Free guide · Scarlet Beast En español →
Kidney failure: choosing a treatment (dialysis, a transplant, or conservative care)
For anyone told their kidneys are failing or will fail, and for the family and friends helping them choose. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, part of the NIH) says that when kidney function drops below 15 percent of normal, there are four choices: hemodialysis, peritoneal dialysis, a kidney transplant, or conservative management, care without dialysis or a transplant. None of them makes the kidneys better, but all can help you feel better, and the choice is yours. This page passes on, by name, what NIDDK says: the signs and when to start; how to choose, changing your mind, and putting your wishes in writing; dialysis at a center or at home; a transplant and conservative management; and food, work, feelings and paying for it. It builds the words to say and the questions to ask, and prints a card to keep with you.
A word with a dotted line under it, like this, opens its official definition, quoted from a U.S. government glossary.
Right now
- Chest pain, trouble breathing, fainting, a seizure, or sudden confusion? Call 911 (ours).
- On peritoneal dialysis, with belly pain, fever, or cloudy used solution, or redness, pus or pain where the tube leaves the skin? NIDDK says seek immediate care.
- With a transplant, a fever of more than 100 degrees or you are not feeling well? NIDDK says call the transplant center right away.
- Worn down, or thinking of ending your life? Call or text 988, any hour (ours).
More help
- The kidneys, on this site: Kidney disease · Kidneys, bladder and urine: find the right page · Kidney disease in children · Polycystic kidney disease · Anemia · High blood pressure.
- Your wishes: When someone you love is dying · Caring for someone.
- Work and money: Applying for disability benefits · Ask for what helps you work · When you can’t afford your medicine · Medical bills.
- Getting ready: My medicines list · Get ready for your appointment · Rides to medical care · When you need a doctor and can’t pay.
- In a crisis: Help right now (988, 911). When the heaviness won’t lift. All our free tools.
Kidneys, bladder or urine, and not sure this is the right page? The pages on this site for bladder infections, kidney stones, blood in the urine, bladder pain, bladder leaks, the prostate, kidney disease and bedwetting, on one list.
Other guides on this site that go with this page
Free to read. We chose these ourselves; no professional did. Each guide was written with AI and has not been reviewed by a professional. They are general information, not advice.
- Mineral and bone disorder in chronic kidney disease (CKD-MBD): the bones, the heart, the tests, phosphorus, and treatment: mineral and bone disorder in kidney disease (CKD-MBD): the bones, the heart, children, the tests, phosphorus in food, medicines, dialysis, and slowing it down.
- Anemia in chronic kidney disease: the symptoms, the causes, the tests, iron, ESA medicines, and food: anemia in kidney disease: why damaged kidneys cause it, the symptoms, when to call 911, the blood tests, iron, ESA medicines, transfusions, and food.
- Glomerular disease: the signs, the causes, the tests, and the treatment: glomerular disease (FSGS, lupus nephritis, membranous nephropathy, minimal change disease and others; foamy or cola-colored urine, swelling, or a kidney biopsy that showed it): what it is, the causes and who gets it, the signs and what it can lead to, the tests and the biopsy, the kinds of medicine and kidney failure, and food, family and research.
- Nephrotic syndrome: in adults and in children: nephrotic syndrome in adults and in children (swelling, foamy urine, protein in the urine): what causes it, the signs and what it can lead to, the urine and blood tests, the treatment, and steroids and relapses in children.
- IgA nephropathy (Berger’s disease): the signs, the biopsy, and the treatment: IgA nephropathy, Berger’s disease (pink, cola-colored or foamy urine, swelling, or a kidney biopsy that showed it): what it is, who is more likely to have it, the signs and what it can lead to, the tests and the biopsy, the kinds of medicine and less salt, and food, family and research.
- One kidney (a solitary kidney): the checkups, keeping it safe, and giving a kidney: one kidney, a solitary kidney (born with one, had one removed, or gave one): the three causes, what it can lead to, the urine, blood and blood pressure checkups, medicines and sports, pregnancy, and giving a kidney.
- Hemodialysis: what happens, a center or home, your access, the problems, and living with it: hemodialysis: what happens during a treatment, a dialysis center or home, protecting your veins and the vascular access, cramps, low blood pressure and access problems, food and liquids, dry weight, and stopping.
- Peritoneal dialysis: how it works, by hand or by machine, the catheter, infection, and living with it: peritoneal dialysis: how it works, by hand during the day or a cycler at night, the catheter and the training, doing an exchange, infection and peritonitis, hernia and weight gain, food and liquids, and how to know it is working.
- Kidney transplant: the tests, the waiting list, the surgery, rejection, and living with a new kidney: kidney transplant: where a kidney comes from, the tests and the waiting list, a living donor, the surgery and your team, the first days, rejection and when to call the transplant center, the side effects of anti-rejection medicines, food, and paying.
- Amyloidosis and the kidneys: the types, the signs, the tests, and the treatment: amyloidosis and the kidneys: the five types (AL, AA, LECT2, hereditary, dialysis-related), who gets them, nephrotic syndrome and the other signs, the tests, the treatment for each type, caring for the kidneys, prevention and food.
- Paying for kidney failure treatment: Medicare, Medicaid, Social Security, insurance, and help with medicines: paying for kidney failure treatment: Medicare at any age, when it starts and ends, choosing a plan, a job plan and the 30 months, Medicaid and CHIP, SSDI and SSI, state programs, help for veterans and others, and help paying for medicines.
- Medicines and your kidneys: the blood pressure medicines, your pharmacist and your list, NSAIDs, and a plan for sick days: medicines and your kidneys: how to tell an ACE inhibitor (-pril), an ARB (-sartan) and a water pill; one pharmacy and one up-to-date list; NSAIDs in pain, fever and cold medicines; the questions to ask before you get sick; and why being dehydrated changes things.
- Conservative management for kidney failure: care without dialysis, your right to decide, the care team, hospice, food, and how you may feel: conservative management for kidney failure: care without dialysis or a transplant; your right to decide; the care plan and team; who may choose it; hospice, which Medicare covers; food; how you may feel; and how long.
This page and its wording were written with AI (Claude) for Scarlet Beast (our AI policy). No doctor, nurse or lawyer has reviewed it. The facts were read on October 18, 2026 on NIDDK’s (NIH) pages on Kidney Failure: What is Kidney Failure?, Choosing a Treatment, Hemodialysis, Peritoneal Dialysis, Kidney Transplant, Conservative Management, Eating Right, and Financial Help for Treatment of Kidney Failure (last reviewed January 2018), in English and in Spanish. Those pages are not new: insurance rules have changed since, and your team may know newer treatment. The numbers (kidney function below 15 percent of normal; starting dialysis between 5 and 10; the waiting list from 20 or less; three times a week, about 4 hours; 3 to 8 weeks of home training; 10 to 20 days to heal; 30 to 40 minutes an exchange; 1 to 2 weeks of training; a fever of more than 100 degrees; 30 months; 3 years) are NIDDK’s. Ours: 911 for chest pain, trouble breathing, fainting, a seizure or sudden confusion; asking for your kidney function number; keeping the night and weekend number on your card; asking for your state’s advance directive form; checking with Medicare what applies now; never stopping a prescribed medicine on your own; 988 when it is too much; and the order of the steps. What we left out: the references, the videos, the drug-discount companies and charities NIDDK lists, the Medicare start and end-date rules, and NIDDK’s outside links. This page saves nothing and loads no trackers.