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Before dialysis was available, total kidney failure meant death. Today, people with kidney failure can live because of treatments such as dialysis and kidney transplant.
Dialysis is a way of cleaning your blood when your kidneys can no longer do the job. It gets rid of your body's wastes, extra salt and water, and helps to control your blood pressure.
There are two kinds of dialysis. In hemodialysis, blood is pumped out of your body to an artificial kidney machine, and returned to your body by tubes that connect you to the machine. In peritoneal dialysis, the inside lining of your own belly acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of your belly in cycles.
A soft plastic tube (catheter) is placed in your belly by surgery. A sterile cleansing fluid is put into your belly through this catheter. After the filtering process is finished, the fluid leaves your body through the catheter.
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Automated Peritoneal Dialysis (APD)
The basic treatment is the same for each. However, the number of treatments and the way the treatments are done make each method different.
CAPD is "continuous," machine-free and done while you go about your normal activities such as work or school. You do the treatment by placing about two quarts of cleansing fluid into your belly and later draining it. This is done by hooking up a plastic bag of cleansing fluid to the tube in your belly. Raising the plastic bag to shoulder level causes gravity to pull the fluid into your belly. When empty, the plastic bag is removed and thrown away.
When an exchange (putting in and taking out the fluid) is finished, the fluid (which now has wastes removed from your blood) is drained from your belly and thrown away. This process usually is done three, four or five times in a 24-hour period while you are awake during normal activities. Each exchange takes about 30 to 40 minutes. Some patients like to do their exchanges at mealtimes and at bedtime.
APD differs from CAPD in that a machine (cycler) delivers and then drains the cleansing fluid for you. The treatment usually is done at night while you sleep.
The type of peritoneal dialysis that is best for you depends on your personal choice and your medical condition. Your doctor will help you to choose the one that is best for you.
Some doctors feel that CAPD and APD have several benefits when compared to hemodialysis. With continuous dialysis, you can control extra fluid more easily, and this may reduce stress on the heart and blood vessels. You are able to eat more and use fewer medications. You can do more of your daily activities and it is easier to work or travel.
However, there are some people for whom peritoneal dialysis may not be appropriate. The abdomen or belly of some people, particularly those who are morbidly obese or those with multiple prior abdominal surgeries, may make peritoneal dialysis treatments difficult or impossible. Peritonitis (infection of abdomen) is an occasional complication although should be infrequent with appropriate precautions. When making a decision about the type of treatment, you should take into consideration that peritoneal dialysis is usually a daily process, similar to the working of the kidney and may be more gentle with fluid removal from the body. Peritoneal dialysis is an effective form of dialysis, has been proven to be as good as hemodialysis.
Peritoneal dialysis is not for everyone. People must receive training and be able to perform correctly each of the steps of the treatment. A trained helper may also be used.
All types of dialysis are expensive, but, for most patients, the federal government now pays 80 percent of all dialysis charges, while private insurance or state medical assistance pays the rest.
When you are told you have kidney failure and need treatment to stay alive, it can be a difficult time in your life. If your kidney diagnosis is new, you may feel overwhelmed, confused and angry. But there are some important things you can do to help yourself. Learn all you can about your different treatment options and take an active role in decisions about your care.
Hemodialysis is a treatment that replaces the work of your own kidneys to clear wastes and extra fluid from your blood. This is done using a special filter called a dialyzer or artificial kidney. Your blood travels through plastic tubing to the dialyzer, where it is cleaned and then returned to you. At the beginning of each treatment, two needles are placed into your access. These needles are connected to the plastic tubing that carries your blood to the dialyzer. Only a small amount of blood is out of your body at any one time. The dialysis machine pumps your blood through the dialysis system and controls the treatment time, temperature, fluid removal and pressure.
This basic process is the same for home hemodialysis, except that you and a care partner are trained to do your treatment at home.
You can do hemodialysis at a dialysis center where a nurse or technician performs the tasks required during treatment. In-center hemodialysis is usually done three times a week for about three to four hours or longer each session. In-center treatments are done at a pre-scheduled time.
You can also do hemodialysis at home where you are the one doing your treatment. At home, you may be better able to fit your treatments into your daily schedule. Studies show that the more you know about your treatment and the more you do on your own, the better you are likely to do on dialysis.
Three types of hemodialysis can be performed at home. They are:
It is also possible to combine daily and nocturnal home hemodialysis. Whether you can combine treatments depends on your needs, your medical condition and your machine.
Whatever treatment option you choose, it is important to know if you are getting the right amount of dialysis. Tests should be done regularly to check the amount of dialysis you receive. For more information, speak with your doctor and your dialysis care team.
Many reports indicate that people using short daily and nocturnal home hemodialysis:
New, easy-to-use machines are being developed for home hemodialysis. These are easier to set up, clean and disinfect. With some newer machines you have fewer supplies to store. If you think home hemodialysis is a good choice for you, ask your doctor about the best equipment for you.
Home hemodialysis is not a good fit for everyone. You need to learn a lot about it. You need to be willing to be responsible for your own treatment. As long as you and/or your care partner can pass the training and learn to place your needles, you should be able to do home hemodialysis.
Finding a center that offers home hemodialysis can be a challenge. If your center does not offer home hemodialysis, see below for Web sites that can help you find centers that offer home hemodialysis. Visit the center. Talk with the home training nurse and other staff. If possible, talk with home patients. Two things are needed for success: 1) a center and doctor willing to train you and follow your care and 2) your commitment to learn and do home hemodialysis for at least a year.
Most home hemodialysis programs ask you to have a care partner who is willing to be with you to help during each treatment. Your care partner can be a family member or friend. This person goes through the training with you so he or she can learn what to do. Sometimes, patients hire a nurse or technician to be their care partner. Medicare does not pay for these helpers, however.
The social worker at your dialysis center should give you information about coverage for home hemodialysis. Medicare pays for part of the cost and training. If you are 65 or older or disabled, you should already have Medicare. You can also get Medicare at any age if you have kidney failure and you or your spouse or parent worked long enough to qualify for Social Security. There are other sources that help pay for dialysis. Check with your social worker. He or she can also discuss any plumbing or wiring changes or additional costs that may occur with home hemodialysis.
If you have an employer group health plan, it will be the primary coverage for the first 30 months of your treatment with Medicare as your secondary insurer. After those first 30 months, Medicare will become your primary insurance.
For more on home hemodialysis see the following PDF brochure:
Have You Thought About Dialysis at Home?
Dialysis Facility Compare—Find information about dialysis centers that offer home hemodialysis training programs. www.medicare.gov
Home Dialysis Central—Learn about home dialysis options, talk to other patients, find out if a dialysis center near you offers a home hemodialysis program. www.homedialysis.org
Healthy kidneys clean your blood and remove extra fluid in the form of urine. They also make substances that keep your body healthy. Dialysis replaces some of these functions when your kidneys no longer work. There are two different types of dialysis - hemodialysis and peritoneal dialysis. The following is about hemodialysis. For more information on peritoneal dialysis, click here.
You need dialysis if your kidneys no longer remove enough wastes and fluid from your blood to keep you healthy. This usually happens when you have only 10 to 15 percent of your kidney function left. You may have symptoms such as nausea, vomiting, swelling and fatigue. However, even if you don't have these symptoms yet, you can still have a high level of wastes in your blood that may be toxic to your body. Your doctor is the best person to tell you when you should start dialysis.
Hemodialysis is a procedure where a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood. To get your blood into the dialyzer, the doctor needs to make an access, or entrance, into your blood vessels. This is done with minor surgery, usually to your arm. For more information on hemodialysis access, click here.
The dialyzer, or filter, has two parts, one for your blood and one for a washing fluid called dialysate. A thin membrane separates these two parts. Blood cells, protein and other important things remain in your blood because they are too big to pass through the membrane. Smaller waste products in the blood, such as urea, creatinine, potassium and extra fluid pass through the membrane and are washed away.
Hemodialysis can be done in a hospital, in a dialysis center that is not part of a hospital or at home. You and your doctor will decide which place is best, based on your medical condition, and your wishes.
In a dialysis center, hemodialysis is usually done 3 times per week for about 4 hours at a time. People who choose to do hemodialysis at home may do dialysis treatment more frequently, 4-7 times per week for shorter hours each time.
Your doctor will give you a prescription that tells you how much treatment you need. Studies have shown that getting the right amount of dialysis improves your overall health, keeps you out of the hospital and enables you to live longer. Your dialysis care team will monitor your treatment with monthly lab tests to ensure you are getting the right amount of dialysis. One of the measures your dialysis care team may use is called urea reduction ratio (URR). Another measure is called Kt/V (pronounced kay tee over vee). Ask your dialysis care team what measure they use and what your number is. To ensure that you are getting enough dialysis:
Possibly. Many patients have their hemodialysis treatments at home. To learn more about home hemodialysis click here.
Yes. Generally speaking, patients on dialysis are advised to increase their protein intake and limit the amount of potassium, phosphorus, sodium, and fluid in their diet. Patients with diabetes or other health conditions may have additional diet restrictions. It's important to talk with you dietitian about your individual diet needs.
Your dialysis care team will monitor your treatment with monthly lab tests to ensure you get the right amount of dialysis and that you are meeting your dietary goals. For more information on nutrition and hemodialysis, click here. For more information on understanding your lab values click here.
In some cases of sudden or acute kidney failure, dialysis may only be needed for a short time until the kidneys get better. However, when chronic kidney disease progresses to kidney failure over time, your kidneys do not get better and you will need dialysis for the rest of your life unless you are able to receive a kidney transplant.
When you begin hemodialysis, the needles put in your fistula or graft may be uncomfortable. Most patients get used to this in time. Your dialysis care team will make sure you are as comfortable as possible during your treatment. Symptoms like cramps, headaches, nausea or dizziness are not common, but if you do have any of them, ask your dialysis care team if any of the following steps could help you:
You can help yourself by following your diet and fluid allowances. The need to remove too much fluid during dialysis is one of the things that may make you feel uncomfortable during your treatment.
Dialysis is expensive. However, the federal government's Medicare program pays 80 percent of all dialysis costs for most patients. Private health insurance or state medical aid may also help with the costs. For more information on insurance click here.
Before you reuse your dialyzer, your dialysis center cleans it according to careful guidelines. If done properly, reuse is generally safe. Before each treatment, your dialyzer must be tested to make sure it is still working well. If your dialyzer no longer works well, it should be discarded and you should be given a new one. Ask your dialysis care team if they have tested your dialyzer and if it still works well.
If you do not wish to reuse your dialyzer, your center may be willing to provide you with a new dialyzer for each treatment. Ask about the center's policy on reuse.
Yes. Dialysis centers are located in every part of the United States and in many foreign countries.
Before you travel, you must make an appointment for dialysis treatments at another center. The staff at your center may be able to help you arrange this appointment. For more information on traveling on dialysis click here.
Yes. Many dialysis patients continue to work or return 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 change your duties.
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