Stage 5 chronic renal failure is reached when the glomerular filtration rate is less than 15% of the normal, creatinine clearance is less than 10 mL per minute, and uremia is present.

When the person is healthy, the kidneys maintain the body's internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulphate).

Erythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation.

[2] Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a dialyzer, that contains a semipermeable membrane.

The dialysis solution has levels of minerals like potassium and calcium that are similar to their natural concentration in healthy blood.

In peritoneal dialysis, wastes and water are removed from the blood inside the body using the peritoneum as a natural semipermeable membrane.

Waste and excess water move from the blood, across the visceral peritoneum due to its large surface area and into a special dialysis solution, called dialysate, in the peritoneal cavity within the abdomen.

This pressure gradient causes water and dissolved solutes to move from blood to dialysate and allows the removal of several litres of excess fluid during a typical 4-hour treatment.

A pressure gradient is applied; as a result, water moves across the very permeable membrane rapidly, "dragging" along with it many dissolved substances, including ones with large molecular weights, which are not cleared as well by hemodialysis.

Salts and water lost from the blood during this process are replaced with a "substitution fluid" that is infused into the extracorporeal circuit during the treatment.

[14][15] An alternative approach utilizes the ingestion of 1 to 1.5 liters of non-absorbable solutions of polyethylene glycol or mannitol every fourth hour.

Pain and discomfort have been reduced with the use of chronic internal jugular venous catheters and anesthetic creams for fistula puncture.

[32] Biocompatible synthetic membranes, specific small size material dialyzers and new low extra-corporeal volume tubing have been developed for young infants.

[33] In children, hemodialysis must be individualized and viewed as an "integrated therapy" that considers their long-term exposure to chronic renal failure treatment.

Dialysis is seen only as a temporary measure for children compared with renal transplantation because this enables the best chance of rehabilitation in terms of educational and psychosocial functioning.

[23] For people who need to travel to dialysis centres, patient transport services are generally provided without charge.

Cornwall Clinical Commissioning Group proposed to restrict this provision to people who did not have specific medical or financial reasons in 2018 but changed their minds after a campaign led by Kidney Care UK and decided to fund transport for people requiring dialysis three times a week for a minimum or six times a month for a minimum of three months.

Among these are preferring hospitals as a way of getting regular social contact, being concerned about necessary changes to their homes and their family members becoming carers.

[36][38] Other reasons include a lack of motivation, doubting abilities for self-managed treatment, and not having suitable housing or support at home.

Kidney disease is the ninth leading cause of death, and the U.S. has one of the highest mortality rates for dialysis care in the industrialized world.

[46] The Chinese Government is trying to increase the amount of peritoneal dialysis taking place to meet the needs of the nation's individuals with Chronic Kidney Disease.

[50] The remote Central Australian town of Alice Springs, despite having a population of approximately 25000, has the largest dialysis unit in the Southern Hemisphere.

[51] Many people must move to Alice Springs from remote Indigenous communities to access health services such as haemodialysis, which results in housing shortages, overcrowding, and poor living conditions.

[53] A Dutch doctor, Willem Johan Kolff, constructed the first working dialyzer in 1943 during the Nazi occupation of the Netherlands.

Then, in 1945, a 67-year-old comatose woman regained consciousness following 11 hours of hemodialysis with the dialyzer and lived for another seven years before dying from an unrelated condition.

Unlike Kolff's rotating drum, Murray's machine used fixed flat plates, more like modern designs.

[56] Nils Alwall of Lund University in Sweden modified a similar construction to the Kolff dialysis machine by enclosing it inside a stainless steel canister.

This allowed the removal of fluids, by applying a negative pressure to the outside canister, thus making it the first truly practical device for hemodialysis.