The term kidney failure surgery can be confusing because there is no single operation that repairs every case of kidney failure.

When kidney function is severely reduced, treatment is usually planned around kidney replacement therapy or supportive management. The main kidney replacement options are hemodialysis, peritoneal dialysis and kidney transplantation. Conservative kidney management is another option for selected patients who do not undergo dialysis or transplant.

Surgery can become an important part of treatment in several situations. For example, a person preparing for hemodialysis may need surgery to create vascular access, while a suitable candidate for transplantation may undergo kidney transplant surgery.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides specialist evaluation and treatment planning for patients with advanced kidney disease and kidney failure.

What Does Kidney Failure Mean?

Kidney failure occurs when the kidneys have lost most of their ability to perform their normal functions. NIDDK describes kidney failure as kidney function below about 15% of normal. Waste products and excess fluid can then accumulate in the body.

The kidneys normally help:

• Remove waste products

• Control fluid balance

• Regulate electrolytes

• Help control blood pressure

• Support red blood cell production

• Maintain bone and mineral balance

When kidney function becomes severely impaired, treatment needs to replace some of these functions or focus on symptom control and quality of life.

What Types of Surgery Are Associated With Kidney Failure?

Depending on the patient's condition, surgery may be involved in:

Dialysis Access Surgery

Patients who require long-term hemodialysis may need an operation to create an arteriovenous fistula (AV fistula) or, when appropriate, an AV graft.

Peritoneal Dialysis Catheter Placement

A catheter is surgically placed into the abdomen so that peritoneal dialysis can be performed.

Kidney Transplant Surgery

A healthy donor kidney is surgically implanted into a suitable recipient.

Other Procedures for Complications

Some patients with kidney failure may require procedures to address complications or associated conditions, although these are not necessarily treatments for kidney failure itself.

The appropriate approach depends on kidney function, symptoms, overall health and the patient's preferred treatment pathway.

Kidney Failure and Dialysis Access Surgery

For people who will require hemodialysis, preparing an appropriate vascular access can be an important step.

An AV fistula is created by surgically connecting an artery to a vein, usually in the arm. Over time, the vein becomes stronger and larger, allowing repeated needle access for dialysis.

An AV graft uses a synthetic tube to connect an artery and vein when a fistula is not suitable.

A temporary venous catheter may be used when dialysis must begin urgently or permanent access has not matured.

Why Is Early Access Planning Important?

A fistula requires time to mature before it can usually be used for regular dialysis.

Early planning may therefore reduce the likelihood of needing to begin long-term hemodialysis through a temporary catheter. NIDDK notes that an AV fistula may require several months to mature, while an AV graft generally matures more quickly.

The timing of access surgery should be individualized by the nephrology and surgical teams.

What Happens During AV Fistula Surgery?

The procedure generally involves connecting an artery to a nearby vein.

The increased blood flow causes the vein to enlarge and strengthen over time.

After surgery, the access needs to be monitored for:

• Blood flow

• Swelling

• Bleeding

• Infection

• Clotting

• Signs of poor maturation

The healthcare team may teach the patient how to protect the access arm.

A mature fistula can then provide vascular access for hemodialysis.

What Is Peritoneal Dialysis Catheter Surgery?

Peritoneal dialysis uses the lining of the abdomen as a filtering membrane.

A peritoneal dialysis catheter is placed into the abdominal cavity so dialysis fluid can be introduced and drained.

This can allow selected patients to perform dialysis at home rather than receiving conventional in-center hemodialysis.

Catheter placement is a procedure rather than a surgery that repairs the kidneys themselves.

The choice between hemodialysis and peritoneal dialysis depends on medical suitability, lifestyle, home circumstances, training requirements and patient preference.

Kidney Transplant Surgery for Kidney Failure

For an appropriately selected patient, kidney transplantation is a major treatment option for kidney failure.

During transplant surgery, a healthy donor kidney is placed into the recipient's body and connected to the blood vessels and urinary tract.

The transplanted kidney can then perform the filtration work that the failed kidneys can no longer adequately perform.

A transplanted kidney may come from:

• A living donor

• A deceased donor

The transplant team performs extensive medical evaluation before surgery to determine whether transplantation is appropriate.

Does Kidney Transplant Surgery Remove the Failed Kidneys?

Usually, the patient's original kidneys are not automatically removed during a kidney transplant.

The donor kidney is generally placed in the lower abdomen and connected to the recipient's blood vessels and bladder.

The original kidneys may remain unless there is a specific reason to remove them, such as recurrent infection, uncontrolled high blood pressure, certain cancers or other clinical problems.

This is one reason kidney transplant surgery is different from simply removing damaged kidneys.

Who May Be Considered for Kidney Transplant Surgery?

Not everyone with kidney failure is automatically eligible for transplantation.

A transplant center evaluates factors such as:

• Overall health

• Heart and blood-vessel health

• Other serious medical conditions

• Infection risk

• Cancer history

• Ability to undergo major surgery

• Ability to take long-term anti-rejection medicines

• Donor availability

A transplant evaluation can include blood tests, imaging and assessments of the heart and other organs.

For selected patients, transplant evaluation can begin before dialysis becomes necessary.

Can Kidney Transplant Be Done Before Dialysis?

Yes, in appropriately selected patients.

This is known as a preemptive kidney transplant.

Early referral allows time for transplant evaluation and donor assessment before kidney function deteriorates to the point where dialysis is required.

NIDDK notes that a transplant center may place an eligible patient on a waiting list when kidney function is 20 or less, even if the person has not yet started dialysis.

Whether preemptive transplantation is possible depends on the patient's medical situation and donor availability.

What Tests Are Done Before Kidney Failure Surgery?

Before a major procedure, the medical team may assess:

Kidney-Related Tests

• Creatinine

• eGFR

• Urea

• Electrolytes

• Urine testing

Blood Tests

• Complete blood count

• Blood group

• Blood chemistry

• Infection screening

• Other tests based on the planned procedure

Heart and General Health Assessment

Depending on age and medical history, evaluation may include:

• ECG

• Echocardiography

• Cardiac assessment

• Chest imaging

• Other preoperative investigations

For transplant candidates, the evaluation is generally more extensive because transplantation involves lifelong follow-up and immunosuppressive therapy.

Is Kidney Failure Surgery Always Necessary?

No.

Kidney failure does not automatically mean that surgery is required immediately.

For example:

• Some patients may be managed with hemodialysis.

• Some may choose peritoneal dialysis.

• Some suitable patients may undergo transplantation.

• Selected patients may receive conservative kidney management without dialysis or transplant.

The appropriate treatment depends on the severity of kidney failure, symptoms, complications, overall health and patient preferences.

What Are the Risks of Kidney Failure-Related Surgery?

The risks depend strongly on the procedure.

Dialysis Access Procedures

Potential complications include:

• Infection

• Bleeding

• Blood clots

• Poor blood flow

• Failure of the access to mature

• Need for revision or another procedure

Kidney Transplant Surgery

Potential complications can include:

• Bleeding

• Infection

• Blood-vessel complications

• Urinary complications

• Delayed kidney function

• Rejection

• Side effects from anti-rejection medicines

Transplant recipients require ongoing medical monitoring because transplantation is a long-term treatment rather than a one-time cure.

What Is Recovery Like After Kidney Transplant Surgery?

Recovery varies from patient to patient.

After transplantation, the medical team monitors:

• Kidney function

• Urine production

• Creatinine

• Fluid balance

• Blood pressure

• Medication levels

• Signs of infection

• Possible rejection

Some transplanted kidneys begin working immediately, while others may take longer to function. Temporary dialysis may occasionally be needed while a new kidney begins working.

Patients must take prescribed anti-rejection medicines and attend regular follow-up appointments.

Can Kidney Failure Be Treated Without Surgery?

Yes.

Depending on the clinical situation, kidney failure may be managed with:

Hemodialysis

Blood passes through a dialysis filter to remove waste and excess fluid.

Peritoneal Dialysis

The abdominal lining is used to help filter waste and extra fluid.

Conservative Kidney Management

Some patients may choose treatment focused on symptom control and quality of life without dialysis or transplantation.

The decision should be made through discussion with the kidney-care team.

When Is Emergency Treatment Needed?

Kidney failure can become medically serious when complications develop.

Urgent medical assessment may be necessary for symptoms such as:

• Severe breathlessness

• Chest pain

• Confusion

• Very little or no urine

• Severe swelling

• Persistent vomiting

• Severe weakness

• Rapid deterioration

These symptoms can be associated with complications of advanced kidney dysfunction and should not be managed through home remedies.

Does Kidney Failure Surgery Restore the Original Kidneys?

Most kidney failure-related procedures do not repair the original damaged kidneys.

For example, an AV fistula provides access for dialysis, while a peritoneal dialysis catheter enables peritoneal dialysis.

A kidney transplant provides a functioning donor kidney, but the original kidneys generally remain in place unless there is a specific reason for their removal.

Therefore, it is more accurate to think of these procedures as ways to provide or support kidney replacement therapy, rather than operations that directly repair established kidney failure.

How Can Kidney Failure Surgery Be Planned in Advance?

Early planning can make treatment transitions more organized.

For patients whose kidney function is progressively declining, planning may involve:

• Discussing dialysis choices

• Evaluating suitability for kidney transplantation

• Planning vascular access

• Discussing peritoneal dialysis

• Reviewing medications

• Assessing nutrition

• Managing blood pressure and diabetes

• Preparing for possible kidney replacement therapy

NIDDK recommends early education and preparation for kidney replacement therapy in people approaching kidney failure.

Kidney Failure Treatment at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized evaluation and treatment planning for patients with advanced kidney disease.

Depending on the patient's condition, care may include:

• Assessment of kidney failure

• Review of creatinine and eGFR trends

• Dialysis planning

• Hemodialysis-related evaluation

• Peritoneal dialysis planning

• Dialysis access coordination

• Kidney transplant evaluation

• Management of complications of advanced CKD

• Preoperative medical assessment

• Long-term post-transplant kidney care

• Coordination with appropriate surgical and transplant teams

The treatment pathway is selected according to kidney function, medical condition, suitability for transplantation or dialysis, and the patient's goals.

Frequently Asked Questions

Is there a surgery that can cure kidney failure?

There is no routine surgery that repairs established kidney failure. Kidney transplantation can provide a functioning donor kidney for appropriately selected patients, while dialysis replaces some kidney functions.

Is dialysis considered a surgery?

Dialysis itself is a treatment rather than a surgery. However, hemodialysis generally requires vascular access, which may involve a surgical procedure such as AV fistula creation.

What surgery is done before hemodialysis?

An AV fistula or AV graft may be created to provide durable vascular access. A temporary catheter may be used when dialysis must begin urgently.

Is kidney transplant a major surgery?

Yes. Kidney transplantation is a major surgical procedure requiring preoperative assessment, hospitalization, lifelong anti-rejection medicines and regular follow-up.

Can a kidney transplant be done before dialysis?

Yes, selected patients may receive a preemptive kidney transplant before dialysis. Eligibility and donor availability determine whether this is possible.

Are failed kidneys removed during transplant?

Usually not. The original kidneys are generally left in place unless there is a specific medical reason to remove them.

Can someone with kidney failure choose not to have surgery?

Some patients may choose conservative kidney management without dialysis or transplantation, depending on their health status, treatment goals and informed discussion with their healthcare team.

Conclusion

The phrase kidney failure surgery can refer to several different procedures rather than one specific operation.

For patients approaching or living with kidney failure, surgery may be involved in creating hemodialysis vascular access, placing a peritoneal dialysis catheter, or performing a kidney transplant. These procedures serve different purposes and are selected according to the patient's kidney function, health status and treatment goals.

Kidney transplantation can provide a functioning donor kidney for appropriately selected patients, while hemodialysis and peritoneal dialysis provide alternative forms of kidney replacement therapy. Some patients may instead choose conservative kidney management.

Early discussion with a nephrologist can help patients understand their options and plan treatment before an emergency situation develops.

For specialist assessment of kidney failure, dialysis planning and transplant-related care, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is intended for general educational and informational purposes only and should not be considered medical advice, diagnosis or treatment. There is no single surgery that cures established kidney failure. Treatment options may include hemodialysis, peritoneal dialysis, kidney transplantation or conservative kidney management, depending on the patient's medical condition and preferences. Dialysis access and transplant procedures have potential risks and require individualized assessment by appropriate medical and surgical specialists. Do not delay urgent medical care because of information in this article. Seek immediate medical attention for severe breathlessness, chest pain, confusion, very little or no urine, severe swelling, persistent vomiting or rapidly worsening symptoms. Consult Dr. Sandip Prabhakar Bhurke or another qualified nephrologist for personalized evaluation and treatment planning.