Dialysis in Turkey: Costs, treatment types and international prices comparison

What does dialysis do and when does it become necessary?

Healthy kidneys quietly perform around a dozen vital functions every hour: filtering waste products from the blood, regulating fluid and electrolyte balance, controlling blood pressure, and stimulating red blood cell production. In end-stage chronic kidney disease (CKD Stage 5),the glomerular filtration rate (GFR) falls below 15 mL/min, meaning the kidneys can no longer keep pace with the body's demands. Urea, creatinine, potassium, and excess fluid begin to accumulate, with potentially life-threatening consequences.

Dialysis takes over the kidneys' filtration role. It does not treat the underlying kidney disease, and it does not restore kidney function. What it does, reliably, session after session, is remove enough waste and fluid to keep you alive, stable, and functional. For most patients on dialysis, the goal alongside treatment is an eventual kidney transplant. For others, dialysis becomes a long-term steady state.

According to the USRDS Annual Data Report, 2023, more than 3.7 million people worldwide are receiving renal replacement therapy. According to the ERA-EDTA European Registry, dialysis prevalence in the UK is approximately 380 patients per million population; in the US, it exceeds 700 per million. The global demand for dialysis is projected to double by 2030, driven largely by rising rates of diabetes and hypertension, the two leading causes of CKD.

When is dialysis typically initiated?

The internationally recognized KDIGO 2023 guidelines (Kidney Disease: Improving Global Outcomes) recommend initiating dialysis when:

• GFR falls below 15 ml/min/1.73 m² with signs or symptoms of uremia, nausea, pericarditis, encephalopathy, or severe fluid overload
• Hyperkalemia becomes refractory to dietary and medical management (serum potassium persistently above 6.0-6.5 mmol/L)
• Metabolic acidosis cannot be controlled with bicarbonate supplementation
• GFR drops below 6 ml/min/1.73 m² regardless of symptoms

Timing matters. Starting too early carries unnecessary risk; starting too late can lead to emergency complications. An experienced nephrologist, not a urologist, who deals with the urinary tract and its surgery, makes this determination based on the full clinical picture.

What types of dialysis are available in Istanbul and which one is right for you?

Three principal dialysis modalities are available at Turquie Santé partner clinics in Istanbul. The choice between them is made by the nephrologist in consultation with the patient, based on clinical factors, vascular access, lifestyle preferences, and residual kidney function.

What actually happens during a hemodialysis session?

Most of the anxiety patients feel before starting dialysis comes not from the procedure itself, but from not knowing what to expect. Here is a clear, honest account of what a session looks like at a Turquie Santé partner clinic in Istanbul.

Vascular access: fistula or catheter?

Before hemodialysis can begin, a reliable pathway for blood to leave and return to the body must be established. An arteriovenous fistula (AVF), a surgical connection between an artery and a vein, usually in the forearm, is the preferred long-term option. It needs to be created two to four months in advance to allow it to develop ("mature") before use.

If dialysis must begin urgently, a central venous catheter is placed instead, a quicker solution but one associated with a higher risk of infection and lower long-term durability.

The four-hour session itself

You settle into a reclining chair or bed. Two needles are placed into the fistula, one draws blood out to the dialysis machine, and the other returns it after purification. If you have a catheter, two channels serve the same function. The machine pumps 250-400 ml of blood per minute through a dialyser: a filter containing thousands of hollow fibers with semipermeable walls. Through those walls, urea, creatinine, excess potassium, and surplus fluid cross into the dialysing solution, which is then discarded. The cleaned blood flows back to you.

Over four hours, your entire blood volume passes through the machine multiple times. The effectiveness of each session is measured by a parameter called Kt/V, which your nephrologist targets at 1.2 or above per session, a meaningful standard, not a vague aspiration.

When the session is done, the needles are removed, a dressing is applied, and you are free to leave.

What patients experience during dialysis

Most patients read, watch films, or talk during sessions. Nursing staff monitor blood pressure, heart rate, and any symptoms throughout.

The whole experience, once familiar, tends to be far less daunting than it sounds in the abstract.

Diet during hemodialysis

Dietary restrictions during hemodialysis are real and need to be taken seriously. Potassium (found in bananas, potatoes, tomatoes, and nuts),phosphorus (found in dairy, nuts, and beans),sodium, and fluid intake must all be limited between sessions.

A renal dietitian, available at all Turquie Santé partner clinics, will work with you to build an eating plan that keeps your blood chemistry stable while remaining genuinely manageable.

Is hemodiafiltration worth choosing over standard hemodialysis?

Hemodialfiltration (HDF) is, in essence, an upgraded form of hemodialysis. It adds a convective component: A large volume of ultrapure substitution fluid (18-25 liters per session) is passed through the dialyser, and then replaced with sterile fluid. This convective flow drags along molecules that are too large for standard diffusion to remove efficiently: beta-2 microglobulin, parathyroid hormone (PTH),inflammatory cytokines, the very molecules responsible for dialysis-related amyloidosis, accelerated cardiovascular disease, and chronic systemic inflammation in long-term patients.

The clinical evidence behind this choice is now quite clear. The CONTRAST randomized controlled trial (Verhave JC et al., JASN 2015) and the ERA-EDTA international registry both reported a 14–15% reduction in all-cause mortality for patients receiving high-volume HDF compared to conventional HD. For patients in Istanbul planning dialysis over months or years, this is a meaningful consideration, one that the nephrologists at Turquie Santé partner centers factor into their recommendations.

For patients who will be on dialysis for the long term and who have good vascular access, hemodiafiltration is what we offer as the default here. The survival data are too consistent to ignore. When patients ask us why it costs a little more, we show them the numbers; that tends to close the conversation quickly.

Is peritoneal dialysis an option for you?

Peritoneal dialysis (PD) takes an entirely different approach. Rather than an external machine, it uses the patient's own peritoneum, the thin membrane lining the abdominal cavity, as the filtering surface. A flexible catheter is surgically placed in the abdomen; through it, sterile dialysing solution is infused and left in place for several hours, during which time waste products and fluid pass across the peritoneal membrane into the solution. The used fluid is then drained out and replaced with a fresh solution.

The defining advantage of PD is independence. Patients perform their own exchanges at home, on their own schedule, without the three-times-weekly clinic visits that hemodialysis requires. It is particularly well-suited to working adults, patients who live far from a dialysis center, those with cardiovascular instability who do not tolerate the blood pressure fluctuations that can occur during HD, and patients with good residual kidney function whose bodies benefit from the gentler, continuous nature of PD.

Training for peritoneal dialysis, how to perform exchanges safely, how to recognize signs of infection, and how to manage the technique at home, takes one to two weeks. This training can be completed in Istanbul, at a Turquie Santé partner center, before the patient returns home with full independence over their treatment.

What should you prepare before your first dialysis session in Istanbul?

Preparing in advance makes a real difference, not just for logistics, but for your safety and the effectiveness of your treatment from day one.

• Vascular access: the priority: If you already have a functioning arteriovenous fistula (AVF) that is regularly used, you can begin hemodialysis in Istanbul almost immediately.
• Medical documents to bring: Recent blood test results, dialysis records, and any reports related to your vascular access are essential for continuity of care.
• If you don't have a vascular access yet: A new AVF can be created by vascular surgery teams in partner hospitals. Keep in mind that it requires 6 to 12 weeks to mature before use.
• Temporary solution if needed: In urgent cases, a central venous catheter can be placed quickly to allow dialysis to start without delay.
• Pre-travel teleconsultation: A remote consultation with the nephrologist is organized to review your medical file and plan your first session with precision.

With the right preparation, your transition to dialysis care in Istanbul becomes a structured, predictable process, not a stressful unknown.

What is life like on dialysis practically speaking?

Dialysis imposes real constraints. Acknowledging them honestly is more useful than minimising them. But within those constraints, a great deal remains possible, and knowing what to expect makes adaptation considerably easier.

Diet: What actually needs to change?

Between sessions, your body can no longer regulate certain elements efficiently, which is why diet becomes a key part of treatment.

• Potassium must be controlled to prevent dangerous heart rhythm disturbances.
• Phosphorus intake should be limited to protect bones and blood vessels.
• Sodium and fluid intake must be monitored to avoid swelling, hypertension, and breathlessness.

Your nephrologist and renal dietitian define precise targets based on your blood tests. The goal is balance, not unnecessary restriction.

Looking after your fistula

Your arteriovenous fistula (AVF) is your lifeline; protecting it is essential for safe, long-term dialysis.

• Avoid blood pressure measurements or injections on the fistula arm.
• Do not carry heavy loads or wear tight clothing on that arm.
• Check daily for the “thrill” (vibration); if absent, contact your care team immediately.
• Watch for warning signs: persistent pain, redness, or swelling.

Simple daily precautions significantly reduce complications.

Travel, work, and staying active

Many dialysis patients work full-time, particularly those on peritoneal dialysis or with a convenient haemodialysis schedule. International travel is feasible, dialysis centres exist worldwide, and Turquie Santé can facilitate holiday dialysis in Istanbul for patients who want to combine treatment with a stay in Turkey.

The most important logistical requirement is advance planning: most dialysis units worldwide require 4-6 weeks' notice for visiting patients.