Starting dialysis without a treatment plan

Sometimes, people with kidney failure from end-stage kidney disease (ESKD) or end-stage renal disease (ESRD) are put on dialysis without a treatment plan — for example, in an emergency. These are known as "crash" or unplanned starts on dialysis. This does not apply to people with acute kidney injury (AKI). 

What is a crash, emergency or unplanned dialysis start? 

A crash dialysis start is when a person with kidney failure is put on dialysis before they are able to get care from a kidney doctor (nephrologist). This means the person has not been able to talk with a kidney doctor, have their questions fully answered or decide on a treatment plan.  

An emergency dialysis start is when a person needs hospital care and is put on dialysis due to life-threatening kidney failure.  

An unplanned dialysis start is when a person with kidney failure is put on dialysis without knowing about or planning for dialysis. It often starts during a hospital stay. 

People with these types of dialysis starts may not have known they had kidney disease. 

What are the next steps? 

If you have a crash or unplanned start on dialysis, you are probably scared and wondering what comes next. It can be hard to think or make decisions when you are not feeling well and have this unexpected treatment. However, there are steps you and your loved ones can take to make a plan that is right for you. 

Partner with your doctor and health care team 

You are the most important member of your health care team. You can: 

• Work with your doctor to find the cause of your kidney disease  
• Talk with your doctor about your family health history, which may give your doctor clues about what caused your kidney disease 
• Ask about your treatment options, including a kidney transplant 
• Ask your questions and share your concerns – see the Kidney Patients' Rights to help feel more confident about talking with your doctors 

Learn about kidney disease and treatment 

Learning more can improve your health and your confidence: 

• Ask your healthcare team for information and resources 
• Search online for information about kidney disease, treatment options and support services 
• Use our First 30 checklist and videos to help you ask questions and adjust to being on dialysis 

Tell your family and friends you need their support 

Some kidney diseases run in families, which means your blood relatives may have a higher chance of also having kidney disease. Tell your family about your new diagnosis and encourage them to talk with their doctor about their chance of kidney disease. 

Ask your family and friends to: 

• Help you think of questions to ask your doctors and health care team 
• Write notes about what your care team tells you 
• Figure out a plan for your care when you return home 

Talk with your doctor about your mental health 

It can be hard to handle the stress and challenges that come with kidney disease and an unplanned dialysis start. Just as you care for your physical health, it is important to care for your mental health. The good news is you are not alone. Talk with your doctor about your feelings. They can connect you with resources available to help you, such as a social worker. 

Learn more about mental health and kidney disease and find resources. 

What does the future hold?  

There is no cure for kidney disease, and the damage to your kidneys cannot be reversed. The good news is you can slow the damage to your kidneys by having a treatment plan, following a kidney-friendly eating plan and staying active. 

Learn all you can about your kidney disease to help feel more in control, such as: 

• A kidney transplant, which can mean a chance at a longer and healthier life without dialysis 
• Insurance and costs for dialysis 
• Tips for working with your doctor to find a cause