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First of all, there are blood values for this, e.g. the blood value creatinine and/or urea. This can then be used to calculate the performance of the kidneys using certain formulas. If kidney function is impaired, this does not necessarily lead to chronic and definitive kidney failure. We kidney specialists differentiate here between stable, limited kidney function and further deteriorating kidney function up to the point where dialysis is required. The time factor naturally plays a major role here. If the loss of kidney function is only very slight, the prognosis with regard to kidney function is naturally better in the long term; if the time course is rapid, i.e. a lot of kidney function is lost per year, dialysis treatment is usually required within a few years.

If a person has renal insufficiency based on the above-mentioned measurement parameters, it is very important to determine the cause. The kidney specialist will determine the cause. Once a diagnosis has been made, the kidney specialist must consider which factors can be treated so that the kidney failure does not continue or is so slow that dialysis is unlikely to be required.

You should also be aware that renal insufficiency must be investigated at an early stage, i.e. when only a small amount of kidney function has been lost. In the early stages of renal insufficiency, kidney failure can usually be halted, and in some cases even cured, with the appropriate diagnostic and therapeutic measures.

If the renal insufficiency is advanced, as in the example above, e.g. 60 ml/min, the main focus is on preventing progression to final renal failure requiring dialysis.

In recent years, a great deal of knowledge has been gained about renal insufficiency (cause and progression). On the one hand, these findings depend on the underlying disease, e.g. kidney inflammation or hereditary diseases such as cystic kidneys. On the other hand, they also relate to concomitant symptoms that occur in all kidney patients, such as high blood pressure, lipometabolic disorders, hyperacidity of the blood and the development of kidney-related anaemia. All of these factors can be treated after an appropriate diagnosis and will hopefully help to preserve your kidney function for the rest of your life.

Don't be afraid to ask your family doctor or a kidney specialist if you have kidney failure, even if it's still early days.

Dialysis is a type of treatment for chronic kidney failure. If kidney function is less than 10%, in most cases long-term renal replacement therapy, i.e. dialysis, is required. Dialysis is not immediately necessary for everyone with a certain level of kidney function. This depends on the patient's physical condition and physical performance, water excretion (accumulation of water in the body), blood salt disorders (accumulation of so-called potassium in the blood), anemia caused by the kidneys (renal anemia), etc. The start of dialysis is therefore a joint decision between the kidney patient and their kidney specialist.

There are 2 possible types of dialysis; one is so-called dialysis by machine (also known as blood washing). For this, blood is taken from the body and pumped through a so-called capillary (which is surrounded by water) and both blood purification and dehydration (many kidney patients no longer have sufficient urine production) are carried out here. This is usually carried out 3 times a week for 4-5 hours. The treatment can be carried out in a so-called dialysis center or at home, as a home dialysis procedure.

The alternative to this is peritoneal dialysis. Here, the peritoneum is used as a dialysis membrane. Here, the blood is purified between a fluid that is filled into the abdominal cavity (usually around 2 liters) and the hair-small vessels in the peritoneum, which are available for the removal of metabolic products and excess water. Peritoneal diuresis is performed via a catheter artificially inserted into the abdomen. This catheter usually heals without any problems and can also be cosmetically well covered. This procedure is carried out at home and naturally gives the kidney patient more freedom, but also transfers more personal responsibility.

Both dialysis procedures - blood washing or peritoneal dialysis - have special nutritional aspects. For both dialysis procedures, it is important that patients consume sufficient calories and protein. Contrary to popular belief that kidney patients, especially dialysis patients, should eat a low-protein diet, this is not the case. The kidney patient's body has problems processing protein and calories in full. It is therefore important to provide enough in the diet.

In addition, blood washing is only carried out three times a week, in contrast to peritoneal dialysis, which works daily and around the clock. In this case, attention must be paid to certain electrolytes, especially potassium, during blood washing. Potassium is only excreted via the kidneys or via dialysis and can accumulate in the body. High potassium levels are dangerous for the muscles and the heart. For this reason, all so-called healthy foods (fruit and vegetables) are only included in the diet to a reduced extent. Special advice is needed to avoid so-called "potassium bombs". On the other hand, there are many excellent recipes available today that make a balanced and, above all, tasty diet possible for dialysis patients.

Furthermore, as urine production decreases, fluid intake must also be reduced. Unfortunately, this is a major problem, as with a complete lack of urine output, which can be the case after several years of dialysis, the fluid intake must of course be greatly reduced and this can lead to a significant reduction in quality of life.

The life expectancy of dialysis patients depends on many factors. Older people often need dialysis, which means that quality of life also plays an important role alongside life expectancy. Basically, it can be said that younger kidney patients do not have a full life expectancy, but with good and intensive dialysis treatment, they can survive for many decades.

Today, we know that a 40-year lifespan is quite possible, even on dialysis, and we have seen and cared for patients with this over and over again.

Nevertheless, we know that cardiovascular diseases (heart valve defects, cardiac circulatory disorders and circulatory disorders of the legs) in particular reduce the life expectancy of dialysis patients. If other concomitant diseases are also present, the chance of survival can be reduced even further.

On the other hand, we know that after a successful kidney transplant, when kidney function has almost returned to normal, life expectancy is significantly longer again despite the operation and the immunosuppressive medication that has to be taken.

Dialysis treatment, like any other therapy, is of course not without side effects. The most subjectively perceived side effect is the time factor. Whether blood or peritoneal dialysis, you have to invest time in coming to dialysis, having dialysis carried out or, in the case of peritoneal dialysis, preparing and carrying out the fluid change at home.

After a transplant, this gain in time is often perceived as a great advantage and appreciated. Other side effects are, of course, the drop in blood pressure during dialysis with dizziness, but also the exertion of the dialysis treatment itself. Older dialysis patients in particular need time to recover after dialysis treatment. Some also suffer from sleep disorders, so it is not advisable to end dialysis in the evening, for example, but rather to have the blood washed in the morning.

Almost all dialysis patients have high blood pressure and need blood pressure medication, which also causes side effects. As already mentioned, a major problem of chronic renal toxicity (this is not a side effect of dialysis, but of the condition of renal insufficiency requiring dialysis) is vascular damage and damage to the heart. These are often also limiting in terms of life expectancy. However, many types of damage can now be recognized and successfully treated through close cooperation between kidney and heart specialists.

Another side effect of chronic kidney failure that affects dialysis patients very severely is the restriction of the amount of fluid they drink. This often takes a very long time to get used to, some dialysis patients never manage this and of course much more water has to be removed from the body per dialysis treatment. This is usually accompanied by dizziness and nausea.