allocation criteria, and the local transplant programme. The kidney care team will explain how the waiting process works.

The donated kidney is usually placed in the lower abdomen. Your own kidneys normally remain in place unless there is a separate medical reason to remove one or both.

Yes. Anti-rejection medicines are taken every day for as long as the transplant is working. Regular blood tests and clinic visits are needed to adjust them and look for side effects or infection.

Rejection is when your immune system recognises the transplanted kidney as foreign and tries to damage it. It may be detected on blood tests before you feel unwell and can often be treated by adjusting medicines. Taking anti-rejection medicines exactly as prescribed and attending follow-up are important.

A transplant may work for many years, but no exact duration can be promised. Taking medicines correctly and attending follow-up helps the team protect the kidney and respond early if problems occur.

With CAPD, the patient or a trained caregiver performs each fluid exchange by hand. With APD, a programmed cycler machine performs repeated exchanges over several hours. Both use the same abdominal catheter.

Because PD is performed at home, it may reduce frequent travel to a dialysis centre and offer more flexibility for work, study, family life, and other activities. For some people, the treatment schedule can be planned around their daily routine. Whether PD is suitable depends on your health, physical ability, home circumstances, and the services available locally.

A PD nurse will guide you, and a family member or caregiver if needed, one step at a time. You will learn how to care for your catheter and perform your dialysis safely, with plenty of time to practise and ask questions. The training is tailored to your needs, and you will only begin doing it independently when you feel confident and ready.

Yes. A suitable caregiver can be trained if you need help. The peritoneal dialysis team makes sure that you or your caregiver can complete every step safely and using the correct clean technique.

It is a soft tube placed through the abdominal wall during a small procedure. A short part remains outside the body for connections. The exit site is covered and cared for as taught by the dialysis team.

An exchange should not usually be painful, although some people notice fullness or mild discomfort. New or significant abdominal pain, cloudy drained fluid, or fever must be reported promptly.

Germs can enter through a connection or the catheter exit site and cause a serious infection called peritonitis. Correct hand washing technique, a clean space, and the exact connection steps taught by the team reduce this risk.

CAPD requires exchanges at planned times. APD commonly runs for several hours using a cycler. Your team will explain the method available locally and help fit the prescribed schedule around meals, sleep, work, and family responsibilities.

A fistula is a connection made between an artery and a vein, usually in the arm, and needs time to become ready. A catheter is a soft tube placed into a large vein, with two ends that come out through the chest and can usually be used soon after insertion.

An AV fistula is usually allowed to develop for about 4–6 weeks before it is used. Some fistulas need longer, depending on healing, blood flow, and how the vein develops. The dialysis team will examine it and confirm when it is ready.

Two needles are usually placed into a mature fistula for each session. A central venous catheter connects directly to the dialysis lines, so arm needles are not used with that access.

Haemodialysis is given on a regular centre schedule, and each session usually lasts several hours. The exact number and length of sessions are prescribed for your medical needs and local programme.

Blood travels through soft lines to a dialyser, where waste and planned extra fluid are removed, and then returns to your body. Staff check your blood pressure, access, machine, and wellbeing throughout the session.

Some people feel well, while others may feel tired, dizzy, cold, or develop cramps. Tell the dialysis team during the session because they can assess the cause and adjust care when appropriate.

Follow the access-care instructions given by your team. Keep a catheter dressing clean and dry. For a fistula, learn to feel its vibration and avoid pressure, injuries, and blood-pressure measurements on that arm unless your team advises otherwise.

No. It is active, planned medical care. Medicines, clinic reviews, blood tests, nutrition support, symptom treatment, and family support continue, but dialysis and transplantation are not included.

No. Your team will continue to care for you and your family. They will review symptoms, adjust medicines, offer practical and emotional support, and explain whom to contact if you feel more unwell or worried.

The team can assess and treat problems such as tiredness, itching, nausea, poor appetite, swelling, pain, sleep difficulty, anxiety, and breathlessness. Treatment is adjusted to the cause and the person’s priorities.

It may be considered when dialysis or transplantation is unlikely to provide the benefits a person hopes for, may create a heavy treatment burden, or does not match the person’s goals. This requires an individual discussion with the kidney care team.

Yes. Follow-up continues according to your health and care plan. The team reviews symptoms, medicines, blood results, nutrition, daily function, and support needs.

These professionals can work alongside the kidney care team to relieve difficult symptoms and support emotional, family, spiritual, or practical concerns. Their involvement does not mean that kidney care has stopped, and it is not limited to the last days of life.

The team can explain the likely course using your kidney function, symptoms, overall health, and other illnesses, but an exact timescale is often uncertain. You can choose how much information you want, take time to think, and return with more questions later.

Yes. Your health, circumstances, and wishes can change. The plan should be revisited with you and your family, although some treatment options may require assessment and preparation and may not be immediately available.

With your agreement, family members can learn the care plan, help with medicines and appointments, notice changes in symptoms, and tell the team about practical or emotional concerns.