Dialysis is a treatment that takes over the job of the kidneys when they
fail
. Most patients begin dialysis when their kidneys have lost 85%-90% of their ability. Dialysis will continue for the rest of their lives (or until they receive a kidney transplant). This is called
end-stage renal disease (ESRD)
.
ESRD is caused by conditions such as diabetes,
kidney cancer
, drug use,
high blood pressure
, or other kidney problems. Dialysis is not a cure for ESRD. It helps you feel better and live longer.
There are two types of dialysis:
Hemodialysis
Peritoneal dialysis
Parts of the Body Involved
Hemodialysis—veins in the arm, leg, or neck
Peritoneal dialysis—abdomen
Reasons for Procedure
The main functions of dialysis are to:
Remove waste and excess fluid from the blood to prevent build-up
Control blood pressure
Keep a safe level of chemicals in the body, such as potassium, sodium, and chloride
It may also be done to quickly remove toxins from the bloodstream. This can occur in cases of poisoning or drug overdose.
Risk Factors for Complications During the Procedure
Topical anesthetic (a pain numbing medicine) is applied to the arm for needle insertion
Heparin
(a medication that prevents blood clotting) is given
Peritoneal Dialysis
Before the first treatment, the physician places a small, soft tube (approximately 24 inches long) in the abdomen. This tube will remain there permanently. A portion of the tube remains outside the body for use in the process. It is important to keep this access clean and dry to prevent infection.
Anesthesia
For hemodialysis: topical anesthetic
Description of the Procedure
Hemodialysis
Blood is filtered through an artificial kidney machine, called a dialyzer. The blood travels from the body to the machine through tubes inserted into a vein in your arm, leg, or neck. An access site called a fistula or shunt may be surgically created in one of your veins.
Fistulas may need as long as 2 to 3 months to fully heal before they can be used. They are never used if the treatment is temporary. They are typically created many months before dialysis is begun.
Hemodialysis is usually done at a dialysis center or hospital. It may be done at home with assistance. It is usually done three times a week. Each treatment lasts from two to four hours.
The abdominal lining is called the peritoneal membrane. In this type of treatment it is used to filter blood instead of a machine. A cleansing solution, called a dialysate, is inserted into your abdomen. Fluid, wastes, and chemicals pass from the tiny blood vessels in the peritoneal membrane into the dialysate. It is then drained after several hours. New dialysate can then be added to repeat the process. A port in the abdomen may be needed for long-term treatment.
There are three types of peritoneal dialysis:
Continuous ambulatory peritoneal dialysis (CAPD)—is the most common type of peritoneal dialysis. A bag of dialysate is infused into the abdomen through a catheter. It remains there for 3-6 hours and is drained. The abdomen is refilled with fresh solution. This way your blood is always being cleaned. No machine is needed.
Continuous cyclical peritoneal dialysis (CCPD)—is done by machine. It is done at night while sleeping.
Intermittent peritoneal dialysis (IPD)—uses the same type of machine as CCPD. This requires assistance and is usually done at a hospital or center. It often takes longer than CCPD.
The time needed for dialysis depends on a few factors:
How much kidney function remains
How much fluid weight gain has occurred since the last treatment
Amount of waste in the body
Body size
Level of minerals in your body such as sodium, potassium, and chloride
Dialysis method used
The approximate time and frequency of each method:
Type
Length of procedure
Frequency of procedure
Hemodialysis
2-4 hours
3 times/week
CAPD
3-6 hours, plus 30 minutes to drain
4 times/day
CCPD
9-12 hours
Every night
IPD
12 + hours
36-42 hours/week
Will It Hurt?
In general, dialysis procedures do not cause pain. You will not feel the blood exchange. There may be some temporary discomfort with the insertion of the needle or tube.
Peritonitis
(infection of the peritoneum), which causes fever and stomach pain (peritoneal dialysis only)
Growth problems in children
Inflammation of the heart sac (pericarditis)
Neurologic problems
Disruption of calcium and phosphorus balance, resulting in weakened bones
Average Hospital Stay
None
Postoperative Care
Once the procedure is complete and blood pressure is stable, you are free to continue daily activities. There are some special considerations:
Dietary Guidelines
Certain dietary guidelines should be followed. This will help to keep overall health and optimize the treatment. Patients who have peritoneal dialysis may have slightly fewer dietary restrictions than hemodialysis patients. This is due to the more frequent filter schedule. Talk to your doctor about your specific dietary needs.
Medications
Your doctor may give various types of medication. These include, but are not limited to
Blood pressure medications
Calcium supplements or multivitamins
Phosphorus binders—to lower phosphorus levels in the blood
Diuretics—to remove excess fluid
Stool softeners or laxatives—to prevent or treat constipation, which can be caused by decreased fluid intake
Iron supplements—to increase iron intake, which is important for production of red blood cells
Outcome
Dialysis helps maintain blood pressure, cleaning of the blood, and chemical and hormonal exchanges that are critical to survival.
Call Your Doctor If Any of the Following Occurs
Signs of infection, including fever and chills
Redness, swelling, warmth, increasing pain, excessive bleeding, or discharge at the catheter or tube insertion site
Blood or cloudiness in the peritoneal dialysis fluid
The Kidney Foundation of Canada: Northern Alberta and the Territories Branch http://www.kidney.ab.ca/
References:
Dialysis. National Kidney Foundation website. Available at:
http://www.kidney.org/
. Accessed July 28, 2008.
Peritoneal Dialysis Dose and Adequacy.
National Diabetes Information Clearinghouse (NDIC) website. Available at:
http://diabetes.niddk.nih.gov/
.
Accessed July 28, 2008.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a
medical condition.
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Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
