Your kidneys work around the clock to clean your blood. When they are badly damaged and can no longer do that job, waste products and extra fluid start to build up in your body. Dialysis is a treatment that takes over part of the kidneys' work, so you can stay alive and carry on with daily life.
This guide explains, in simple terms, what your kidneys do, when dialysis is needed and the treatment options available in Malaysia. It is general information only. Always follow the advice of your nephrologist and care team.
What do your kidneys do?
Most people have two kidneys, each about the size of a fist, sitting towards the back of the body just below the ribs. Their jobs include:
- Filtering waste such as urea and creatinine out of the blood and removing it in urine.
- Controlling how much water is in your body.
- Balancing salts and minerals such as sodium, potassium and phosphorus.
- Helping to control blood pressure.
- Making hormones that help the body produce red blood cells, and activating vitamin D for strong bones.
Dialysis can take over the work of filtering waste and removing extra fluid, but not every kidney function. That is why most people on dialysis still need medicines, such as injections for anaemia (EPO), phosphate binders and blood pressure tablets.
When is dialysis needed?
Chronic kidney disease usually gets worse slowly, over many years. In Malaysia, diabetes is the leading cause of kidney failure, followed by high blood pressure.
Doctors measure kidney function with a blood test called eGFR. When eGFR falls below 15, which is stage 5 chronic kidney disease, this is known as end-stage kidney failure. But the decision to start dialysis does not depend on one number alone. Your nephrologist will also look at your symptoms, such as:
- Feeling very tired and weak
- Nausea, vomiting or loss of appetite
- Swelling of the legs, ankles or face
- Breathlessness, especially when lying down
- Itchy skin that does not go away
- Trouble sleeping, poor concentration or confusion
- Passing less urine than usual
There is also a condition called acute kidney injury, for example after a severe infection or serious dehydration. These patients may need dialysis for a short time until their kidneys recover.
Tip: If you have chronic kidney disease, ask your doctor about treatment options early, before you actually need dialysis. Planning ahead gives time to prepare your dialysis access and to make decisions calmly with your family.
Treatment options in Malaysia
There are several options for end-stage kidney failure. The right one depends on your health, age, lifestyle and the support you have at home.
Haemodialysis (HD)
Blood flows out of the body to a machine and a special filter (dialyser) that removes waste and extra fluid, then returns to the body. It is usually done at a dialysis centre three times a week, for about four hours each session. Haemodialysis is the most common type of dialysis in Malaysia.
Peritoneal dialysis (PD)
PD uses the lining inside your abdomen (the peritoneum) as a natural filter. Dialysis fluid flows into the abdomen through a soft tube (catheter), stays there for a few hours, then is drained out. PD is done by yourself at home every day, either by hand or with a machine overnight. The Ministry of Health Malaysia (MOH) encourages PD as the first choice for patients who are suitable for it.
Kidney transplant
A kidney from a living donor, usually a family member, or from a donor who has died is placed in your body through surgery. For suitable patients, a transplant can offer a better quality of life. However, anti-rejection medicines must be taken for life, and the wait for a donor can be long. Ask your nephrologist whether you can be assessed for a transplant.
Conservative care
Some people, especially older people or those with other serious health problems, may choose not to have dialysis. The care team will help control symptoms with medicines and diet, with the focus on comfort and quality of life. This is a valid choice and is worth discussing openly with your family and doctor.
For a closer look at the two types of dialysis, read haemodialysis or peritoneal dialysis.
Preparing your dialysis access
Before dialysis starts, your body needs a safe "way in" for the treatment:
- An AV fistula is a connection between an artery and a vein in your arm, made in a minor operation. It is the preferred access for haemodialysis, but it needs a few weeks to a few months to mature before it can be used.
- An AV graft is a soft tube joining an artery and a vein, used when your blood vessels are not suitable for a fistula.
- A haemodialysis catheter is placed in a large vein in the neck or chest, usually for temporary or emergency use.
- A PD catheter is a soft tube placed in the abdomen for peritoneal dialysis.
Because a fistula takes time to mature, it is best made early. Learn how to look after it in caring for your AV fistula.
Living with dialysis
Dialysis is a long-term commitment, but many people keep working, look after their families and travel. A few things help:
- Attend every session and do not cut treatment short without your doctor's advice.
- Follow your fluid and diet limits. See diet and fluids on dialysis.
- Take your medicines as prescribed, including anaemia injections and phosphate binders.
- Get the hepatitis B vaccine if your dialysis team recommends it.
- Look after your emotional health. Feeling sad, worried or angry is normal. Talk to your family, your nurses or a patient support group.
When to get urgent help
Call 999 or go to the nearest hospital emergency department if you have:
- Severe breathlessness or chest pain
- An irregular heartbeat, or sudden severe weakness
- Confusion, extreme drowsiness or a seizure
- Bleeding from your dialysis access that does not stop with pressure
For other problems, such as a fever, worsening swelling or sudden weight gain, contact your dialysis centre as soon as possible.
Next steps
- Talk through your treatment options with your nephrologist, and bring a family member along.
- Read how to choose a dialysis centre if you are about to start haemodialysis.
- Find a dialysis centre close to your home or workplace.
- If you contribute to PERKESO (SOCSO), check the list of PERKESO panel centres and read dialysis costs and financial aid.