I Have Chronic Kidney Disease — Do I Need Dialysis?

AdminKidneyMD
1 day ago
2 min read

A middle-aged man with a worried expression sits at a kitchen table, resting his chin on his hand. A paper labeled "LABORATORY RESULTS" is in front of him. He is looking out the window, appearing reflective or concerned about his chronic kidney disease diagnosis. — Facing a CKD diagnosis often comes with heavy questions. Your doctor will use your lab results and symptoms to determine if and when dialysis or other treatments are necessary.

Being told you have chronic kidney disease (CKD) can feel overwhelming. One of the first worries many people have is: “Will I need dialysis?”

The good news is that most people with CKD never progress to dialysis. Let’s break it down.

📊 CKD Stages and Dialysis

CKD is divided into five stages, based on how well your kidneys filter waste (your eGFR).

Stage 1–4 CKD: Your kidneys are still working, though not at full capacity. Most people in these stages manage with lifestyle changes, medications, and regular follow-up.
Stage 5 CKD: This is kidney failure (eGFR usually <15). Dialysis is considered only if you develop symptoms or complications that your kidneys can no longer handle.

🤢 When Is Dialysis Needed?

Dialysis isn’t started just because your lab numbers look low. Doctors look at how you’re feeling and whether waste products are building up in your body. These are called uremic symptoms.

Common uremic symptoms include:

Nausea and vomiting
Loss of appetite or unintended weight loss
Extreme fatigue or weakness
Swelling in the legs, ankles, or around the eyes
Shortness of breath
Confusion, trouble concentrating, or sleep problems
Severe itching
Muscle cramps or twitching

If you don’t have these symptoms, and your labs are stable, dialysis may not be necessary even at stage 5.

🔍 How Do I Know My Risk of Progression?

Doctors often use the Kidney Failure Risk Equation (KFRE). This calculator uses your lab results (like eGFR and urine protein) to estimate your 2- and 5-year risk of needing dialysis.

👉 Example: For a 65-year-old with an eGFR of 25 and only mild protein in the urine, the KFRE predicts about a 10% chance of needing dialysis within 5 years. That means there’s a 90% chance they won’t need it in that time.

Ask your nephrologist if your KFRE score has been calculated—it’s one of the best tools for understanding your personal outlook.

✅ The Good News

Most people with CKD never require dialysis.
Each year, only about 2–4% of people with CKD progress to kidney failure.
Over 10 years, the majority of people with stage 3 CKD remain stable, especially if blood pressure, diabetes, and lifestyle are well managed.
Even among those with stage 4 CKD, fewer than half will need dialysis within 10 years.
With the right care—healthy diet, controlling blood pressure and diabetes, and avoiding harmful medications—up to 70–80% of patients can avoid dialysis.