HomeWhat are the other treatment options?
When kidney failure reaches an advanced stage, several treatments can help replace or support kidney function. Home haemodialysis is one of these options, but there are others, each with its own specific features and varying suitability depending on your lifestyle, preferences and overall health
Understanding these different possibilities can help you move forward step by step in your care journey and support discussions with your nephrologist to choose the treatment approach best suited to your individual situation
Peritoneal dialysis
This type of dialysis uses the peritoneum, a natural membrane in the abdomen, as a filter to remove toxins and excess fluids from the body. It can be performed continuously during the day (CAPD) or overnight using an automated cycler (APD).20
Advantages
- A gentler treatment method: No extracorporeal blood circulation, which reduces the risk of hypotension.
- Home-based support: for patients who are not fully independent, a community nurse can assist with connection procedures.
- Greater flexibility : with overnight APD, dialysis takes place during the night, leaving daytime free for other activities.
Disadvantages
- Risk of infection : strict hygiene is essential to prevent peritoneal infections.
- Less suitable for certain patients : particularly those who have undergone multiple abdominal surgeries.
In-centre dialysis: a supervised alternative
For patients who prefer treatment managed by a healthcare team, in-centre dialysis offers an option suited to different patient profiles and levels of independence.²⁰ This treatment takes place in specialised facilities that provide continuous medical supervision.
Haemodialysis in a hospital or medical dialysis centre
In-centre haemodialysis is usually carried out three times a week in a specialised facility under the continuous supervision of healthcare professionals. Each session lasts around 4 hours, during which the blood is filtered through a dialyser to remove toxins and excess fluids.
Advantages20
- Continuous medical supervision, with nephrologists, specialist nurses and technicians always available.
- Full management of treatment by the healthcare team, reducing stress related to treatment organisation.
- Ongoing monitoring of medical parameters (blood pressure, weight, general condition) to adapt treatment according to patient needs.
- Opportunities for regular interaction with other patients, creating a supportive environment.
Disadvantages20
- Frequent travel to the centre, which may be restrictive depending on distance and available transport
- Post-dialysis fatigue, often more pronounced than with daily home dialysis due to faster removal of toxins and fluids.
- The two consecutive dialysis-free days can place strain on the body, increasing the risk of toxin build-up and fluid imbalance.
Who is this type of dialysis suitable for?21
In-centre haemodialysis is generally recommended for patients who:
- Require close medical supervision due to frailty.
- Prefer comprehensive medical monitoring and do not wish to manage treatment themselves.
- Are unable to carry out dialysis at home because of personal, family or logistical constraints.
Self-care dialysis: a more independent alternative
Self-care dialysis is an intermediate option for patients who have acquired the skills needed to manage their own treatment while still benefiting from a medical environment and support if needed. It takes place in a specialised dialysis centre where the patient performs their own dialysis sessions after receiving training from the healthcare team.20
Advantages20
- Greater independence, allowing patients to take an active role in their treatment while remaining in a safe environment.
- Fewer scheduling constraints than in a fully medicalised centre, offering greater flexibility.
- Medical support remains available without being intrusive.
Disadvantages20
- Requires prior training and a good level of independence to manage treatment safely.
- May not be suitable for patients with reduced physical or cognitive abilities, or for those uncomfortable with technical procedures.
- Limited immediate assistance in the event of complications, requiring increased patient vigilance.
Who is this type of dialysis suitable for?21
Self-care dialysis is suitable for patients who:
- Want greater independence while remaining in a medical setting.
- Are able to learn and carry out their treatment themselves.
- Are looking for a balance between close medical supervision and autonomous treatment management.
Which type of in-centre dialysis should you choose?
The choice between different facilities will depend on the availability of centres, the patient’s preferences, overall health and level of independence. Some patients may prefer full support, while others may seek greater independence through self-care dialysis.
Kidney transplantation: the option closest to natural kidney function
Kidney transplantation is considered the preferred treatment for end-stage chronic kidney disease. It allows patients to regain near-normal kidney function by replacing a failing kidney with a healthy kidney from either a living or deceased donor.²¹ This surgical procedure can significantly improve quality of life and reduce dependence on replacement therapies such as dialysis.
Advantages of kidney transplantation21
- Significant improvement in quality of life : transplantation allows patients to regain a more active daily life with fewer medical constraints.
- Greater freedom and independence : unlike dialysis, which requires regular sessions, transplantation allows for a more flexible lifestyle.
- Improved life expectancy : studies show that transplant recipients generally live longer than patients remaining on dialysis.
- Fewer dietary restrictions : transplant patients can usually follow a more varied diet compared with the restrictions associated with dialysis.
- Reduced cardiovascular complications : restored kidney function lowers the risk of cardiovascular disease, which is common in patients undergoing conventional dialysis.
Drawbacks and limits21
- Waiting time for a donor kidney : access to transplantation depends on the availability of a compatible donor and may involve several years of waiting.
- Lifelong immunosuppressive treatment : to prevent rejection, patients must take daily immunosuppressive medication, increasing the risk of infections and side effects.
- Risk of complications : although transplantation is highly effective, risks include graft rejection, infections and side effects related to post-transplant treatment.
- Patient selection criteria : not all patients are eligible for transplantation. A comprehensive medical assessment is required.
Procedure and post-transplant follow-up
Before transplantation, compatibility testing is carried out to reduce the risk of rejection. Once the transplant has taken place, close follow-up is essential: regular consultations and blood tests are required to monitor kidney function and adjust immunosuppressive treatment.21,23
A decision to discuss with your nephrologist
Although kidney transplantation is considered the best treatment option for end-stage kidney disease, each patient should discuss the feasibility and benefits of this solution with their medical team in relation to their personal situation.
The decision should take into account the patient’s overall health, lifestyle and alternative treatment options such as home dialysis.
Conservative management: a choice focused on quality of life
Conservative management is a palliative option for patients with advanced chronic kidney disease who are unable or unwilling to undergo dialysis or transplantation. Its main objective is to slow disease progression and improve patient comfort by relieving symptoms and optimising quality of life.20,21,23
Principles of conservative management
This type of care is based on a holistic and personalised approach21 including:
- This type of care is based on a holistic and personalised approach : treatment of pain, fatigue, digestive disorders, oedema and high blood pressure.20,23
- Comprehensive medical and psychological support : regular follow-up with a nephrologist, palliative care team and psychologist to help manage the emotional and physical impact of the disease.20,23
- Adjustment of medication : management of anaemia, electrolyte imbalances and metabolic acidosis to help reduce complications.20,23
- Specific dietary support : adapting nutrition to reduce strain on the kidneys and maintain nutritional balance (reduced salt intake, protein limitation, potassium and phosphate monitoring).20,23
- Social and family support : involving loved ones and helping patients organise daily life and anticipate future needs.20,23
Why choose conservative management?
The decision to choose conservative management is often influenced by several factors:
- Advanced age and/or severe comorbidities making dialysis or transplantation too risky.
- A wish to prioritise comfort and quality of life over demanding treatments.
- Lack of a compatible donor or access to transplantation.
- A desire to avoid the logistical and physical constraints associated with replacement therapies (frequent travel, treatment side effects, impact on daily life).
An informed and supported decision
The decision to opt for conservative management should be made jointly between the healthcare team, the patient and their loved ones. It is based on a comprehensive assessment of the patient’s health, preferences and quality-of-life priorities. Regular discussions with the nephrologist and palliative care teams help adapt the care plan according to disease progression and patient needs, ensuring respectful and compassionate support throughout the course of the illness.