Both kidneys have to fail for a patient to develop “Kidney Failure” since one normal kidney can perform the work of two kidneys. The kidneys have a number of functions. They get rid of excess fluids in the body so that the fluids we drink do not accumulate in the body. Fluids that accumulate in the body can cause swelling of the legs and abdomen and can enter the lungs causing shortness of breath. Accumulation of fluids in the bloodstream can also result in very high blood pressure.

The other major function of the kidneys is to filter out substances that are produced by the breakdown of foods we eat, and by our normal body metabolism. Many of these substances have adverse effects and are actually toxic. These are called uremic toxins. If they are not filtered out adequately, these toxins accumulate in the blood and tissues. As they build up in the body they can cause nausea, vomiting, itching, drowsiness, and twitching movements. If untreated by dialysis, these uremic toxins reach very high levels and can eventually result in coma and death.

There are 2 types of dialysis. One is where the patient’s blood is pumped by machine into a filter where excess water and uremic toxins are removed (“hemodialysis”). This is usually performed 3 days a week (3-4 hours per day) in a dialysis center, although it can be performed in a patient’s home as well. The other type is where sterile solutions are instilled into the abdomen and then drained. This process also removes the excess fluid and the uremic toxins (“Peritoneal Dialysis”). This process is performed repeatedly, every day at home or at work. Peritoneal dialysis can also be performed at night during sleep so that all days are free (“Automated or Cyclic Peritoneal Dialysis”).

Either type of dialysis - hemodialysis, or peritoneal dialysis - does the job of keeping the patient safe, and allows the patient to carry out his or her normal activities, including employment.

Lower Manhattan Dialysis offers all of the various dialysis options, so that you can choose what best fits your lifestyle: In-center hemodialysis, home hemodialysis, home peritoneal dialysis, or night cyclic peritoneal dialysis.

This is a very important question. The timing of when to start dialysis is not an exact science. It has been shown in medical studies that there is no advantage to starting patients on dialysis early before they actually need it. Unfortunately, many patients are advised to start dialysis prematurely. On the other hand, if dialysis is delayed too long it can be very dangerous. If the start of dialysis is delayed too long, patients can suffer from uremic symptoms as noted previously, such as nausea and vomiting, total body itching, severe shortness of breath, severe lethargy, and even convulsions and coma, and eventual death. And, the build-up of chemicals such as potassium could result in sudden death, often without any warning signs or symptoms.

The patient’s nephrologist has to balance all these issues and recommend a start date for dialysis for each individual patient.

If a patient has kidney disease but doesn’t yet need dialysis, he or she may want to see a nephrologist with special expertise in dialysis since there are a number of medical treatments that have been shown to slow down the course of kidney failure so that the need for dialysis may be postponed for many months and even years in some cases. Studies have shown that patients with chronic kidney disease have better outcomes if they are referred to a nephrologist early.

If a patient has been told that the need for dialysis is getting closer, that patient might want to seek a consultation or a second opinion from one of our expert nephrologists.

Schedule a consultation with our Expert Nephrologists

Kidney transplantation remains the best alternative for end-stage renal disease for those patients who are eligible. Most patients are eligible. Very elderly patients or those with multiple or severe medical problems such as cancer, severe heart disease, etc. might not be eligible for transplantation. At Lower Manhattan Dialysis Center, we pride ourselves in referring all our eligible patients for transplantation as quickly as possible, and we have some of the highest transplantation rates in New York.

As beneficial as transplantation can be, most patients with kidney failure will tend to be on dialysis for a period of time prior to receiving a new kidney; sometimes for a period of years. This is why it is very important to seek out a dialysis center with an excellent track record in measures of life span and good health on dialysis in addition to a good transplantation record. Transplantation also has its own set of risks and complications which can at times be severe, and therefore, transplantation may not be for everyone. For many of those patients who are not interested in or are not eligible for transplantation, a good dialysis center can keep them functioning well on dialysis for long periods. In our own experience, we can proudly report that we have had some patients remain well on dialysis for over 30 years!

Choosing a dialysis center is not so easy at first glance. Many patients opt for convenience, choosing a dialysis center closest to home or choosing a dialysis facility where the patients’ nephrologists have an affiliation, or choosing a “brand new” center. However, these are not always in the patient’s best interests. Not all dialysis centers are equal.

Some dialysis centers unfortunately have been shown to have very poor results with respect to mortality and transplantation of their patients. When choosing a dialysis center, a person needs to investigate. Prior to starting dialysis treatments, a patient or his family and loved ones should do their “homework”. They should compare dialysis centers and choose those with the best outcomes rather than choose convenience.

The Lower Manhattan group of dialysis centers has a long and proven track record. Lower Manhattan Dialysis Center is owned and operated by nephrologists, rather than by a dialysis chain or a private investor. Their group of nephrologists have many years of dialysis experience and are “hands-on”, monitoring patients closely, reviewing their results, and making the proper adjustments to make sure each patient is kept as healthy as possible. Unlike most other dialysis centers, our doctors at Lower Manhattan Dialysis Center will see all of the patients on dialysis during almost every dialysis treatment. We believe that seeing patients less often can lead to poorer medical outcomes. Our impressive results with regard to transplantation and mortality statistics make Lower Manhattan Dialysis Center the number one choice for many patients.

The 2 key subjects about which one should want to know about in a center are their rates of transplantation and rates of mortality. The sooner a patient receives a kidney transplant, the sooner he or she will be off dialysis and can have a better quality of life. And, the chances of survival while one is on dialysis is obviously a key statistic of paramount importance.

At Lower Manhattan Dialysis Center, we are proud of our proven record with regard to patient care. We know that kidney transplantation is the best option for patients with end stage renal disease who are medically eligible for transplantation. In fact, we encourage all our patients who are eligible, to seek a family member or friend who might be able to donate a kidney so that the patient can quickly be freed from the need for dialysis. We can happily report that in the combined 2 year period 2021 - 2022, of our patients who received a kidney transplant, 48% had a waiting time of only a few months up to 2 years before receiving their new kidney (Average 8 ½ months waiting time.) And 38% more were transplanted by 3 years. That means that more than three quarters of our patients who were transplanted in the years 2021 to 2022 received their new kidney some time between a few months up to 3 years waiting time of starting dialysis (Average 18 months waiting time). These patients are fortunately no longer in need of dialysis and are able to return to their previous lifestyles and employment. Federal government statistics for the years 2017-2020 reveal that Lower Manhattan Dialysis Center’s standardized transplantation ratio (STR) was 229% higher than expected for our facility per Federal calculations, and 238% higher than the standardized transplantation ratio for all New York State Dialysis Centers. Perhaps even more important, as per federal reports, Lower Manhattan Dialysis Center was more likely to place their patients on a transplant waiting list in the years 2017-2020 at a rate which is 261% higher than expected! Remember, that if a dialysis center fails to list a patient for transplantation, that patient will remain on dialysis at that center forever!

Perhaps more important, a center’s statistics on mortality should be of most concern. At Lower Manhattan Dialysis Center, as reported by the federal government, our standardized mortality ratio (SMR) for the years 2017-2020 revealed that we had 25% fewer deaths than expected for our facility per Federal calculations. Further, for our patients’ first year on dialysis during the years 2017-2019, we had 70% fewer deaths than expected. We believe that these excellent results are related to the fact that we employ nephrologists who monitor our patients during almost all their dialysis treatments, unlike almost every other dialysis center in New York.

When evaluating dialysis centers, one must question statements without supporting proof. One must see proven track records of quality dialysis by reviewing actual statistics for each center. One can readily see that the quality of dialysis at a facility can make a great difference. It can translate into life or death outcomes. It can translate into freedom from dialysis vs. long term dialysis.

On the other hand, for patients who are not eligible or refuse transplantation, we are happy to report that at Lower Manhattan Dialysis Center our longest patient was on dialysis with us for 32 years! And, we have numerous patients who are still doing well on dialysis with us now for between 20 and 32 years. The key we believe is quality of dialysis and excellent medical monitoring.

Statistics say it all. At Lower Manhattan Dialysis Center, statistics reveal that we have more transplants and fewer deaths than expected as per Federal government reports! When evaluating which dialysis center one should go for treatments, a patient must choose wisely. Quality of care is far superior to convenience.

If you are eligible, home dialysis may be your best choice. Whether you are receiving Peritoneal Dialysis or Hemodialysis at home, home dialysis offers a variety of advantages over dialyzing in-center, giving a patient more freedom and flexibility to run his or her life as normally as possible without interruption to work, school, or family events. Unfortunately, many patients do not have an available or competent caregiver at home who can help with dialysis, and patients themselves may be unable to solely perform the necessary requirements of home dialysis. This is especially true for home hemodialysis. But despite this, we have been able to overcome many obstacles for our patients. Patients who never thought it would be possible are now able to receive their hemodialysis treatments in their homes.

Consultation with a nephrologist with expertise in dialysis can sometimes make a big difference to patients in various stages of kidney failure. Whether in early or late stages of kidney failure including patients who have been told that they are nearing the need for dialysis, an expert nephrologist can sometimes slow the progression of a patient’s kidney failure by prolonged periods, even years if consulted early. They may even be able to postpone the actual start of dialysis for patients who have already been told that the time has come to start dialysis. By having the progression of their kidney disease slowed, some patients will be able to receive a kidney transplant before they would have to start dialysis at all!

If you would like a second opinion, or a general consultation by one of the highly acclaimed nephrologists who are associated with Lower Manhattan Dialysis Center contact us.

Schedule a consultation with our Expert Nephrologists

1. Among the highest transplantation rates in New York State. The sooner the patient gets transplanted, the sooner the patient will be free of dialysis and go about his or her life as usual.

2. Low mortality compared to many other dialysis centers: 70% fewer deaths than expected during the first year on dialysis.

3. Excellent care during dialysis. For patients who are not eligible for transplantation or who choose not to receive transplantation: our longest patient was with us on dialysis for 32 years. And currently, we have patients who have continued with us on dialysis for 15-30 years!

LOWER MANHATTAN DIALYSIS CENTER should be your first choice no matter where you live in New York.

Statistics say it all. At Lower Manhattan Dialysis Center, statistics reveal that we have more transplants and fewer deaths than expected as per Federal Government reports! When evaluating to which dialysis center one should go for treatments, a patient should make choices based on the facts, not all dialysis centers are equal. Quality of care is far superior to convenience of location. Whether a patient lives in Manhattan, Brooklyn, Queens or the other boroughs, Lower Manhattan Dialysis Center should be a first choice.

Nutrition plays a very important role in managing Kidney Disease. The recommended diet for people who have kidney failure is low in Potassium, Sodium, and Phosphorus. Good fluid balance is important for dialysis patients – you will need to learn how much fluid to drink and how to restrict your fluid intake in order to prevent fluid overload. Your diet may also include a consistent carbohydrate level if you are diabetic or your doctor recommends that you lose weight. Some patients who are starting dialysis are in a poor nutritional state due to their chronic kidney disease and may need to improve their nutritional status. In this case, a Kidney Dietitian can provide you with a high-calorie, high-protein meal plan based on your weight, medical history, and laboratory levels.

At Lower Manhattan Dialysis Center, a Kidney Dietitian will meet with you to create a personal Dialysis Meal Plan for you, based on your medical history, body weight, and blood test results. Your individualized Dialysis Meal Plan at Lower Manhattan Dialysis Center will include your cultural food preferences and even plant-based foods if desired. The Kidney Dietitian will monitor your weight and test results, and work with you to achieve and maintain your optimal nutritional goals.