Kidney disease [1] takes many different forms and may lead to kidney failure. Although there are ways to treat people with kidney failure—namely dialysis [2]or kidney transplant [3]—these treatments are not actual cures for kidney disease.

When kidneys function properly, they remove excess fluid, minerals and wastes from the body. The kidneys also produce hormones that keep bones and blood healthy. When kidneys are not working properly, wastes build up in the body, which can affect many vital functions such as blood pressure, red blood cell production, platelet function, bone health and—important for children—growth. People whose kidney function has declined need treatment to overcome some of the consequences of kidney failure.

Dialysis [2] is one treatment method that can replace part of the kidneys’ tasks. “Chronic” dialysis (or “renal replacement therapy”) becomes necessary when the kidney function has deteriorated to less than 15% of normal. This stage is often called “endstage renal disease” or ESRD. There are two types of dialysis. Hemodialysis uses a machine to clean and filter a person’s blood by removing wastes, excess salt and water from the body. It is usually performed in a hospital or dialysis unit, at least three times a week over 4 hours, but substantially longer in small children. The second method is called peritoneal dialysis. It also removes wastes, excess minerals and water, however, it is done via the peritoneal lining of the abdomen to filter the blood. This is done over 8 to 12 hours every night of the week at home.

The preferred option for treating endstage kidney failure is kidney transplantation [3], which involves the surgical placement of a healthy kidney from a donor. Humans can live with a single kidney; receiving a healthy kidney graft means a return to nearly normal kidney function for many transplant recipients.

The decision to have dialysis or a transplant—or both, since dialysis is often necessary to bridge the time to transplantation—depends on many different factors. Children who are still growing fare better with a functioning graft than with chronic dialysis. If your child is being considered for these types of treatments, the doctors, nurses and other healthcare professionals of the pediatric nephrology team [4] will guide you through the process.