Kidney Dialysis

What is kidney dialysis?

Kidney dialysis is a mechanical way to do the work your kidneys normally do. It uses a machine to:

  • Clean your blood by removing wastes
  • Remove extra water, which helps control blood pressure and swelling
  • Helps your body keep the right balance of chemicals, such as potassium, sodium, and calcium

If you have kidney failure, dialysis can help you live longer. If you are otherwise healthy, dialysis may allow you to keep working or enjoying the things you like to do. If you are able to have a kidney transplant, you will be able to stop dialysis after the transplant.

If you are very sick and have other health problems, dialysis may seem like a burden that only prolongs your suffering. Having dialysis is a very personal decision to be discussed with your family and your healthcare provider.

When is it used?

Dialysis may be used when you have kidney (renal) failure. If kidney failure is not treated, you will have too much water, waste, or chemical imbalance in your blood. Any one of these problems could kill you.

Dialysis is generally started when your kidneys are working at less than 10% of their normal function. There are 2 kinds of kidney failure: acute (sudden) and chronic (slow-developing and permanent). If you have acute kidney failure, you may need dialysis until the cause of the kidney failure is corrected. If you have the chronic form, you may need dialysis for the rest of your life.

The decision to use dialysis depends on:

  • Why your kidneys stopped working
  • Other health conditions
  • Your overall health

How is it done?

There are 2 types of dialysis: hemodialysis and peritoneal dialysis. Neither type is painful.

Hemodialysis is the most common method of dialysis. Your blood is filtered through a machine. The machine takes wastes and extra water out of your blood and then returns the cleaned blood back to your body.

Several months before your first treatment, an access to your bloodstream must be made. It provides a way for blood to be carried from your body to the dialysis machine and then back into your body. The access can be created in different ways:

  • A plastic tube (catheter) may be inserted into a large vein in your neck, chest, or leg near the groin. This is called a venous catheter.
  • Or you may have minor surgery to create a connection between an artery and a vein. The connection is usually in the forearm. A connection called a fistula can be made using your own blood vessels. This is called an arteriovenous (AV) fistula. Or a connection called an AV graft can be made using a synthetic tube.

Your provider will give you more details on which type of access might work the best for you. You will be given an anesthetic before the access is created so the procedure will not be painful.

When you have hemodialysis, the dialysis machine is attached to the access with a needle. It is usually done about 3 times a week in a dialysis clinic. Each treatment takes about 3 to 5 hours. During treatment, you can read, write, sleep, talk, or watch TV.

Peritoneal dialysis (PD) uses the lining of your abdomen (the peritoneal membrane) to filter your blood. A small, soft tube called a catheter is used to fill your abdomen with minerals and sugar dissolved in water. This cleansing liquid is called dialysis solution. Wastes, chemicals, and extra water move into the dialysis solution while it is in your abdomen. After a certain time, the solution is drained from your abdomen through the catheter, taking the wastes with it. Your abdomen is then filled again with new dialysis solution. Each cycle of filling and draining is called an exchange and is repeated several times to clean your blood.

PD can be done in different ways.

  • Continuous cycler-assisted peritoneal dialysis (CCPD) uses a machine called a cycler to fill and drain your abdomen. It is usually done a few times while you sleep. CCPD is also sometimes called automated peritoneal dialysis (APD).
  • Continuous ambulatory peritoneal dialysis (CAPD) uses gravity instead of a machine to fill and empty your abdomen. With CAPD, you do manual exchanges of fluid a few times during the day. You drain a fresh bag of dialysis solution into your belly by hanging the bag higher than your belly. For a number of hours you let the fluid work inside your belly to remove the waste fluids. Then you drain the fluid from your belly by hanging the bag at a level lower than your belly catheter.

Before your first treatment, the catheter used for peritoneal dialysis is put into your belly through a small cut near your belly button. Your healthcare provider will make the cut and insert the catheter after you have been given an anesthetic. The catheter will be closed with a clamp or valve when you are not having dialysis.

Your provider will give you a schedule for how often you will need to have dialysis. You will have frequent weigh-ins and lab work to make sure the dialysis is helping you get rid of wastes and keeping a good balance of minerals.

Your healthcare provider will teach you how to care for your access site to prevent infection and to keep the site working.

Can dialysis be done at home?

Most states allow both hemodialysis and peritoneal dialysis to be done at home. There are many advantages to having dialysis treatments at home. You can set your own work and treatment schedule, you can cut down on travel, and you can do your treatments in private or talk with family or friends during treatments. However, having dialysis at home has disadvantages, too. You need space for the equipment, your electric and water bills may go up, you may need to add more wiring in your house, and you will need special training to learn how to perform your treatments properly. If you are having hemodialysis at home, it is very important to have a trained helper. Ask your healthcare provider if home dialysis might be a possibility for you.

What are the risks of dialysis?

Possible problems with hemodialysis include:

  • Problems with the access to your blood vessels, such as infection, blockage from clotting, and poor blood flow
  • Muscle cramps
  • A sudden drop in blood pressure, which can make you feel weak, dizzy, or sick to your stomach

The most common serious problem with peritoneal dialysis is an abdominal infection called peritonitis. The infection can be treated with antibiotics.

How can I take care of myself?

Before you decide to start dialysis, some of the questions you may want to discuss with your healthcare provider include:

  • Which type of dialysis is the best for me?
  • How long will I need dialysis?
  • What follow up visits will I need to make?
  • What happens if dialysis stops working?
  • How will dialysis change my normal activities?
  • Can I still go to my job or school?
  • What will I need to do to have dialysis in my home?
  • What training do I need to do home dialysis?

Once you have started dialysis:

  • Follow the dialysis schedule as prescribed.
  • Carefully follow your healthcare provider’s instructions for caring for the access site.
  • You may need to make some changes in your diet. Carefully follow the diet prescribed by your healthcare provider or dietitian.
  • Don’t drink more liquids than your provider recommends.
  • Take medicines exactly as prescribed by your provider.

Ask your provider:

  • How and when you will hear your test results
  • How long it will take to recover
  • What activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

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