“Every kidney patient deserves to understand what is happening in their body. When you know your options, you can make decisions with confidence — not fear.”
Written by Dr Rahul Agarwal, Consultant Vascular & Endovascular Surgeon
CARE Hospitals, Banjara Hills, Hyderabad
Introduction
Being diagnosed with chronic kidney disease (CKD) that is progressing toward dialysis is one of the most overwhelming experiences a patient and family can face. Many people receive this news weeks or months before dialysis starts — and that window of time is actually the most valuable opportunity to plan well and protect future options.
This guide is written for patients approaching dialysis, newly started on dialysis, and their families — to help you understand the choices ahead and how to make the most of them.
When Should Dialysis Access Be Planned? 📌
The most common mistake is waiting too long. An AV fistula takes 6–8 weeks to mature before it can be used — which means it must be created well before dialysis is urgently needed. Ideally, fistula surgery should happen when your eGFR (estimated glomerular filtration rate) is around 15–20 mL/min, giving time for maturation before the kidneys fail completely.
Patients who arrive for emergency dialysis without an existing access must rely on a temporary catheter, which carries significantly higher risks. Read more about catheter risks in our guide on Dialysis Access Options Explained: AV Fistula, Graft and Central Line.
Understanding Your Dialysis Options 🧠
Haemodialysis (HD)
The most common form of dialysis in India. Blood is circulated through a machine that filters waste and returns clean blood to the body. Sessions typically last 3–4 hours and happen three times a week. Requires a functioning dialysis access (ideally an AV fistula).
Peritoneal Dialysis (PD)
Fluid is infused into the abdomen through a surgically placed catheter, and the peritoneal membrane acts as the filter. PD is done at home, either manually (CAPD) or with a machine overnight (APD). It does not require an AV fistula. Suitable for selected patients with appropriate support at home.
Kidney Transplantation
The best long-term option for eligible patients. A functioning transplant eliminates the need for dialysis altogether. If you are a transplant candidate, this should be planned early — ideally before dialysis becomes necessary (pre-emptive transplant).
The Vascular Surgeon’s Role in Your Care 🩻
Many patients do not realise that a vascular surgeon is a core member of the kidney care team. The vascular surgeon’s role includes:
- Vein mapping with Doppler ultrasound to assess which veins are suitable for fistula creation
- Creating the AV fistula at the optimal site and time
- Monitoring maturation and intervening if problems arise
- Managing long-term complications of the access
- Planning secondary or tertiary access when needed
To understand what AV fistula surgery involves and what to expect afterwards, read our guide on Life After AV Fistula Surgery: What to Expect & How to Heal.
Protecting Your Veins Before Surgery 💉
One of the most important — and most frequently overlooked — actions a CKD patient can take is to protect their arm veins before fistula surgery. The forearm veins used for blood tests and IV drips are exactly the same veins your surgeon may need for your fistula. Once they are damaged, they cannot be undone.
- Tell every healthcare provider: “Please do not use my planned fistula (usually non-dominant side) hand or forearm for blood tests or IV lines”
- Wear a medical alert bracelet if needed
- Avoid blood pressure measurements on the planned fistula arm
- Ask your nephrologist to refer you to a vascular surgeon as soon as your eGFR reaches 20 mL/min
Questions to Ask Your Care Team 💬
- “When do you expect I will need to start dialysis?”
- “Should I be referred to a vascular surgeon now?”
- “Am I a candidate for peritoneal dialysis or a transplant?”
- “How do I protect my veins in the meantime?”
- “What will happen if I need to start dialysis urgently?”
Warning Signs That You Need Urgent Review ⚠️
- Rapidly worsening breathlessness or leg swelling (fluid overload)
- Confusion, extreme fatigue, or nausea (uraemic symptoms)
- A sudden fall in urine output
- Irregular heartbeat (may indicate high potassium)
When to See a Vascular Surgeon 🧑🏻⚕️
You do not have to wait until you are on dialysis to see a vascular surgeon. In fact, the earlier you meet one, the better your options. A pre-operative vein mapping assessment can be done months in advance, and the optimal timing of fistula creation can be planned around your CKD trajectory. Learn more at our Dialysis Access & AV Fistula page.
Frequently Asked Questions 🙋🏻♂️
I have been told my kidneys may fail in 6 months. What should I do now?
Ask your nephrologist for an urgent referral to a vascular surgeon for vein mapping and fistula planning. Discuss whether haemodialysis, peritoneal dialysis, or transplantation is the right option for you. The next few months are your most valuable planning window.
Can I have a fistula created even if I am not on dialysis yet?
Yes — and this is actually the ideal approach. Creating a fistula before dialysis begins (pre-emptive fistula creation) allows full maturation time and avoids the need for a catheter entirely.
What if I decide I want a transplant rather than dialysis?
A transplant is the best outcome if you are eligible. But most patients wait months or years for a suitable donor, and dialysis is needed in the interim. Having a well-functioning fistula improves your overall health and makes you a better transplant candidate.
Key Insights 🔑
The best time to plan your dialysis access is before you urgently need it. Every week of lead time is a gift to your future self.
Your veins are a limited resource. Protect them as though your life depends on it — because one day, it might.
📖 Related Reading:
- Dialysis Access Options Explained: AV Fistula, Graft and Central Line
- Living Well on Dialysis: Practical Tips for Patients and Families
- Dialysis Access & AV Fistula Surgery in Hyderabad
About the Author 🧑🏻⚕️
Dr Rahul Agarwal is a Consultant Vascular & Endovascular Surgeon at CARE Hospitals, Banjara Hills, Hyderabad, specializing in AV Fistula surgery, peripheral artery disease, varicose veins, dialysis access, and limb salvage.
Book a Consultation
If your kidney function is declining and you want to plan your dialysis access in advance, consult Dr Rahul Agarwal today.
2 responses to “Approaching Dialysis: A Patient’s Guide to Planning, Choices and Protecting Your Options”
[…] Approaching Dialysis: A Patient’s Guide to Planning and Choices […]
[…] How a patient manages their daily life, diet, medications, and emotional wellbeing has a direct impact on dialysis outcomes. Patients who stay informed and engaged tend to have fewer complications and a better quality of life. If you are just approaching dialysis, read our guide on approaching dialysis: a patient’s guide to planning, choices and protecting your options. […]