A few years ago, my friend Donald donated his dad one of his kidneys. While of course donating a kidney to a living relative who is a match and needs one seems an obvious choice, it might raise concern depending on what the need for transplant was—will the donor, too, find him or herself in need of a kidney down the road and also needing a donor? Today is World Kidney Day: what do you know about kidney disease, kidney donation, and transplant—and of course, about what your kidneys do!
What do the kidneys do?
A lot of what we eat and drink is not completely used up by the body. The kidneys are responsible for filtering out excess water, salt, and waste products from our blood . The excess water and wastes becomes urine. Hydration is important for kidney health, because the less concentrated blood is (more water), the easier it flows through the parts of the kidney that filter wastes out.
What is kidney disease?
Kidney disease ranges from mild to severe.  Most kidney diseases, according to the Kidney Foundation of Canada, affect the nephrons—the part of the kidney that filters wastes out of the blood. Kidney disease can be caused by a number of things, such as autoimmune disease, transplant of another organ, infection or repeated infection, or poorly controlled diabetes. Kidney disease may progress slowly over weeks or years, and without any symptoms, or it may occur rapidly, as a result of infection, certain diseases that attack the kidney or kidneys, or other causes. Sometimes, this type of acute kidney injury will resolve, and long-term dialysis treatment to artificially filter the blood will not be needed.  Kidney function may only be at 15 to 30% when noticeable symptoms begin—early symptoms of kidney disease may include tiredness, poor appetite, and itching (as toxins build up in the body).  Often, supportive treatments may stop kidney damage, depending on the cause. 
What is kidney failure?
Kidney failure occurs when as a result of disease or even severe infections the kidney becomes severely damaged. Kidney failure occurs when kidneys function under 15% of their usual healthy capacity. People who experience kidney failure often experience severe fatigue, nausea, difficulty breathing as fluid builds up in the body, and skin itchiness.
When kidney function is either severely impaired or failing, this is when dialysis begins to be discussed, as well as potential for performing a kidney transplant. 
What is dialysis?
Dialysis is a treatment that is done one of two ways to remove toxins from your body, either through a shunt in your arm or leg (hemodialysis), or with a fluid in your abdominal cavity that attracts toxins and then is drained (peritoneal dialysis). The method of dialysis that is done depends on a variety of factors, the number one being the type and cause of your kidney disease. Hemodialysis, which uses a shunt to remove blood from the body, clean the blood, and return the blood to the body. How long hemodialysis takes will depend on body size, level of kidney function, how much waste gathers in your body between treatments, and how much water is retained by the body between treatments.  Usually, hemodialysis takes three or four hours, three days a week. 
Peritoneal dialysis can either be done continuously without reliance on machines, or with an automated device that is used during sleep.  You can learn more about the different types of dialysis by visiting the National Kidney Foundation’s website.
What is transplant?
Some people may not tolerate dialysis well, or require transplant to resume the life they had before kidney failure. A transplant takes a healthy kidney from a donor—often related, as kidney donors can be living, since we only need one kidney to survive!—who is of the same blood type and similar size to the recipient. A kidney transplant requires lifelong care, in ensuring medicines used to prevent rejection of the donated kidney are taken on time. If a donated kidney rejects, this can be life threatening, and may require the person to go back on dialysis. Transplant recipients should always wear medical ID jewelry.
Living with kidney disease
If you have kidney disease, it is important to remain connected with your medical team, follow advice regarding diet, fluid intake, and medicine, and stay on your treatment schedule for dialysis if you need it. Transplant also requires a lot of work to raise funds, have post-transplant caregivers available, and cover the costs of post-transplant anti-rejection medicines that will have to be taken the rest of the person’s life. If you live with kidney disease, a medical ID bracelet for kidney disease or a kidney failure medical bracelet is a good step to ensure care providers are aware if you may need dialysis or medicine.
To learn more about World Kidney Day—March 9th, 2017, visit WorldKidneyDay.org.