What should I ask my renal team before agreeing to dialysis or transplantation? 

Deciding between dialysis and transplantation or choosing a specific type of dialysis is one of the most significant decisions you will make in your kidney care journey. In the UK, the NHS promotes a “Shared Decision-Making” model, ensuring that “no decision is made about you, without you.” To help you navigate this process, it is essential to ask your renal team targeted questions that cover clinical outcomes, lifestyle impacts, and long-term expectations. 

The choices you make now will define your daily routine for years to come. Whether you are considering hospital-based haemodialysis, home therapies, or the transplant waiting list, your renal multi-disciplinary team (MDT) is there to provide tailored information. This guide provides a framework of questions to ensure you have all the facts before giving your informed consent. 

What We Will Discuss in This Article 

• Key questions about different dialysis modalities (Haemo vs. Peritoneal) 

• Understanding the transplant assessment and “work-up” process 

• Questions regarding the risks and success rates of surgery 

• The impact of each treatment on work, travel, and diet 

• Exploring “Conservative Care” as an alternative pathway 

• Practical questions about vascular access and surgical recovery 

• How to use the “Ask 3 Questions” technique during your consultation 

Questions about starting dialysis 

If your kidney function is declining, dialysis may soon be necessary to take over the work of your kidneys. It is vital to understand that dialysis is not a one-size-fits-all treatment. In the UK, you typically have choices between clinic-based haemodialysis and home-based options. 

Key questions for your dialysis nurse or consultant: 

• What are my options? Am I medically suitable for both haemodialysis and peritoneal dialysis? 

• How will this affect my life? How many hours a week will I spend on treatment, and can I still work? 

• Where will I have it? Is there a dialysis unit near my home, or can I do this myself at home? 

• What about access? What is the difference between an AV fistula and a neck line (catheter), and which is best for me? 

• What if I change my mind? Can I switch from peritoneal dialysis to haemodialysis later if my circumstances change? 

Questions about kidney transplantation 

For many, a transplant is the “gold standard” treatment, but it involves major surgery and a lifelong commitment to medication. The assessment process (the “work-up”) is thorough and can take several months. 

Key questions for your transplant coordinator: 

• Am I suitable? What tests do I need to undergo to see if I am fit enough for the operation? 

• How long is the wait? What is the average waiting time for my blood group in the UK? 

• What are the risks? What are the chances of the kidney not working, and what are the main surgical risks for someone with my health history? 

• What about living donation? If a friend or family member wants to donate, how does that process start? 

• What medicines will I need? What are the long-term side effects of the anti-rejection drugs I’ll have to take? 

Differentiation: Dialysis vs. Transplantation 

It is helpful to ask your doctor to differentiate between the two pathways based on your personal health goals. While transplantation generally offers a longer life expectancy, it carries different risks than dialysis. 

Treatment Factor	Haemodialysis (Clinic)	Peritoneal Dialysis (Home)	Kidney Transplant
Primary Goal	Life-support; waste removal	Life-support; waste removal	Restoration of kidney function
Daily Freedom	Fixed hospital sessions	High (performed at home)	Full freedom from machines
Diet & Fluid	Strict restrictions	Often more relaxed	Near-normal diet
Surgery Need	Minor (for access)	Minor (for catheter)	Major abdominal surgery
Longevity	Lifelong (or until transplant)	Lifelong (or until transplant)	10–20+ years on average

Triggers for lifestyle adjustments 

Your lifestyle will change regardless of the treatment you choose. Asking about specific “triggers” can help you prepare mentally and practically for the transition. 

• Work: ‘What adjustments will I need at work, and when can I return to full duties after a transplant?’ 

• Travel: ‘How do I arrange “dialysis away from base” for a holiday, and can I travel abroad while on the transplant list?’ 

• Diet: ‘Will I need to see a renal dietitian, and what are the main triggers for potassium or phosphate buildup in my current diet?’ 

• Emergency: ‘What are the triggers for me to call the renal unit immediately (e.g., fever, weight gain, or access pain)?’ 

My final conclusion 

The most important step in choosing a renal treatment is ensuring you feel heard and informed. By asking these questions, you take control of your healthcare journey. Remember that your renal team including doctors, nurses, dietitians, and social workers are there to support you. There are no “silly” questions when it comes to your health and your future. 

If you experience severe, sudden, or worsening symptoms, such as sudden chest pain, extreme breathlessness, or a total inability to pass urine, call 999 immediately. 

Authority Snapshot 

This article was written by Dr. Stefan Brincat, a Consultant Nephrologist at St George’s University Hospital NHS Foundation Trust in London. Dr. Brincat has extensive experience in managing advanced kidney disease and guiding patients through the complex decision-making process for dialysis and transplantation. His work at St George’s ensures that this guide is aligned with current UK clinical pathways and patient-centred care standards.