Travelling on dialysis

Kidney disease doesn't have to keep you home. With enough planning ahead, most dialysis and CKD patients can travel — for a family reunion, a pilgrimage, a beach holiday, or work abroad. The secret is simple: plan earlier, and sort out your dialysis before anything else.

Adapted with permission from renalcarematters.com.

Start planning at least 6 to 8 weeks ahead

Travel is possible for most people with chronic kidney disease (CKD) or on dialysis — but it takes far more lead time than it does for a healthy traveller. Dialysis centres at your destination often need to be booked weeks in advance, your medicines must be secured in enough supply, and your nephrologist (kidney doctor) should clear you to travel based on how stable you are right now.

Give yourself a runway. Six to eight weeks is a comfortable minimum for a trip that involves dialysis away from home. It leaves time to gather test results, wait for a centre to confirm your slot, and order extra medicines. Rushing this is where problems happen.

The most common mistake: booking flights and hotels before confirming dialysis. Not every centre accepts visiting patients, and slots are limited — especially in tourist spots. Always confirm your dialysis slot first, then book everything else around it.

Get clearance from your nephrologist first

Before you commit to any trip, ask your kidney doctor whether it is safe to travel now. For some patients, travel needs extra caution and explicit clearance. Hold off — unless your nephrologist says otherwise — if you have had any of the following:

A hospital admission in the last 4 weeks.
Blood pressure that is not yet controlled.
A recent change in your dialysis prescription.
An active infection anywhere in the body.
Severe anaemia (very low haemoglobin) or severe fluid overload.
A recent heart problem, such as chest pain or heart failure.
Active peritonitis (an infection of the abdominal lining) if you are on peritoneal dialysis.

When in doubt, ask. A short conversation before you book can save you an emergency far from home.

For haemodialysis: book your dialysis slot before anything else

If you have haemodialysis (HD) three times a week, your treatment cannot wait for your holiday. Dialysis slots at popular destinations can fill months in advance, so never assume you can simply arrange a session when you arrive. Confirm your slot in writing — with the centre's name, address, phone number, and the name of the nephrologist who will supervise your sessions.

Missing dialysis is far more dangerous than missing almost any other treatment. If a booked centre falls through at the last minute, go straight to the nearest hospital emergency department — do not wait to see if you feel okay.

Finding a centre and what to send them

To find a guest dialysis centre abroad, you can search a free directory such as the Global Dialysis Directory (globaldialysis.com), which lists centres in more than 140 countries by city. Your own nephrologist's professional network is often the smoother path — a personal referral between kidney doctors makes booking much easier.

Once you find a centre, they will ask for information about you before they accept you. Prepare to send:

Your dialysis prescription — machine settings, blood flow rate, dialysate composition, ultrafiltration (fluid removal) goal, and session length.
Recent labs — haemoglobin, ferritin, PTH, potassium, phosphorus, and albumin.
Your hepatitis B and C serology and HIV status.
Your access type (fistula, graft, or catheter) and any recent notes about it.
Any special instructions from your nephrologist.

Hepatitis and HIV blood tests are mandatory — no exceptions. Every dialysis centre in the world requires current HBsAg, anti-HCV, and anti-HIV results, usually done within the last 3 to 6 months. Without them you may be refused treatment or placed in an isolation room. Have these tests done before you leave, and carry the paper results with you.

Documents to prepare before you leave

Carry a small folder of paperwork — both printed and saved on your phone. At a minimum, bring:

A medical summary letter from your nephrologist, in English (and the local language if you can).
Your current medicine list with generic names and doses.
Your dialysis prescription sheet.
Recent labs, done within the last 4 weeks.
Copies of your PhilHealth and any private health insurance cards.
Emergency contacts, including your home dialysis centre's phone number.

Packing your medicines

Bring enough medicine for the whole trip plus about 50% extra — a buffer for delays, lost luggage, or an unexpected extra day or two. Always keep your medicines in your hand-carry, never in checked bags that can go missing. Carry your nephrologist's letter in the same bag; customs officers in many countries ask for it before letting you bring injectables or controlled medicines through.

A few things travellers on dialysis most often get wrong:

Temperature-sensitive medicines. Erythropoietin (EPO/ESA) and insulin must stay cool, roughly 2 to 8°C — use an insulated medicine pouch (a Frio wallet or similar). Tell the cabin crew so they don't accidentally freeze it, and don't leave it in a cold overhead bin.
Phosphate binders. These are the most commonly forgotten medicine. They must be taken with every single meal, no matter where you are eating — you cannot skip them just because a dish "looks low in phosphorus." They are bulky, so pack more than you think you need.

Diet and fluid on the road

Your kidney diet does not go on holiday with you. If anything, eating out makes it harder, so plan ahead.

Your fluid limit stays the same wherever you are. Heat, humidity, and more walking will make you feel thirstier, but going over your fluid allowance can flood your lungs, not just cause swelling. Suck on ice chips instead of drinking full glasses, and track your intake as strictly as you do at home.

Restaurant food is almost always very high in sodium (salt) — assume any restaurant meal has two to three times more salt than home cooking. Street food and buffets are especially risky for potassium and phosphorus. Skip dark colas, sports drinks, coconut water, and fresh fruit juices, which are loaded with potassium and phosphorus.

Safer choices when eating out: grilled or steamed meat or fish with plain rice, asking for no sauce, no seasoning, and no added salt. Avoid soups and broths — they are extremely high in sodium. Plain bread, plain pasta, egg whites, and simple salads with the dressing on the side are usually safe. When you are stuck, a plain grilled chicken sandwich with no sauce is a reliable emergency meal almost anywhere.

Flying with kidney disease

Air travel is generally safe, with a few things to know. Aircraft cabins are pressurised as if you were a couple of thousand metres up a mountain, which shifts fluid around a little and dries you out through breathing. On long flights you may notice more leg swelling — compression stockings help. Do not try to fix the dry feeling by drinking more; stay within your fluid limit.

At airport security, the scanners are safe for an arteriovenous fistula or graft. Let the staff know before screening that your arm has a dialysis access, and ask them not to put a blood pressure cuff or a tight band on that arm. Carry your nephrologist's letter for all injectables (EPO, insulin), needles, and supplies, and ask for wheelchair assistance if you tire easily.

Mind the timing of long flights. Try not to take a long-haul flight (over 6 hours) the day right before or right after dialysis without checking with your nephrologist. The ideal pattern is dialysis, then one rest day, then travel. Flying while you are at your driest and most tired — straight after a session — raises the risk of low blood pressure and cramps in the air.

If you are on peritoneal dialysis

If you do peritoneal dialysis (PD), you have a real advantage for travel — there is no dialysis centre to find and book. CAPD exchanges can be done anywhere you have a clean surface and good technique, and cycler machines are accepted by airlines as medical equipment. Your supplier can often ship dialysate straight to your hotel; arrange that at least 4 to 6 weeks ahead, since a week's worth of bags is heavy and bulky.

The one rule you can never bend is sterile technique. Peritonitis (infection of the abdominal lining) becomes much more likely when the routine slips, and treating it in a foreign hospital is complicated and expensive. Always do your exchanges in a clean, closed room, away from pets, open windows, and air-conditioning vents. Wear a mask, never rush, and carry extra antiseptic and supplies for emergencies.

If you have CKD but are not yet on dialysis

If you have CKD stages 1 to 4 and are not on dialysis, you can usually travel freely. The main risks are dehydration, missed medicines, diet slips, and accidental exposure to kidney-harming drugs. Carry a short medical summary in English that states your CKD stage and your eGFR (a number that shows how well your kidneys are filtering) — it is vital if you need care abroad.

Unlike dialysis patients, non-dialysis CKD patients often need to drink a little more than usual while travelling, because dehydration can suddenly worsen kidney function. Aim for pale yellow urine. In hot weather or with a stomach bug, call your nephrologist early — prompt rehydration can prevent acute kidney injury (AKI), a sudden drop in kidney function.

Avoid these, whatever your CKD stage: painkillers called NSAIDs (such as ibuprofen and mefenamic acid, common in travel kits); scans with contrast dye without a hydration plan; herbal or traditional remedies sold as local medicine; and heavy alcohol or heat without replacing fluids. Any of these can harm already-vulnerable kidneys.

Travel insurance and your emergency plan

For dialysis patients, proper travel insurance is not optional. Standard policies exclude pre-existing conditions, so you need one that clearly covers emergency dialysis, hospital care for kidney problems, medical repatriation, and prescription medicines. Declare your kidney disease fully and honestly — hiding it can void the whole policy when you need it most.

Keep the contact number of the nearest Philippine Embassy or Consulate at your destination. They can help with emergency repatriation, connect you with Filipino healthcare workers nearby, and give consular support if you end up in hospital. Filipino nurses and doctors work in hospitals all over the world and can be a real comfort and help.

Carry your key information at all times — on your phone and on paper (a laminated card works well): your name, blood type, and allergies; your nephrologist's name and number with country code; your home dialysis centre and its emergency number; your medicine list and dialysis prescription; your hepatitis and HIV results; your insurance policy number and 24-hour helpline; and the name and address of the nearest hospital.

Your pre-travel checklist

Run through this before you go:

Nephrologist clearance obtained.
Medical summary letter in English prepared.
Dialysis centre booked and confirmed in writing (for HD patients).
Hepatitis B, C, and HIV results obtained (within 6 months).
Recent labs within 4 weeks.
All medicines packed with 50% extra, in hand luggage.
Insulated pouch for EPO/ESA and insulin; phosphate binders more than enough.
Travel insurance with dialysis cover confirmed.
Emergency card prepared; nearest hospital and Philippine Embassy contacts saved.
Diet and fluid strategy planned; compression stockings and a blood pressure monitor packed.
PD supply delivery arranged at your destination (for PD patients).

Travel really is possible on dialysis — thousands of Filipino patients do it every year. Plan early, talk to your kidney doctor, sort out dialysis first, and enjoy the trip you have been looking forward to.

Ask us before you travel

Adapted with permission from renalcarematters.com. Medically reviewed by a nephrologist. This guide is educational and not a substitute for consultation.