Does Kidney Dialysis Fix the Kidneys

Patients in the hospital who require kidney replacement therapy (also known as dialysis) frequently ask if the procedure will fix their kidneys. It’s a common question. Kidneys that fail may or may not recover. Recovery depends on the reason for failure. Nephrologists attempt to treat the cause of the kidney failure. Frequently, the kidneys get stunned and need support until they recover — making urine and removing toxins. When will they recover? We have to give the kidneys enough time to wake up and start working again. The first step in the recovery process is the production of adequate urine. The second step in the recovery process is the removal of deadly toxins. It requires both steps to get off of the dialysis machine. If a patient is neither making enough urine nor removing enough toxins, then that patient may require kidney replacement therapy using a dialysis machine to stay alive. Kidney dialysis therapy doesn’t fix the kidneys. The kidney machine does the work of the kidneys, removing both fluid and toxins. It allows time for the possibility of kidney recovery. We call a frequent cause of sudden or acute kidney injury ATN. ATN is stunning of the kidneys. Predicting recovery in this situation can be complex. Positive signs include the production of urine, decreased levels of toxins in the body, and improvement in kidney function. We use a variety of other tools at our disposal to assess if a patient has recovered from AKI with ATN. Don’t confuse acute kidney injury and likely recovery of kidney function with chronic kidney disease and unlikely recovery of kidney function. Recovery of kidney function, getting off dialysis, occurs rarely in chronic kidney disease. Once a patient is in stage 5, we assume the kidneys will not recover. The kidneys have burnt out, and we must plan for long-term kidney replacement therapy. So in summary, dialysis does not fix the kidneys. Treatment of the mechanism of injury may fix the kidneys. Or the kidneys when ATN is present may, over time, get unstunned. Dialysis, however, does the work of the kidneys, allowing time for the possibility of kidney recovery. That’s the difference. When ATN is present, we are hopeful for recovery, but there is no guarantee that the patient will come off of the kidney dialysis machine. We assess daily, hopeful to stop dialysis if possible.