When someone tells you that you need to start dialysis, your brain doesn’t process it like information. It lands like a verdict.
I know because I’ve been there. I sat in that chair — or maybe I was standing, or pacing, I honestly can’t remember — and all I heard after a point was noise. The doctor kept talking. I kept nodding. And somewhere inside me, something very quiet broke.
That’s the part nobody puts in the brochure.
So today, I want to talk about dialysis the way I wish someone had talked to me about it — not with medical jargon, not with a clipboard, but with honesty and a little grace.
So, what actually is dialysis?
Your kidneys are supposed to be your body’s filter. Every single day, they clean your blood, remove waste, balance your fluids, and regulate things like blood pressure and mineral levels. When kidneys fail — whether slowly over years or more suddenly — that work stops getting done.
Dialysis is a machine (or a method) that steps in to do the job your kidneys can no longer do.
There are two main types:
Hemodialysis is what most people picture — you’re connected to a machine through access points in your body (usually a fistula or a catheter), and your blood is cleaned outside your body and returned to you. Sessions typically happen three times a week and last around four hours each.
Peritoneal dialysis uses the lining of your abdomen as the filter. A fluid is introduced through a catheter in your belly, it absorbs waste, and then it’s drained out. This one can often be done at home.
Both do the same essential job. Which one is right for you depends on your health, your lifestyle, and what your medical team recommends.
Why does dialysis become necessary?
Kidney disease is often quiet. For years — sometimes decades — your kidneys can lose function without you feeling dramatically different. That’s both a mercy and a trap, because by the time symptoms appear, the damage is often significant.
When kidney function drops to a critical level (typically around 10–15% of normal), your body can no longer safely manage on its own. Waste builds up in the blood. Fluid accumulates where it shouldn’t. The heart, lungs, and brain begin to feel the effects.
At that point, dialysis isn’t a last resort. It becomes a lifeline.
For some people it’s a bridge — they start dialysis while waiting for a transplant. For others, it becomes a long-term way of life.
Either way, it’s not the end of the story. It’s a new chapter — one that requires adjustment, but not defeat.
What nobody prepares you for: the emotional weight
I’ve talked to enough dialysis patients — and I’ve lived this myself — to know that the hardest part of starting dialysis often isn’t physical.
It’s grief.
You grieve the life you had before the schedule. The freedom to eat and drink without calculating. The days that weren’t divided by appointments. The version of yourself that didn’t know what a fistula was.
That grief is real and it is valid. Please don’t let anyone rush you through it.
But here’s what I also know: people adapt in ways that surprise even themselves. The routine that felt like a cage eventually becomes familiar.
The machine that looked terrifying becomes almost ordinary. And somewhere along the way, you start building a life around it — not despite it.
You are not your diagnosis. But your diagnosis is part of your story now, and there is no shame in that.
If you’re just starting — or supporting someone who is
Give yourself permission to feel what you feel. Ask every question, even the ones that feel small or silly. Find your people — a support group, an online community, an advocate (hello, that’s me). And please, keep showing up for your sessions.
Dialysis works when you work with it.
This month, we’re walking through everything — the medications, the labs, the supplements, the routines. You don’t have to figure it all out today. Just take it one session at a time.
—Hilda Addo, The Kidney Disease Advocate
Have questions about dialysis? Drop them in the comments. If you’re newly diagnosed or newly started, I especially want to hear from you.