Dialysis

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Dialysis is a treatment that does some of the things healthy kidneys do. It is needed when your own kidneys can no longer take care of your body’s needs. You need dialysis when you develop end stage kidney failure – usually by the time you lose about 85 to 90 percent of your kidney function.

Like healthy kidneys, dialysis keeps your body in balance. Dialysis does the following:

• Removes waste, salt and extra water to prevent them from building up in the body
• Keeps a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate
• Helps to control blood pressure

Is kidney failure permanent?

Not always. Some kinds of acute kidney failure get better after treatment. In some cases of acute kidney failure, dialysis may only be needed for a short time until the kidneys get better.

In chronic or end stage kidney failure, your kidneys do not get better and you will need dialysis for the rest of your life. If your doctor says you are a candidate, you may choose to be placed on a waiting list for a new kidney.

Where is dialysis done?

Dialysis can be done in a hospital, in a dialysis unit that is not pat of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes.

Types of Dialysis

There are two main types of dialysis – peritoneal dialysis (the type that most nephrologists would do if they had to do dialysis) and hemodialysis. Both can be performed at home by the patient after training. Doing treatments at home is usually preferred rather than travelling to a clinic and doing it on the clinic’s schedule.

Peritoneal Dialysis

Peritoneal dialysis is done in your home and is considered the best modality to begin therapies as it is a more gentle treatment than hemodialysis. It is a daily therapy. Your home therapies nurse will teach you the proper techniques to do this safely. Most nephrologists choose this modality for their patients and would do this themselves if they had to start dialysis.

In this type of dialysis, your blood is cleaned inside your body. The doctor will do surgery to place a plastic tube called a catheter into your abdomen (belly) to make an access. During the treatment, your abdominal area (called the peritoneal cavity) is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate. There are several kinds of peritoneal dialysis but two major ones are: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD).

Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. You do this yourself, usually four or five times a day at home and/or work. You put a bag of dialysate (about two quarts) into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange. You use a new bag of dialysate each time you do an exchange. While the dialysate is in your peritoneal cavity you can go about your usual activities at work, at school or at home.

Continuous Cycling Peritoneal Dialysis (CCPD) usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1 ½ hours and exchanges are done throughout the night while you sleep.

Dialysis does some of the work of healthy kidneys, but it does not cure your kidney disease. You will need to have dialysis treatments for your whole life unless you are able to get a kidney transplant.

Hemodialysis

Is an artificial kidney (hemodialyzer) is used to remove waste and extra chemicals and fluid from your blood. To get your blood into the artificial kidney, the doctor needs to make an access (entrance) into your blood vessels. This is done by minor surgery to your arm or leg.

Ideally, an access is made by joining an artery to a vein under your skin to make a bigger blood vessel called a fistula. However, if your blood vessels are not adequate for a fistula, the doctor may use a soft plastic tube to join an artery and a vein under your skin. This is called a graft. Occasionally, an access is made by means of a narrow plastic tube, called a catheter, which is inserted into a large vein in your neck. This type of access may be temporary but is sometimes used for long-term treatment. 

The time needed for your dialysis depends on:

• How well your kidneys work
• How much fluid weight you gain between treatments
• How much waste you have in your body
• How big you are
• The type of artificial kidney used

Usually, each hemodialysis treatment lasts about four hours and is done three times per week. 

Additional facts:

• You may have some discomfort when the needles are put into your fistula or graft, but most patients have no other problems. If this happens, you may feel sick to your stomach, vomit, have a headache or cramps. With frequent treatments, those problems usually go away.
• Hemodialysis and peritoneal dialysis have been done since the mid 1940s. Dialysis, as a major treatment, was begun in 1960 and is now a standard treatment all around the world. CAPD began in 1976. Thousands of patients have been helped by these treatments.
• We do not yet know how long patients on dialysis will live. We think that some dialysis patients may live as long as people without kidney failure.
• Dialysis costs a lot of money. However, the federal government pays 80 percent of all dialysis costs for most patients. Private health insurance or state medical aid also help with the costs.
• Many patients live normal lives except for the time needed for treatments. Dialysis usually makes you feel better because it helps many of the problems caused by kidney failure. You and your family will need time to get used to dialysis.
• You may be on a special diet on dialysis. You may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis.
• Dialysis centers are located in every part of the United States and in many foreign countries. The treatment is standardized so travel is possible. You must make an appointment for dialysis treatments at another center before you go. The staff at your center may help you make the appointment.
• Many dialysis patients can go back to work after they have gotten used to dialysis. If your job has a lot of physical labor (heavy lifting, digging, etc.), you may need to get a different job.

—Source: The National Kidney Foundation