Evidence-based practical guide · As of August 2026
Living with kidney disease
Orientation from chronic kidney disease to transplantation – for patients and the people around them. What to watch for? How to prevent? What to ask at the next appointment? When to act immediately?
Urgent and emergency card
When to act immediately
Severe breathlessness, chest pain, confusion
Also with a seizure, fainting or barely any urine together with a clear deterioration: call 911. Take your medication list and your kidney or dialysis card with you.
PD: cloudy drain bag
Call your PD centre immediately – even without pain or fever. Keep the bag for testing and do not postpone treatment.
HD: the shunt has no thrill or bleeds heavily
No thrill: contact your dialysis centre immediately. Heavy bleeding: press a small clean pad directly on the spot, call 911 and keep the pressure on – do not put a tourniquet around the arm.
After a transplant: fever or less urine
Also with pain over the graft, rapid weight gain or a missed dose of immunosuppression: contact your transplant centre the same day. Rejection can occur without symptoms – never skip your check-ups.
Good to know
The five most important points up front
The trend matters, not a single value
eGFR and urine albumin have to be judged together with cause, trend, blood pressure and symptoms. “15 percent kidney function” is an everyday approximation, not an exact measurement.
Dialysis starts on the clinical picture
A low eGFR alone does not determine the start. What counts are uraemic symptoms, fluid overload, dangerous electrolyte disturbances and progressive malnutrition.
Plan early, keep options open
Transplant assessment, dialysis training and access planning should begin before an emergency situation arises.
PD and HD are different ways of living
Both can work medically. What decides is suitability, daily life, independence, support and personal goals – not the idea that one modality is better for everyone.
A transplant is treatment, not a cure
For suitable people usually the preferred kidney replacement therapy – but it requires lifelong follow-up, reliable immunosuppression, infection protection and cancer screening.
Classification
The GFR stages at a glance
CKD is described by cause, GFR category and albuminuria. The eGFR is an estimate – a single low value is not yet a chronic diagnosis.
eGFR in ml/min/1.73 m² · Classification per KDIGO 2024. On top of that comes the albuminuria category A1–A3 (urine albumin/creatinine ratio).
The guide in five chapters
Read the chapter that fits you right now
Reading tip: the emergency card first, then your own current chapter. Every chapter closes with the questions that help at your next appointment.
General information
What the kidneys do, eGFR and albuminuria, common causes, nutrition without a one-size-fits-all diet, medication and vaccination.
Predialysis
Plan by risk, compare all treatment paths, prepare access and transplantation in time, conservative care as an option.
Peritoneal dialysis
CAPD, APD and assisted PD, catheter and training, daily self-checks, spotting peritonitis early, everyday life and travel.
Hemodialysis
In-centre, home and nocturnal HD, vascular access, daily shunt checks, what to do before, during and after treatment.
Kidney transplantation
Assessment and the waiting list, living donation, immunosuppression, recognising rejection, long-term follow-up.
Important note
This guide does not replace a personal diagnosis, prescription or emergency care. Never change fluid, nutrition, dialysis or immunosuppression on your own. With severe symptoms call 911. It builds on international and German guidelines – among them KDIGO, ISPD, AWMF/DGfN and the German Medical Association's transplantation guideline – researched as of 26 August 2026.