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What is dialysis and which modality is best for me?

Chronic kidney disease (CKD) occurs when the kidneys are not able to function at normal levels. Kidney function can deteriorate rapidly or over time. The degree to which you have CKD is determined by how well your kidneys are working.

Dialysis is a treatment that performs some of the functions diseased kidneys are not able to do. Healthy kidneys work to filter waste products from your blood. They also help to maintain fluid and chemical balances.

Today, dialysis is allowing more than 350,000 Americans to live full lives. Because their own kidneys are no longer healthy, they undergo regular dialysis treatments to help regulate the amount of excess fluid in their bodies. Dialysis also removes waste products from the bloodstream. If allowed to build up, these waste products can cause an individual to feel tired and sick. This condition is called uremia, because it occurs when the amount of urea in the blood stream is elevated. Urea is the waste product that results when you eat protein. Healthy kidneys eliminate it, but unhealthy kidneys are not able to rid your body of it.

Some symptoms of uremia and chronic kidney disease are:

  • dizziness
  • weakness
  • loss of appetite
  • nausea
  • vomiting
  • confusion

I have kidney disease – will I need dialysis?

Your health care providers will run laboratory tests on a regular basis to monitor the extent of your kidney disease and to make a decision about the use of dialysis. There are two main blood chemical levels that are typically checked to make a diagnosis about the stage of your disease:

  • blood urea nitrogen (BUN) level
  • creatinine level

Your BUN level shows the amount of urea left in your blood. Creatinine, which is the waste product that results from muscle metabolism, is measured in both your blood and your urine. A rise in BUN and creatinine levels indicates the progression of CKD. As the numbers go up, kidney function is likely going down.

Along with your BUN and creatinine levels, your health care team will be looking at other indicators of deteriorating kidney function. Some of these include:

  • retaining excess water in your body
  • difficulty breathing
  • experiencing sensations in your legs
  • metallic taste in your mouth

Dialysis is usually indicated when a person reaches end stage renal disease; that is, when you have lost 85 to 90 percent of your kidney function.

What are the different types of dialysis modalities?

There are two main types of dialysis: hemodialysis (HD) and peritoneal dialysis (PD). Whichever type of dialysis you perform, you will need a dialysis access. For hemodialysis, the AV fistula is the access of choice, there is also an AV graft. A catheter can be used and is usually considered a temporary access. Your doctor will talk to you about the different hemodialysis access options and which one is best for you. For PD, you will need a catheter placed in your abdomen to perform peritoneal dialysis.

Hemodialysis options

Hemodialysis works by having your blood circulate through a man-made filter (or dialyzer), which cleans it. Blood circulates through the dialyzer for several hours during a treatment, with a machine controlling the speed and several safety factors.

Today, there are hemodialysis options that can help you better fit hemodialysis you’re your lifestyle. Traditional hemodialysis is done at a dialysis center three times per week. Each treatment lasts about three to four hours. In-center self care hemodialysis also lasts about three to four hours, three times per week; however, patients perform some of their treatment giving them a better sense of control. In-center nocturnal hemodialysis is performed at a dialysis center three times a week but happens overnight while the patient sleeps, usually for about eight hours each treatment. Home hemodialysis provides the most control for patients as they can choose when to perform dialysis and will perform the treatment, usually with the help of a care partner at home.

Peritoneal dialysis options

Peritoneal dialysis differs from hemodialysis in that your blood is cleaned inside your body. Your abdomen is lined with a semipermeable membrane (peritoneal membrane) that separates your blood and the dialysate. The abdominal cavity is filled with a dialysis fluid, or dialysate, via a catheter. The dialysate is left in the abdomen for several hours, where it absorbs excess fluid and waste products. Then it is drained and replaced with fresh dialysate — this process is called an exchange.

Usually PD is administered using a cycler. This automated machine works to flush fluid in and out of the abdomen while an individual sleeps. For people who perform automated peritoneal dialysis (APD) they may also need to perform a manual exchange sometime during the day. There is also the option of continuous ambulatory peritoneal dialysis (CAPD) which is performed manually by the dialysis patient at home, work or wherever they may be.

Can dialysis cure chronic kidney disease?

Dialysis does some of the work that healthy kidneys normally do, but if you have chronic kidney disease, it will not change the fact that your kidneys no longer function as well as they once did. You will always need to get dialysis treatments, unless you have a kidney transplant.

For those diagnosed with acute kidney failure, some function may return. In acute kidney failure, kidneys stop working suddenly. This can happen for a number of reasons, including:

  • blood pressure drops severely
  • blood supply to the kidneys is restricted
  • urine flow is obstructed, due to conditions such as kidney stones, bladder tumors or an enlarged prostate
  • kidneys are damaged from a reaction to allergens, medications or toxic substances

Dialysis cannot cure chronic kidney disease, but it can help an individual live a longer and more satisfying life. Talk to your doctor about the dialysis options and your lifestyle, so that you can both determine the best dialysis modality for you.

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