Understanding Your Kidney Treatment Options
When your kidneys can no longer do their job on their own, there are several pathways forward. This guide explains each option in plain language to help you and your loved ones make an informed decision together with your kidney specialist.
This guide is for people who have been told they have advanced chronic kidney disease (CKD) — sometimes called stage 4 or stage 5 kidney disease, or kidney failure. At this stage, your kidneys are working at less than 15–20% of normal capacity, and your medical team may begin discussing your treatment options. There is no one-size-fits-all answer — the best choice depends on your health, lifestyle, values, and what matters most to you.
What Do Your Kidneys Normally Do?
Your kidneys are two fist-sized organs that work around the clock. Every day they filter your entire blood supply about 40 times, removing waste products, balancing salt and water, and controlling your blood pressure. When kidneys stop working well, these waste products build up — and that is what makes you feel unwell.
The treatments described in this guide are different ways to take over the kidneys’ job — or to keep you as comfortable as possible if you decide not to pursue dialysis or transplantation.
Treatment Option 1a
Tertiary Hospital Based Haemodialysis in Metropolitan Perth
The most common starting point for dialysis — your blood is cleaned by a machine at a specialist tertiary hospital in metropolitan Perth, where complex and high-acuity patients receive care from a full multidisciplinary nephrology team.
Tertiary Hospital Based Haemodialysis in Metropolitan Perth
During haemodialysis, your blood is drawn out through a needle or a tube into a machine called a dialyser (sometimes called an artificial kidney). The machine filters out waste and excess fluid, then returns the clean blood to your body. Most people attend a dialysis centre three times a week, and each session lasts around four to five hours.
To allow the machine to access your blood reliably, a surgeon creates a connection between an artery and a vein in your arm — this is called a fistula, and it is the preferred access as it lasts longer and has fewer complications. In some situations, a temporary venous access device called a Hickman Catheter — a soft tube inserted into a large vein in the neck or chest — may be used instead. This is usually a short-term measure while a fistula matures, or as a bridge when dialysis needs to start urgently.
Tertiary hospital based HD is best suited to patients who are medically complex, newly starting dialysis, or who require close specialist oversight. Once clinically stable, patients may transition to a Community Satellite Dialysis Unit closer to home. For those who want the most flexibility and best long-term outcomes, Home Haemodialysis is the gold standard — see those sections for full details.
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Travel and cost burden — an important reality for many patients
Many patients begin dialysis at a tertiary hospital such as Royal Perth Hospital and remain there until a closer satellite unit vacancy or home therapy option becomes available. This can involve travelling long distances three times every week, adding significant travel costs, transport inconvenience, and time burden — particularly for those in outer suburbs, regional areas, or who do not drive. This is a temporary but sometimes prolonged situation. It is important to discuss transport assistance and any available financial support with your social worker or renal coordinator early.
Advantages
- Treatment fully managed by trained dialysis nurses and full nephrology team
- Immediate access to specialist physicians, pharmacists, and allied health on-site
- Social environment and peer support at the dialysis unit
- No equipment to manage or store at home
- Best option for complex, high-acuity, or newly starting patients
- Pathway to satellite or home dialysis as your condition stabilises
Things to Consider
- Fixed schedule — 3 sessions per week, every week, non-negotiable
- Significant travel to a tertiary hospital (e.g. Royal Perth Hospital) — three times weekly
- Travel costs and transport inconvenience — particularly difficult for those in outer suburbs or without a car
- Transition to satellite or home therapy often takes many months to arrange
- You may feel fatigued for several hours after each session
- Significant dietary and fluid restrictions between sessions
- Surgical procedure required for vascular access (fistula or Hickman Catheter)
Treatment Option 1b
Satellite Dialysis Units — Closer to Home
Community-based haemodialysis centres located in suburban areas — designed to bring stable, low-to-moderate acuity patients closer to their own neighbourhood, managed by specialist dialysis nurses.
Community Satellite Dialysis Unit
Satellite dialysis units are purpose-built haemodialysis centres located in suburban and community settings across metropolitan Perth — separate from, but linked to, the tertiary hospital. They are designed to bring dialysis closer to where you live, reducing the travel burden that comes with attending a tertiary hospital three times every week.
These units are nurse-led, meaning your treatment sessions are managed by specialist dialysis nurses who monitor you closely each session. A consulting nephrologist regularly reviews patients and is available for advice, but the day-to-day running of your dialysis is in the hands of an experienced nursing team. This model works very well for patients who are clinically stable with a well-established dialysis routine.
Who is satellite dialysis suitable for?
✓ Well-established fistula or access
✓ Low to moderate medical acuity
✓ No requirement for complex acute interventions on-site
⚠ Newly starting dialysis — usually begins at tertiary first
✗ High acuity or medically complex — tertiary hospital preferred
An honest note about vacancies
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Satellite unit places are in high demand across Perth, and vacancies are limited. Although every effort is made to transfer suitable patients to a satellite unit close to their home, waiting times can be many months or even years. During this period, patients typically continue dialysis at the tertiary hospital. Your renal coordinator will place you on the satellite waiting list and advocate for transfer as soon as a suitable place becomes available. It is worth asking your team which satellite units serve your area and what the current expected wait is.
Advantages
- Much closer to home — significantly less travel time and cost compared to a tertiary hospital
- Familiar, community-based environment — many patients find it more comfortable and less clinical
- Consistent nursing team who know you well
- Treatment fully managed by specialist dialysis nurses — no need to operate equipment yourself
- Social connection with other local dialysis patients
- Consulting nephrologist review remains part of your ongoing care
- A stepping stone that keeps the door open to home therapy when ready
Things to Consider
- Vacancies are limited — waiting times can be long and unpredictable
- Suitable for stable patients only — complex medical episodes may require temporary transfer back to the tertiary hospital
- Fixed 3-sessions-per-week schedule still applies
- Less immediate access to on-site specialist physicians compared to a tertiary unit
- Travel still required — just shorter than to a tertiary hospital
- Satellite units do not offer home dialysis training on-site
Treatment Option 1c
Home Haemodialysis
The same life-saving blood-filtering treatment as tertiary hospital / satellite HD — but done by you, in your own home, with comprehensive team support every step of the way.
Home Haemodialysis (Home HD)
Home HD uses exactly the same principle as tertiary hospital / satellite haemodialysis — your blood is filtered through a dialysis machine — but the machine comes to you. After a structured training period, you and your support person operate the machine at home. This typically means more frequent, gentler sessions, which closely mimic how healthy kidneys actually work.
Research consistently shows that home HD patients feel better, have lower blood pressure, have fewer hospital admissions, and live longer on average than those attending tertiary hospital or satellite dialysis three times a week. The flexibility also makes it much easier to maintain work, family, and social life — and eliminates the travel burden entirely.
Choose Your Schedule — Three Models of Home HD
Standard Home HD
The same 3 sessions per week as at the tertiary hospital or satellite unit, but done at home on your schedule. Sessions run 4–5 hours, often in the evening or while watching TV.
Short Daily HD
Shorter, more frequent sessions remove waste more steadily — closer to natural kidney function. Many patients report feeling much better on this schedule.
Nocturnal HD
Long, slow, overnight dialysis while you sleep. You connect to the machine at bedtime and disconnect in the morning — your days are entirely free. Evidence supports the best outcomes.
The Support You Will Receive
Home HD is never a solo journey. Your renal unit provides a comprehensive support framework from day one:
Benefits of Home HD
- Significantly better blood pressure control — fewer medications often needed
- Less fluid restriction — gentler fluid removal with more frequent dialysis
- More energy and better quality of life reported by most patients
- Fewer dietary restrictions (potassium and phosphate)
- Greater flexibility — dialyse when it suits you, not a fixed clinic schedule
- Reduced exposure to hospital-acquired infections
- Evidence of better long-term survival compared with tertiary hospital / satellite HD
- Maintain work, study, family, and social commitments more easily
- Nocturnal option leaves daytime completely free
Things to Consider
- Requires a committed training period (4–8 weeks)
- You or your helper performs the needle insertions
- Space needed at home for machine and supply storage
- Minor home modifications (water connection, power)
- Higher carer burden if you rely on a helper
- Some people find it hard to “switch off” from dialysis when it’s at home
- Not suitable if manual dexterity is significantly impaired
Am I Suitable for Home HD?
Most patients who are motivated and medically stable are suitable. Your renal team will assess:
- Your motivation and commitment to learning the treatment
- Suitable home environment and space for the machine
- Availability of a trained helper (partner, family member, carer) — note: some patients dialyse independently with full team backing
- Adequate manual dexterity to handle the needles and equipment
- Overall medical stability — active infections or complex conditions may require tertiary hospital dialysis initially
Ask your nephrologist: “Am I a candidate for home haemodialysis?” — many people who are eligible are never offered it. The evidence strongly supports it as the best dialysis option for suitable patients.
Treatment Option 2
Peritoneal Dialysis (PD)
A gentler, home-based dialysis that uses your body’s own natural lining as the filter.
Peritoneal Dialysis
Your belly (abdomen) is lined by a thin membrane called the peritoneum. In peritoneal dialysis, a soft flexible tube (called a catheter) is placed through the belly wall by a small surgical procedure. A special cleansing fluid called dialysate is passed through this tube into your abdomen, where it soaks up waste products and extra fluid from your blood. After a few hours, the fluid is drained out — taking the waste with it. This process is called an “exchange.”
There are two main types: CAPD (Continuous Ambulatory Peritoneal Dialysis) where you do 3–4 exchanges manually throughout the day, and APD (Automated Peritoneal Dialysis) where a small machine called a cycler does the exchanges overnight while you sleep.
Advantages
- Done at home — much more flexible lifestyle
- Gentler, continuous process — more like natural kidneys
- Usually fewer dietary restrictions
- Overnight option (APD) frees up your days
- Travel is possible with planning
- More independence and control
Things to Consider
- You manage your own treatment — requires learning
- Daily commitment, 7 days a week
- Risk of infection around the catheter or inside the abdomen (peritonitis)
- Storage space needed for dialysis bags and equipment
- Not suitable for everyone (e.g. after certain abdominal surgeries)
Treatment Option 3
Kidney Transplantation
The closest treatment to a cure — a healthy donor kidney takes over the work of your failed kidneys.
Kidney Transplantation
In a kidney transplant, a healthy kidney from another person (a donor) is surgically placed into your lower abdomen. Your own failed kidneys are usually left in place unless they are causing problems. The new kidney is connected to your blood vessels and bladder, and in most cases it starts working soon after the operation.
There are two types of donors:
- Living donor — a family member, partner, or friend donates one of their kidneys while they are alive. A person can live a full, healthy life with one kidney. Results tend to be better with a living donor.
- Deceased donor — a kidney from someone who has died and agreed to be an organ donor. Most transplant recipients receive a deceased donor kidney.
After a transplant, you will take immunosuppressant medicines every day for life — these prevent your body from rejecting the new kidney. You will have regular check-ups, but most people with a successful transplant enjoy a much better quality of life than on dialysis.
Advantages
- Best quality of life and survival outcome overall
- Freedom from dialysis schedules
- Fewer dietary restrictions
- Better energy and wellbeing for most people
- Living donor transplant can be planned in advance
Things to Consider
- Major surgery with anaesthetic risks
- Waiting list — median wait is 3–5 years in Australia
- Life-long immunosuppressant medicines needed
- Higher risk of certain infections and skin cancers
- Transplants do not last forever (average 12–20 years)
- Not everyone is medically suitable
Treatment Option 4
Conservative Kidney Management
A valid, dignified choice — focusing on quality of life, symptom relief, and living well without dialysis.
Conservative (Supportive) Care
Conservative care — also called supportive or non-dialytic care — is a positive, active choice to manage kidney failure without dialysis or transplantation. It is not “giving up.” It is a care plan that puts quality of life first, and it is the right choice for some people, particularly those who are elderly, have multiple serious health conditions, or for whom dialysis would be very burdensome with little benefit.
Your medical team will focus on:
- Controlling symptoms such as tiredness, fluid retention, breathlessness, itching, pain, and nausea
- Medicines to slow kidney decline and manage blood pressure, anaemia, and bone health
- Diet and fluids adjusted to keep you as comfortable as possible
- Psychological and spiritual support for you and your family
- Advance care planning — making sure your wishes are known and respected
Some people on conservative care live for months to years and maintain a good quality of life. Your care will involve a whole team including nephrologists, palliative care specialists, nurses, dietitians, and social workers.
Advantages
- No dialysis machine or procedures
- Time spent at home or where you feel comfortable
- Focus on what matters most to you
- Avoids burdens of dialysis (travel, fatigue, needles)
- Integrated palliative support from the start
Things to Consider
- Life expectancy is generally shorter than with dialysis
- Symptoms may worsen over time as kidney function declines
- Requires honest conversations with family about future planning
- Some people change their minds and start dialysis later — this is always possible
Side-by-Side Overview
Comparing Your Options at a Glance
This table is a simplified guide. Your kidney specialist will discuss what is realistic for your individual situation.
| Feature | Tertiary Hospital HD | Satellite Dialysis Unit | Home HD | Peritoneal Dialysis | Transplantation | Conservative Care |
|---|---|---|---|---|---|---|
| Where treatment happens | Tertiary hospital (e.g. Royal Perth Hospital) | Community satellite unit near home | Your home | Your home | Hospital (operation), then home | Home / community |
| How often | 3 × per week | 3 × per week | 3–6 × per week (or nightly) | Daily (every day) | Once (surgery), then ongoing medicines | Regular clinic visits |
| Session duration | 4–5 hrs | 4–5 hrs | 2–3 hrs (or 6–8 hrs overnight) | 30 min exchange × 4, or overnight cycler | N/A after recovery | N/A |
| Patient acuity | Any — incl. complex | Low–moderate only | Stable patients | Stable patients | Post-op stable | Any |
| Who manages treatment | Full nephrology team + dialysis nurses | Specialist dialysis nurses; nephrologist review | You (± helper), fully trained | You (after training) | Surgical team, then nephrology | Multidisciplinary team |
| Travel burden | High — tertiary hospital, 3×/week | Lower — community location | None | None | Minimal after recovery | Minimal |
| Access / wait time | Weeks (access surgery); immediate availability | Weeks (access surgery); vacancy wait months–years | Weeks (access) + 4–8 weeks training | Weeks (catheter + training) | Years (waiting list) | None — can start now |
| Lifestyle flexibility | Limited | Moderate | Excellent | Good | Excellent | Excellent |
| Evidence for outcomes | — | Comparable to tertiary | Better BP, survival | Comparable | Best overall | Quality-focused |
| Main considerations | Travel cost & burden; complex patients well supported | Vacancy wait; suitable for stable patients only | Training required; needling; home space needed | Daily commitment; peritonitis risk | Rejection; lifelong immunosuppression | Symptom progression over time |
Watch & Learn
Patient Education Videos
Real stories and expert explanations to help you understand each treatment option and what life on treatment looks like.
Living with Kidney Disease
Patient stories covering dialysis and transplant journeys.
Watch videos
Living Well with Kidney Failure
Series covering HD, PD, transplant and life with kidney failure.
Watch videos
Kidney Health Education Series
13-part series from dialysis options to transplant and beyond.
Watch videos
Treatment Options Videos
HD, PD, transplant and supportive care — also in multiple languages.
Watch videos
Home Dialysis Patient Stories
Real patients share why they chose home HD or peritoneal dialysis.
Watch videos
The Peritoneal Dialysis Experience
Detailed video of a real PD treatment — what it looks and feels like.
Watch video
Common Questions
Frequently Asked Questions
Do I have to start dialysis straight away when my kidneys fail?
Can I switch between treatment options?
What is eGFR and when is it low enough to need treatment?
Can I still work or travel on dialysis?
What if I don’t want dialysis at all? Is that okay?
How do I get on the transplant waiting list?
Will I still need to take tablets and watch my diet?
Talk to Your Kidney Specialist
There is no single right answer — the best treatment is the one that fits your health, your life, and your values. Your renal team is here to walk this path with you.