In stage 5 CKD, when the kidneys are in failure, children usually need specialist treatment, such as dialysis and/or a kidney transplant. Children start preparing for one or both of these treatments in stage 4.
Dialysis
Dialysis uses special equipment or a machine to remove extra water, salts and waste products from the blood. Dialysis can only work as well as 10–15% of two healthy kidneys, and it cannot do everything that kidneys do – such as produce the hormones that help activate vitamin D or make red blood cells, so your child will continue to need a special diet and medicines when they are on dialysis.
Types of dialysis
There are two main types of dialysis – haemodialysis (blood is cleaned in a large machine) and peritoneal dialysis (dialysis fluid is placed inside your child’s abdomen (tummy) where the body’s natural filter removes water and waste products, and then the dialysis fluid is removed and replaced with fresh dialysis fluid). Your child’s healthcare team will give you information so you can help decide the best type for your child.
Surgery before dialysis
Each type of dialysis needs a small operation before dialysis can start. This surgery creates access to your child’s body so the dialysis can work.
Kidney transplant
A kidney transplant is currently the best treatment for almost all children with ERF. After a successful transplant, children can live healthy lives and feel much better. A new kidney may work for many years.
Kidney transplantation is major surgery. A healthy kidney is removed from one person (a donor) and placed in the body of another person who needs it (a recipient). Children need to have many tests before the operation, and may need to wait for up to a year or longer before a suitable kidney becomes available. They will need to stay in hospital for ten days or longer after the surgery, to recover and check that their new kidney works well. They will also need to take medicines every day, go to follow-up appointments and take care of their health after the transplant.
When it happens
Sometimes, a kidney transplant can take place before a child needs dialysis. This is not always possible and depends on many factors, including the availability of suitable donors. Most children can have a kidney transplant, though those under 2 years of age usually need to wait until they are big enough for the operation.
Children may need further kidney transplants, dialysis or other care later in life.