Dialysis usually starts when kidney function falls below about 15% (eGFR under 15) and symptoms or complications appear, not at a single blood-test number. Most people on hemodialysis attend three sessions a week of around four hours each. Food matters as much as the machine: on dialysis you usually need more protein, less salt, and potassium and phosphorus tailored to your reports.
When does dialysis start in Chronic Kidney Disease (CKD)?
An eGFR below 15 defines kidney failure, but it marks the time to prepare, not the day to begin. Nephrologists start dialysis when swelling, breathlessness, persistent nausea or vomiting, itching, confusion, high potassium or poorly controlled blood pressure appear. In the IDEAL trial, planned early starts brought no survival benefit over symptom-guided starts.
Does a creatinine of 2.0 mean dialysis? No. For many middle-aged adults it corresponds to an eGFR of roughly 30 to 40, far above the dialysis range, though age, sex and muscle mass change this. Your eGFR, symptoms and trend matter more.
How often is dialysis needed?
Conventional hemodialysis is usually three sessions a week of about four hours. Limited studies of more frequent or longer sessions have not shown better outcomes. Some people who still pass good urine may begin with fewer sessions, but only on a nephrologist’s advice. Never skip or shorten a session, even if you feel well. Our unit provides hemodialysis for chronic and acute kidney failure.
Protect your dialysis access
If you have an AV fistula:
- Do not allow blood pressure checks, drips or blood draws on that arm.
- Do not carry heavy bags or sleep on the arm.
- Feel for the buzz (thrill) daily. Report if it is weak or missing.
- Keep the site clean and report redness, pain or bleeding.
What to eat on dialysis: an Indian vegetarian guide
- Protein: needs rise to about 1.0 to 1.2 g per kg of body weight, because dialysis removes protein. For a 60 kg adult that is roughly 60 to 72 g a day. Do not copy a pre-dialysis CKD diet, which usually restricts protein. Dal, curd and paneer can stay in controlled portions, and egg whites are a good option if you eat eggs.
- Salt: keep sodium under 2.3 g a day, about one level teaspoon of salt in total. Count pickles, papad, namkeen and packaged foods.
- Potassium: your blood reports decide how strict to be. Coconut water, bananas, oranges, tomatoes, spinach and potatoes are the usual ones to watch. Soaking cut potatoes in water before cooking reduces potassium.
- Phosphorus: limit colas and processed foods with phosphate additives, which are absorbed easily.
- Fluids: your nephrologist sets a daily limit. Tea, soup, dal and fruit all count.
When to call or come in
Contact us if you have breathlessness, rapid weight gain, severe swelling, fever, a fistula that bleeds or stops buzzing, or a missed session. Chest pain, fainting or severe weakness needs emergency care: call 108, 112 or +91 8888236000.
Frequently asked questions
Is dialysis for life?
In chronic kidney failure it is usually long-term unless a transplant is possible. In acute kidney injury it may be temporary.
Is dialysis painful?
The needle insertion stings briefly. Sessions are usually painless, though cramps or low blood pressure can occur.
Can I eat dal on dialysis?
Yes, in controlled portions. Dialysis raises protein needs, and dal is a main source for vegetarians.
How much water can I drink?
It depends on your urine output and weight gain between sessions. Your nephrologist sets the limit.
Can I skip a session if I feel fine?
No. Waste, fluid and potassium build up silently and can become dangerous.
Will I need a kidney transplant?
Transplant suits some patients. Ask your nephrologist about eligibility and workup.
Talk to our nephrology team
Visit our Dialysis Unit or Nephrology department, and check cashless and PMJAY support.
This article is for general information and does not replace advice from your doctor or dietitian.