Tips for Living with Long-Term Dialysis

• 1 December 2019
• Dr. Obinna Nwobi

Average life expectancy on dialysis is about 5 to 10 years, and many people live 20 or 30 years with good care (National Kidney Foundation). The range is enormous because survival depends far more on your age, your other medical conditions, and how consistently you get treated than on dialysis itself. Younger patients with fewer other illnesses do substantially better; the first year on dialysis carries the highest risk, so the start of treatment is the most important stretch to get right. Kidney transplant, when you are a candidate, offers longer survival than staying on dialysis. You can influence your own outcome: attend every session in full, protect your dialysis access, take your medications, and follow your prescribed diet and fluid limits.

The Honest Answer

There is a real answer to this question, and patients deserve it rather than a shrug.

The National Kidney Foundation states that average life expectancy on dialysis is 5 to 10 years, while noting that many patients live 20 or even 30 years with proper care. Both halves matter. The average is sobering. The tail is real, and people are living in it right now.

Registry data fills in the shape between those numbers. The United States Renal Data System — the national kidney-failure registry maintained by the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases — has reported five-year survival for patients starting hemodialysis at roughly 40%, and roughly 50% for patients starting peritoneal dialysis, in the incident cohorts analyzed in its mortality chapter. Survival has been improving across successive cohorts.

Two things follow from those figures:

1. Averages are not prognoses. They pool a 78-year-old with diabetes and heart failure together with a 34-year-old whose only problem is kidney failure. Your number is not the average.
2. Kidney failure is not a death sentence. The NKF states it plainly, and it is worth repeating: people on dialysis work, travel, raise families, and continue doing what they love.

(Sources: National Kidney Foundation, “How Long Can Someone Be On Dialysis?” and “Living Well with Dialysis”; USRDS Annual Data Report, Mortality chapter, NIDDK.)

What Actually Changes Your Number

Age. This is the single largest factor. Expected remaining lifetime on dialysis falls steeply with age, mirroring — at a lower level — the pattern in the general population.

Your other conditions. Diabetes and hypertension are the two leading causes of kidney failure in the United States, accounting for roughly 47% and 29% of new cases respectively (CDC/USRDS). Both also damage your heart and your arteries. Cardiovascular disease, not the dialysis machine, is what most often shortens life on dialysis.

The first year. Mortality is highest early in treatment, particularly in the first months of hemodialysis. Getting your access, your medications, and your schedule right at the start is disproportionately valuable.

Treatment consistency. Skipped and shortened sessions let fluid and waste accumulate, which strains your heart. This is the largest lever most patients personally hold.

Your dialysis access. A well-functioning arteriovenous fistula or graft delivers better dialysis with lower infection risk than a central venous catheter. KDOQI’s 2019 vascular access guideline suggests an AV access in preference to a central venous catheter in most patients starting and continuing hemodialysis, citing the lower infection risk. Access problems mean missed and inadequate treatments.

Transplant eligibility. For patients who are candidates, kidney transplantation is associated with longer survival than remaining on long-term dialysis — a finding reproduced across ages, including in older candidates. Ask your nephrologist whether evaluation is appropriate for you.

Does Dialysis Ever Stop? (“Once you start, is it forever?”)

For most people with end-stage kidney disease, dialysis continues for life or until a kidney transplant. There are exceptions — some people with sudden, acute kidney injury need dialysis temporarily and recover kidney function. Your nephrologist can tell you which situation you are in. Dialysis is also a choice you continue to make; some patients, usually with advanced age or serious additional illness, decide with their families and care team to stop, and hospice and palliative teams support that decision.

Where Vein Health Clinics Fits In

We are not your dialysis center and we are not your nephrologist. We do the vascular surgery that makes dialysis possible and keeps it working.

When your kidney function declines to the point that dialysis is planned, Dr. Nwobi creates your dialysis access:

• AV fistula — an artery connected directly to a vein in your arm. The vein thickens and enlarges over the following weeks, allowing the blood flow rates hemodialysis needs.
• AV graft — a soft tube used to connect the artery and vein when your own vessels are not suitable for a fistula.
• Peritoneal dialysis catheter — a soft catheter placed in the abdomen for home peritoneal dialysis.

KDOQI’s 2019 guideline frames this as part of an “ESKD Life-Plan”: rather than a single one-time decision, your access is planned with a contingency plan, a succession plan, and a plan to preserve the veins you will need years from now. That is the way we prefer to think about it too — the access you get today should not cost you the access you will need in a decade.

We also maintain access. Fistulas and grafts narrow, clot, and occasionally get infected. We monitor yours and treat problems so you do not lose dialysis time.

Four Things That Protect Your Years

1. Choose the dialysis type that fits your actual life. In-center hemodialysis is typically three sessions a week of about four hours. Home hemodialysis and peritoneal dialysis offer more schedule control. Home dialysis use is growing — at the end of 2021, 14.1% of US dialysis patients dialyzed at home, up roughly 45% over the prior decade (NIDDK). Your nephrologist will walk you through which options suit you medically; the one you can realistically stick to is the one that protects you.

2. Never skip or shorten a session. If your schedule is fighting your treatment, change the schedule, not the treatment. Ask about a different shift or a home modality.

3. Take your medications. Dialysis replaces filtration, not everything your kidneys did. Most patients need medications to manage problems like anemia and bone disease. If cost or side effects are getting in the way, say so out loud to your team — that is a solvable problem, and silence is what makes it permanent.

4. Follow your prescribed diet and fluid limits. Your plan is specific to your modality and your labs, and it typically involves limiting some nutrients and fluid. Ask your renal dietitian for it in writing.

Protecting Your Access — a Short Checklist

• Do not let anyone draw blood from or place an IV or blood-pressure cuff on your access arm.
• Check your fistula or graft daily for its buzz or thrill; know what normal feels like for you.
• Do not sleep on the access arm or carry heavy bags with it.
• Keep the site clean, and wash before and after treatment.

Call us the same day if your access stops buzzing, becomes painful, red, swollen, or warm, if the arm swells, or if bleeding after treatment does not stop with normal pressure.

When to Seek Emergency Care

Call 911 or go to the nearest emergency department if you have:

• Chest pain, severe shortness of breath, or trouble breathing while lying flat
• Bleeding from your access site that will not stop with firm, direct pressure
• Confusion, fainting, or a seizure
• Severe muscle weakness or an irregular, racing heartbeat (possible high potassium)
• Fever with chills, especially with a catheter or a red, painful access site

Do not wait for your next scheduled dialysis session for any of the above.

FAQs

How long can you live on dialysis? Average life expectancy on dialysis is about 5 to 10 years, and many people live 20 or 30 years with good care (National Kidney Foundation). Your own outlook depends most on your age, your other medical conditions, and how consistently you receive full treatments.

How long do dialysis patients live on average? National registry data from the USRDS has shown roughly 40% of patients starting hemodialysis alive at five years, and roughly 50% of patients starting peritoneal dialysis. Survival has improved across successive cohorts. These are population averages and do not predict any individual’s outcome.

Can you live a long life on dialysis? Yes. Many people spend decades on dialysis while working and traveling. The strongest predictors you personally control are treatment consistency, medication adherence, diet and fluid limits, and keeping your dialysis access healthy.

Once you start dialysis, is it forever? Usually yes for end-stage kidney disease, unless you receive a kidney transplant. People with acute kidney injury sometimes need dialysis only temporarily and recover kidney function. Your nephrologist can tell you which applies to you.

Is home dialysis better for survival? Home modalities offer more flexibility and more frequent treatment, and home dialysis use is rising in the US. The right modality is an individual medical decision — discuss it with your nephrologist rather than assuming one is universally better.

Do dialysis patients live longer with a transplant? For patients who are transplant candidates, kidney transplantation is associated with longer survival than remaining on long-term dialysis. Ask your nephrologist whether transplant evaluation is appropriate for you.

What is dialysis access, and why does it matter so much? It is the surgically created connection — a fistula, a graft, or a peritoneal catheter — that makes dialysis possible. A well-functioning AV access supports better dialysis with lower infection risk than a central venous catheter, which is why guidelines favor it for most hemodialysis patients. Access problems are a leading cause of missed and inadequate treatment.

How long does a dialysis session take? In-center hemodialysis is typically about four hours, three times a week. Home schedules vary by modality. Your prescription is set by your nephrologist.

Need dialysis access — or is your access not working?

Dr. Obinna Nwobi is a board-certified vascular surgeon who creates and maintains dialysis access for patients across Central Florida. If your nephrologist has told you it is time to plan for dialysis, or your fistula or graft is not working the way it should, we can see you.

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Citations

1. National Kidney Foundation — “How Long Can Someone Be On Dialysis?” — kidney.org/news-stories/how-long-can-someone-be-dialysis
2. National Kidney Foundation — “Living Well with Dialysis” (average 5–10 years; many live 20–30 years)
3. National Kidney Foundation — “Key Points: About Dialysis for Kidney Failure” (kidney failure is not a death sentence; modality comparison)
4. USRDS Annual Data Report, Mortality chapter (NIDDK) — five-year survival ≈40% hemodialysis / ≈50% peritoneal dialysis in the incident cohorts analyzed; improving across cohorts; expected remaining lifetime falls steeply with age. doi:10.1053/j.ajkd.2016.02.017
5. NIDDK — “Kidney Disease Statistics for the United States” (>808,000 people living with ESKD, 68% on dialysis; 14.1% of dialysis patients dialyzing at home at the end of 2021, up ~45% over the decade)
6. CDC MMWR — “Reported Cases of End-Stage Kidney Disease — United States, 2000–2019” (diabetes ~47%, hypertension ~29% of new ESKD cases in 2019)
7. National Kidney Foundation — KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update (ESKD Life-Plan; AV access preferred over CVC in most HD patients, lower infection risk)
8. Transplantation (2024) — survival benefit of deceased-donor kidney transplantation versus long-term dialysis across ages. doi:10.1097/tp.0000000000005125