Kidney Failure Treatment

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When your kidneys no longer function adequately on their own, one of several forms of dialysis or a kidney transplant are your options. Dialysis acts as an artificial kidney that mechanically removes waste and excess fluid from the body. A kidney transplant replaces a damaged kidney with a new, healthy organ. If you are facing kidney failure -- also referred to as end-stage renal failure or end-stage renal disease (ESRD) -- and must make this choice, we help you understand your options and choose the treatment that is right for you.

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Kidney Transplantation

For those well enough to receive one, kidney transplantation is the standard of care for end-stage kidney disease. Our kidney transplant team has performed thousands of complex kidney transplants that have improved the quality of life for our patients and their loved ones.

Request an Evaluation
To be evaluated for a transplant, talk with your nephrologist about a referral. If you need assistance obtaining a referral, our transplant program coordinators are happy to help.

After we review your records, you will be scheduled for a day-long evaluation and will be assigned a pre-transplant coordinator who can answer your questions and help you arrange the tests and appointments associated with your initial evaluation. If you are a candidate, we review your transplant options -- either a kidney from a living donor or placement on the waitlist.

Our Locations

Duke Health offers kidney transplant evaluations and ongoing management of people with kidney disease at clinics in Durham and Raleigh.

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Dialysis

Duke nephrologists manage care for more than 850 people who are on dialysis, either because they are waiting for a kidney transplant, are not a good candidate for kidney transplantation, or because dialysis is the preferred treatment method. If you are considering dialysis, you have several options. We have 16 dialysis clinics in the northeastern Piedmont region of North Carolina, including Durham, Wake, Person, Vance, Warren, and Franklin counties.

Peritoneal Dialysis

Peritoneal dialysis uses your abdominal cavity as a surface for exchange of waste and fluid. A catheter is surgically implanted into the abdominal cavity. The catheter typically exits the skin just above the belt line. About two weeks after the catheter is placed, you can start being trained at the dialysis clinic to perform peritoneal dialysis on your own at home. Training usually lasts one week.

During dialysis, fluid is moved into the peritoneal cavity where wastes diffuse from the blood into the fluid, and excess fluid can be removed from the blood as well. Then the fluid is drained into a bag on the floor and a fresh volume of fluid is instilled. Usually, peritoneal dialysis is done through a machine the size of a boom box. It warms and moves the fluid in and out of the abdominal cavity while you sleep. Peritoneal dialysis is done every night and does not require a partner to be present.

In-Center Hemodialysis

Hemodialysis requires an “access point” to get the blood out of your system to the dialysis machine and then back to you. This is often a connection between an artery and vein called an AV fistula, which can be created during an outpatient, same-day procedure. These need to be created several months before dialysis is needed. The in-center hemodialysis procedure is performed for you by staff, typically three times per week for three to five hours per treatment. We offer late-day dialysis shifts at several clinics for people who continue to work.

Home Hemodialysis

With the proper training, a process similar to in-center hemodialysis can be performed at home. This makes it possible to perform dialysis at your convenience, whether at night, over a long period of time, or in shorter, more frequent treatments. Typically, home hemodialysis is done five times per week for about three hours and usually requires a partner to be present. However, additional training is available for people without a care partner, allowing them to do home hemodialysis alone.

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855-855-6484

Why Choose Duke

Nationally Recognized Leaders
Our nephrologists, transplant surgeons, vascular surgeons, and interventional radiologists are nationally recognized leaders in treating kidney failure. Our transplant center prepares you for a kidney transplant while you are on the waitlist. If you have a compatible living donor, you can schedule your surgery when you and your donor are ready. If you and your donor are not compatible, we have several options, including paired exchange which matches you and your donor to a compatible pair elsewhere.

Our Nephrologists See Patients in Dialysis Centers
If you choose in-center dialysis, our nephrologists are available throughout the region to see in-center hemodialysis patients once a week. We believe this leads to better patient care and helps to ensure our patients experience the best possible outcomes.

Videos on Chronic Kidney Disease

In this set of videos, Duke experts talk about what happens when your kidneys do not work as they should -- and options for treatment.

Watch the Videos

We Offer Several Inpatient Dialysis Options
We also offer acute dialysis services for inpatients, including continuous renal placement therapy -- a gradual method of removing fluid and wastes from the blood of patients too ill to be treated with conventional hemodialysis.

Our Team Works Together to Ensure Personalized Care
Our nephrologists, vascular surgeons, interventionists (doctors specializing in minimally invasive procedures), dialysis nurses, and sonographers (specialists in ultrasound imaging) work together to ensure you get the highest quality of personalized care.

Simpler, Safer Dialysis Vascular Access
Our vascular surgeons use advanced procedures to access blood vessels for dialysis treatment, typically using your body's natural defenses to prevent infection. Our surgeons are experts in identifying the safest locations to create surgical ports to access your blood vessels. Better access to your blood vessels helps make dialysis faster and more efficient.

You May Have Access to Our Clinical Trials
As a Duke patient, you may be eligible to participate in clinical trials that test new therapies before they become widely available.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2025–2026.

This page was medically reviewed on 07/28/2025 by

Ruediger W. Lehrich, MD | Nephrologist