Written or medically reviewed by a board-certified physician. See About.com's Medical Review Policy.

Updated September 08, 2014.

One of the greatest fear that newly diagnosed patients with kidney disease have is the fear of impending dialysis (unless they have opted to manage their kidney disease conservatively without dialysis). They worry about its impact on not just their health, but also on their social life, their ability to work and make a living, and implications for their family. With these extremely pertinent issues raging in the mind of a typical patient with advancing Chronic Kidney Disease (CKD), most patients will inevitably try to put dialysis off as long as possible.


The million dollar question patients have at the diagnosis of advanced CKD is how much time they have until they will definitely need to start dialysis. 

IS IT POSSIBLE TO PREDICT HOW LONG YOU HAVE BEFORE DIALYSIS BECOMES NECESSARY

So, does science give us any crystal ball that your nephrologist could gaze into and say, "Mr. X, you could expect to be on dialysis in 3 years"! Or is dialysis that Damocles Sword of eternal peril? Being able to reasonably answer this question is important for multiple reasons. Patients need a timeline to plan their lives. Their families needs to know what to expect. And very importantly, the nephrologist utilizes this crucial information to manage the kidney disease. For instance, if you have opted to go in for hemodialysis to support your kidney function and are expected to start dialysis within a year, it might be a good idea to have a permanent dialysis access (called a "fistula") put in. Hence, being able to predict the rate of decline in kidney function up to the point when dialysis will become unavoidable is paramount.

 

Like most other things in Nephrology, unfortunately there is no simple and straight answer to this question. The rate at which your kidney function will decline, and in the worst case scenario, get to the point where dialysis is required depends on multiple factors. We now have a pretty good idea of what these factors are, thanks to a recent analysis from a study done in Canada, and other older studies (the details of which can be found here and here). These factors are:

• Patient's age (older people could have higher risk)
• Patient's sex 
• Ethnicity (African Americans for instance have a higher risk)
• Individual genetic/family history
• The GFR at the time of diagnosis (lower GFR, or higher CKD stages are associated with higher risk)
• Amount of protein in the urine (albuminuria) - high is bad 
• Blood levels of calcium, phosphate, bicarbonate, and albumin 
• Socioeconomic status 
• Other coexistent illnesses like diabetes, heart disease, liver disease, etc
• Episodes of Acute Kidney Injury (AKI)
• Cause of kidney disease - diabetic kidney disease might decline faster than kidney disease purely from old-age related kidney scarring 

As you might imagine, these factors are very variable in each patient, thus making the prediction of onset of end stage kidney disease (requiring dialysis) difficult. Which is why you might not always get a straight answer from your nephrologist! What can be deduced is that a higher number of adverse factors could be concerning news for patients. As a nephrologist, I tend to follow up these patients more closely and trend their kidney function every few months. 

NOT ALL PATIENTS DIAGNOSED WITH KIDNEY DISEASE WILL DECLINE TO THE POINT WHERE THEY NEED DIALYSIS

An important, and reassuring point that needs to be kept in mind is that progression to end stage kidney disease, or CKD 5, in spite of the above mentioned factors is the exception and not the norm. Only a minority of early stage CKD stage 1-4 patients will in fact get to the point where they need dialysis. Let me give you an objective idea about this. As per the most reliable statistics (details here and here) that we have available at this time, only about 1.5% CKD stage 1-4 patients per year will progress to stage 5 and need dialysis. Aggressive treatment and risk factor modification by a good nephrologist could make the difference between you being a part of that 1.5%, or not.