Life-Sustaining Kidney Treatment Close to Home
Kidney failure requiring dialysis transforms everything: shock, fear of machine dependence, anxiety about how treatment will consume your life, and exhausting three-times-weekly trips for hours-long sessions.
Our renal dialysis unit provides comprehensive haemodialysis with experienced nephrology teams and modern equipment. You don’t need endless travel to distant centres, impossible choices between dialysis and employment, or isolation from family.
Expert dialysis care, enabling quality of life, work when possible, and community connection, is available right here.
Our Renal & Dialysis Unit Nephrologist
Medical Disclaimer: This information is for educational purposes and does not replace professional medical advice. Kidney failure is a life-threatening condition requiring specialist nephrologist care. Dialysis is a complex medical treatment requiring comprehensive evaluation, ongoing monitoring, and strict adherence to treatment regimens and dietary restrictions. Please consult with qualified nephrologists for assessment and individualised dialysis treatment recommendations. For kidney failure emergencies, seek immediate medical attention or contact emergency services.
Common During Treatment Symptoms
Hypotension (Low Blood Pressure)
Rapid fluid removal plus blood volume changes can drop blood pressure, causing dizziness, nausea, sweating, cramping, and rarely loss of consciousness. Treatment includes slowingthe ultrafiltration rate, giving IV saline (temporary fluid replacement), raising legs, and sometimes stopping dialysis early. Preventing hypotension involves limiting between-session fluid gain (less fluid needing removal = gentler treatment) and adjusting dry weight appropriately.
Muscle Cramps
Particularly legs, painful cramping during or after dialysis from electrolyte shifts and fluid removal. Treatment includes stretching, massage, IV saline, sometimes IV dextrose or hypertonic saline, and adjusting dialysate sodium concentration. Not fully preventable, but frequency can be reduced.
Nausea and Vomiting
From rapid toxin removal, blood pressure changes, or individual sensitivity. Usually manageable with antiemetic medications and treatment adjustments.
Post-Dialysis Assessment
After the prescribed treatment time, dialysis is stopped, blood is returned from the dialysis circuit to your body, needles are removed, and firm pressure is applied to the puncture sites until bleeding stops (typically 10-20 minutes). Weight and blood pressure are rechecked, you’re assessed for immediate post-dialysis complications, and you’re cleared to leave when stable.
Post-Dialysis Recovery
Most patients feel exhausted after dialysis, “washed out” for hours to a full day. This post-dialysis fatigue is normal but debilitating. Many patients rest extensively after sessions. Some sleep the remainder of dialysis day. Fatigue improves on non-dialysis days but never completely resolves. This chronic fatigue profoundly affects quality of life, limiting work capacity, reducing energy for family and activities, and contributing to depression.
Understanding Kidney Failure and Dialysis
Your kidneys are remarkable organs performing crucial functions, keeping you alive. Two fist-sized organs located on either side of your spine, just below your ribcage,the kidneys filter your blood continuously, removing waste products, excess fluid, and toxins whilst retaining essential nutrients, proteins, and blood cells. Every day, your kidneys filter approximately 200 litres of blood, producing 1-2 litres of urine containing concentrated waste products.
Beyond filtration, kidneys perform vital functions including regulating blood pressure (through renin-angiotensin system and fluid balance), producing erythropoietin (hormone stimulating red blood cell production), activating vitamin D (essential for calcium absorption and bone health), balancing electrolytes (sodium, potassium, calcium, phosphate), and maintaining acid-base balance (keeping blood pH in narrow safe range).
When kidneys fail, these functions cease.
Waste products accumulate in the blood (uraemia), fluid builds up, causing dangerous swelling (oedema) and heart failure, blood pressure becomes uncontrolled, electrolytes become dangerously imbalanced (high potassium can cause fatal heart rhythms), anaemia develops from lack of erythropoietin, bones weaken from vitamin D and mineral imbalances, and acid accumulates in the blood (acidosis). Without treatment, kidney failure causes death within days to weeks.
Kidney failure occurs in two patterns:
Acute Kidney Injury (AKI):
Sudden kidney failure over hours to days from specific causes, severe dehydration, infections (sepsis), medications or toxins, urinary obstruction, or acute illnesses. Many cases of AKI are reversible, kidneys recover function with treatment of the underlying cause and supportive care (sometimes including temporary dialysis). AKI patients might need dialysis for days to weeks whilst their kidneys heal, then discontinue dialysis once kidney function recovers.
Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD):
Progressive irreversible kidney damage over months to years from chronic conditions, diabetes (the most common cause), hypertension, glomerulonephritis (kidney inflammation), polycystic kidney disease, HIV-associated nephropathy, chronic obstruction, and other causes. CKD progresses through five stages based on kidney function (measured by eGFR, estimated glomerular filtration rate). Stage 5 CKD (eGFR under 15) is end-stage renal disease requiring dialysis or transplantation to sustain life. Unlike AKI, ESRD is permanent, the kidneys will never recover function. Dialysis is lifelong unless kidney transplantation occurs.
Dialysis is a life-sustaining treatment replacing kidney function.
Dialysis machines remove waste products and excess fluid from blood, balance electrolytes, correct acidosis, and partially replace kidney filtration function. Dialysis doesn’t cure kidney failure, it sustains life whilst kidneys remain non-functional. Dialysis is necessary indefinitely for ESRD patients until transplantation (if they’re transplant candidates) or until end-of-life, when dialysis is discontinued.
Two types of dialysis exist:
Haemodialysis:
Blood is removed from your body, passed through an artificial kidney (dialyser containing thousands of tiny hollow fibres acting as filtration membranes), then returned to your body. Haemodialysis requires vascular access (surgical creation of fistula, graft, or catheter enabling blood removal and return), occurs at dialysis centres (typically three times weekly for 4-5 hours per session), and provides efficient waste removal and fluid removal in concentrated treatment sessions.
Peritoneal Dialysis:
Dialysis fluid is instilled into your abdominal cavity through a permanently placed catheter. Your peritoneum (abdominal lining) acts as a natural filter, waste products and fluid cross from blood vessels in the peritoneum into dialysis fluid, which is then drained and discarded. Peritoneal dialysis occurs at home (patients perform exchanges themselves daily), offers more flexibility and independence, and provides gentler continuous treatment. However, not everyone is suitable for peritoneal dialysis, and it requires manual dexterity, adequate hygiene, space at home, and commitment to strict technique, preventing infections.
At Botshilu, we provide haemodialysis services.
Our focus is on providing accessible, high-quality haemodialysis, enabling patients to maintain maximum quality of life whilst receiving life-sustaining treatment.
Why Choose Botshilu for Dialysis
Dialysis consumes enormous time and energy, typically 12-15 hours weekly just for treatment sessions, plus travel time, recovery time after sessions, and managing complications. Where you receive dialysis profoundly affects your quality of life, ability to work, family relationships, and overall well-being.
Botshilu’s Renal Dialysis Unit offers:
Experienced Nephrology Team:
Our nephrologists are specialist kidney doctors who’ve completed medical school plus 4-5 years of nephrology training, are registered with HPCSA as nephrology specialists, have extensive experience managing dialysis patients, understand complications of kidney failure and dialysis, optimise medical management alongside dialysis, and coordinate comprehensive kidney care. Dialysis isn’t just about machines, it requires expert medical management of complex multisystem disease.
Dedicated Dialysis Nurses:
Our dialysis nurses are registered nurses with specialised dialysis training and experience. They connect patients to dialysis machines safely, monitor patients throughout treatment sessions, manage complications during dialysis (blood pressure changes, cramping, nausea, chest pain), administer dialysis-related medications, educate patients about kidney failure and dialysis, assess vascular access function, and provide compassionate support, recognising dialysis patients face extraordinary challenges.
Dialysis nursing is highly specialised, managing vascular access, operating dialysis machines, calculating ultrafiltration (fluid removal), monitoring for complications, and supporting chronically ill patients requires extensive knowledge and skill.
Modern Dialysis Equipment:
We use contemporary haemodialysis machines with advanced features including volumetric ultrafiltration control (precisely removing prescribed fluid volume), online clearance monitoring (measuring dialysis adequacy in real-time), blood volume monitoring (reducing hypotension risk), automated alarms and safety systems, and efficient high-flux dialysers (modern artificial kidneys providing excellent waste removal).
Quality dialysis equipment matters, older machines, inadequate maintenance, or compromised water treatment produce suboptimal dialysis, causing complications and poor outcomes. We maintain equipment rigorously, ensuring safe, effective treatment.
Vascular Access Care:
Functional vascular access is a dialysis patient’s lifeline, without good access, dialysis cannot occur. We provide comprehensive access care including pre-dialysis access creation planning (coordinating with surgeons creating fistulas or grafts), access assessment before each session (checking for adequate flow, listening for bruit, feeling for thrill), access cannulation using sterile technique (needle insertion into fistula or graft), access monitoring detecting problems early (stenosis, thrombosis, infection), and access preservation education (protecting access arm, recognising warning signs).
When access problems occur, we coordinate urgent intervention, surgical revision, interventional radiology procedures, or temporary catheter placement, enabling continued dialysis whilst access is repaired.
Comprehensive Medical Management:
Dialysis sustains life but doesn’t address all kidney failure complications. Our nephrologists provide comprehensive management including anaemia treatment (erythropoietin injections stimulating red cell production, iron supplementation), bone disease prevention (managing calcium, phosphate, parathyroid hormone with diet, medications, and activated vitamin D), blood pressure control (crucial for cardiovascular health, many dialysis patients need multiple blood pressure medications), cardiovascular risk reduction (dialysis patients have very high heart disease and stroke risk), nutrition optimisation (specialised renal diet), infection prevention and treatment, and addressing complications (restless legs, pruritus/itching, sleep disturbances, depression).
Kidney failure is a multisystem disease requiring more than just dialysis; comprehensive medical management improves quality of life and survival.
Flexible Scheduling:
We offer multiple dialysis shift times accommodating diverse patient needs, including morning shifts (starting early, enabling afternoon/evening availability for work or family), afternoon shifts, and Saturday sessions. Whilst dialysis requires substantial time commitment (typically Monday-Wednesday-Friday or Tuesday-Thursday-Saturday schedules), we work with patients finding schedules enabling maximum life participation possible.
Multidisciplinary Care:
Optimal dialysis care requires a team approach. Our nephrologists work with dialysis nurses providing daily patient care and education, renal dietitians specialising in kidney failure nutrition (critical component of dialysis care), social workers supporting patients facing enormous practical and emotional challenges, vascular surgeons creating and maintaining vascular access, interventional radiologists performing access procedures when needed, pharmacists managing complex medication regimens, and other specialists (cardiologists, endocrinologists, surgeons) addressing dialysis patients’ multiple comorbidities.
Patient Education:
Understanding kidney failure and dialysis enables informed participation in care. We provide comprehensive education including kidney failure pathophysiology (what’s happening in your body), dialysis mechanism (how treatment works), dietary restrictions and fluid management (critical for success, preventing between-session weight gain and managing electrolytes), medication compliance (dialysis patients often take 10-15 medications daily, understanding why each is necessary improves adherence), access care and protection, recognising complications requiring urgent attention, and coping strategies for living with chronic illness and dialysis dependence.
Educated, empowered patients have better outcomes and quality of life.
Continuity of Care:
Dialysis is lifelong for most patients (unless transplanted). Building relationships with a consistent nephrology team, familiar nurses, and fellow patients creates community and support. Local dialysis enables this continuity, you’re not transferred between facilities, you see the same team building trust over months and years, and you’re part of the dialysis community providing mutual understanding and support.
FAQ
Frequently Asked Questions
Common Concerns and Honest Answers
Dialysis is artificial process removing waste products and excess fluid from blood when kidneys can no longer function adequately. Kidneys normally filter blood continuously, removing toxins and regulating fluid and electrolyte balance. When kidney function falls below 10-15% (end-stage renal disease), waste products and fluid accumulate causing life-threatening complications, dialysis becomes necessary to sustain life.
Most haemodialysis patients require treatment three times weekly. Each session typically lasts 4-5 hours. This schedule (Monday-Wednesday-Friday or Tuesday-Thursday-Saturday) allows two-day gap and one three-day gap weekly. Some patients require more frequent dialysis depending on residual kidney function, body size, and other factors.
You'll sit or recline in comfortable chair. Two needles are inserted into your vascular access (fistula, graft, or catheter). Blood flows through tubing to dialysis machine where it passes through artificial kidney (dialyser) removing wastes and excess fluid, then returns to your body. Throughout treatment, machines monitor blood pressure, heart rate, and treatment parameters. You can read, watch television, use phone, sleep, or talk with staff and other patients. Most patients feel tired afterwards.
Needle insertion causes brief discomfort (similar to blood test but larger needles). During treatment, most patients feel nothing or mild sensations. Some experience low blood pressure causing dizziness, nausea, or cramping, staff adjust treatment reducing symptoms. After treatment, needle sites may be slightly sore. Most patients adjust and tolerate treatment well.
Vascular access is how blood enters and returns from dialysis machine. Three types: Fistula (connecting artery and vein in arm surgically, best option, created months before dialysis starts), Graft (synthetic tube connecting artery and vein, when fistula not possible), Catheter (tube inserted into large vein in neck or chest, temporary solution). Good vascular access is crucial for effective dialysis. Fistulas last longest with fewest complications but require planning, created 3-6 months before dialysis needed allowing time to mature.
Many dialysis patients continue working. Requires flexible employment accommodating dialysis schedule (three half-days weekly). Some employers accommodate, others don't. Type of work matters, physically demanding jobs difficult when fatigued from treatment. Evening or Saturday dialysis sessions sometimes available helping employment. Honestly, dialysis makes working challenging, but many manage successfully with supportive employers.
Dialysis patients have dietary restrictions. Fluid restriction (typically 500ml-1000ml daily beyond urine output, very challenging), Potassium restriction (high potassium causes dangerous heart rhythms, avoid bananas, oranges, tomatoes, potatoes, many other foods), Phosphate restriction (requires phosphate binders with meals), Sodium restriction (limiting salt reduces thirst and fluid retention), Adequate protein (dialysis removes protein, need higher intake). Dietitian provides detailed guidance. Diet restrictions are one of dialysis's most difficult aspects.
Yes, but requires planning. Arrange dialysis at destination facility weeks-months in advance (dialysis centres coordinate with travelling patients' home units). Medical records sent ahead. Additional costs as destination facility isn't your usual provider. Travelling complicates dialysis but is possible with organisation.
Variable, depends on age, other medical conditions, dialysis adequacy, and adherence to treatment. Younger healthier patients may live decades. Elderly patients with multiple conditions may survive months-few years. Five-year survival on dialysis is approximately 35-40% (worse than many cancers), sobering reality. However, some patients live 20-30+ years on dialysis. Kidney transplant dramatically improves survival versus remaining on dialysis.
Kidney transplant is best treatment for kidney failure, superior survival and quality of life versus dialysis. Requires evaluation determining transplant suitability (age, other medical conditions, cancer history, infections). If suitable, placed on transplant waiting list. Waiting time varies (months to years depending on blood type and antibodies). Living donor transplant (family member or friend donating kidney) is faster with better outcomes than deceased donor transplant. Not everyone is transplant candidate, but most should be evaluated.
Missing dialysis is dangerous. Wastes accumulate, fluid overloads, electrolytes become dangerously abnormal, causing heart problems, breathing difficulty, confusion, seizures, death. One missed treatment causes noticeable symptoms. Multiple missed treatments can be fatal. Dialysis is not optional, it replaces failed kidney function keeping you alive.
Low blood pressure during treatment (dizziness, nausea, cramping), Vascular access problems (clotting, infection, stenosis requiring interventions), Infections (especially catheter-related bloodstream infections), Anaemia (treated with erythropoietin injections), Bone disease (kidney failure and dialysis affect bone metabolism), Cardiovascular disease (heart disease, stroke, leading cause of death in dialysis patients), Malnutrition (dietary restrictions, poor appetite, protein loss during dialysis), Fatigue (extremely common, debilitating), Depression and anxiety (understandable given life impact).
Honestly, no. Most dialysis patients feel chronically unwell, fatigue, weakness, poor appetite, nausea, itching, muscle cramps, difficulty concentrating. Treatment days are particularly draining. Dialysis sustains life but doesn't restore normal kidney function (kidneys work 24/7, dialysis 12 hours weekly). Most patients describe significantly reduced quality of life compared to before kidney failure. However, you adjust to "new normal," and good days are possible.
Peritoneal dialysis (different type using abdomen's lining as filter) is home-based treatment performed daily. Some patients prefer peritoneal dialysis, more flexibility, fewer dietary restrictions, no needles. However, requires manual dexterity, suitable home environment, and motivation performing treatment independently. Botshilu offers haemodialysis; peritoneal dialysis requires referral to nephrologists offering home dialysis programmes. Not everyone is suitable candidate for peritoneal dialysis.
Dialysis is life-sustaining treatment, not cure. Some patients, particularly elderly with multiple serious illnesses, choose conservative management (treating symptoms without dialysis). Without dialysis, kidney failure progresses causing uraemia (toxin accumulation), fluid overload, death within days-weeks. This is legitimate choice when quality of life on dialysis would be unacceptable or life expectancy very limited regardless. Palliative care supports patients choosing conservative management. This is deeply personal decision requiring discussion with nephrologist and family.
Depends on cause of kidney failure. Acute kidney injury (sudden kidney failure from infection, medications, dehydration) sometimes recovers, dialysis is temporary. Chronic kidney disease (gradual irreversible kidney damage from diabetes, hypertension, glomerulonephritis) doesn't recover, dialysis is permanent unless transplanted. Your nephrologist will explain whether your kidney failure is potentially reversible or permanent.
Yes, you can discontinue dialysis anytime (it's your choice). However, stopping dialysis when kidneys haven't recovered is fatal, death occurs within days-weeks. Some patients choose to stop dialysis when quality of life becomes unacceptable, other illnesses make continued treatment futile, or they're simply ready to die. This requires serious discussion with nephrologist, family, and often palliative care team. Starting dialysis doesn't mean you're committed forever, but stopping has profound consequences.
Ideally, plan ahead. When chronic kidney disease progresses, nephrologist monitors kidney function predicting when dialysis will be needed (usually eGFR under 10-15ml/min). Vascular access created months before needed (fistula takes 3-6 months maturing), Dialysis education (classes explaining treatment, lifestyle changes, diet), Choosing dialysis modality (haemodialysis vs. peritoneal dialysis), Psychological preparation (huge life change), Financial arrangements (confirming medical aid coverage), Social support (arranging transport, emotional support). Unfortunately, many patients start dialysis emergently without preparation, much more difficult.
At Botshilu's renal dialysis unit in the hospital. You'll have consistent treatment schedule (same days, similar times). Consistency in staff, surroundings, and routine helps adjustment.
Yes. Family can sit with you during treatment (space permitting). However, 4-5 hours is long time, many patients prefer family drop them off and collect them afterwards. Some patients appreciate company, others prefer quiet time.
Yes. Dialysis units have multiple patients treated simultaneously in shared space (individual recliners/chairs separated by curtains or space). Some patients find community with fellow patients supportive, shared experience creates bonds. Others find it confronting seeing others' struggles.