Dialysis – What are Your Options?

When the kidneys decline to the point that they are no longer able to filter toxins from the body, dialysis becomes a way for a patient to continue living an active life.

What is dialysis?

Dialysis is a medical treatment used in patients whose kidneys no longer perform the necessary functions of filtering toxins and waste from the blood. By using dialysis, a patient can continue to live an active life, although some changes in diet, schedule, and activity may be necessary. Dialysis is a treatment that essentially replicates the kidney’s function in filtering waste from the blood and regulating fluid levels.

Who needs dialysis?

Dialysis is intended for patients with advanced or end-stage renal disease or permanent kidney failure. A physician will monitor the patient’s creatinine and blood area nitrogen levels to track how well the kidneys are performing their job. When a measure called the creatinine clearance levels fall to 10-12 cc/minute, the patient typically becomes a candidate for dialysis.

If a patient begins to show symptoms of kidney failure, a doctor may begin dialysis regardless of the patient’s creatinine level.

Some symptoms of kidney failure may include the following:

  • Swelling of tissues, especially in the feet and ankles
  • Fatigue
  • Inability to urinate or decreased urine output
  • Nausea or vomiting
  • Drowsiness
  • Shortness of breath
  • Confusion

However, many of these symptoms are non-specific, in that they are also symptoms of other medical conditions. An evaluation by a physician is necessary to diagnose kidney failure.

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Types of dialysis

Physicians typically recommend one of two different types of dialysis, based on which would be best for the patient’s needs and lifestyle. The two types of dialysis are hemodialysis and peritoneal dialysis. Hemodialysis is much more common in the United States.

Hemodialysis

Hemodialysis works by filtering the patient’s blood to remove waste and excess fluid with the use of a machine containing a dialysis membrane. The procedure is performed by inserting a specialized plastic tube, called a gortex graft, in between a vein and artery in the patient’s arm or leg. Needles are then placed into the graft, and blood begins to pass from the body through the dialysis membrane to be filtered before traveling back to the patient. Waste from the blood is collected by the machine to be disposed of after the treatment.

This type of dialysis usually takes place in a hemodialysis unit that contains all of the equipment and medical staff needed to perform the procedure. The patient may be able to receive dietary counseling and other services at the unit as well. Treatment is usually performed three times a week, with each procedure lasting 2 ½ to 4 ½ hours. While the treatment takes place, the patient reclines in a type of lounge chair and may read, watch television, work on paperwork, or sleep. The staff will monitor the patient’s blood pressure and the rate of the dialysis’ progress.

Many patients choose hemodialysis because they don’t have to play as much of an active part in the dialysis procedure as those patients who use peritoneal dialysis. In addition, peritoneal dialysis is not an option for some people, due to other preexisting medical conditions. Those who do use hemodialysis often must follow a more rigorous diet and fluid restrictions than those undergoing peritoneal dialysis.

Peritoneal Dialysis

Peritoneal dialysis uses the peritoneal membrane in the patient’s stomach to help filter out waste. During the treatment, the abdominal cavity is flooded with special fluids and solutions that help carry waste out of the body through a plastic tube called a peritoneal dialysis catheter, which is inserted into the abdominal cavity.

This type of dialysis requires the patient to take a more active role in the treatments, because they administer the dialysis themselves. The treatment can be performed at home, but it must be done four to five times a day. The patient begins the process by weighing themselves to determine how much solution they must use. The next step involves cleaning the site where the peritoneal catheter is inserted into the abdomen, in order to prevent infection. Once the cleaned catheter is in place, waste from the body is drained into a solution bag. This bag is then disconnected from the catheter and disposed of, and a new bag of solution is connected to the catheter and drained into the body. The fluid remains in the abdominal cavity for several hours, before being drained back into the solution bag and disposed of. The process of switching out the solution takes around 30 minutes.

There is another option for peritoneal dialysis that involves a machine called a cycler that is used while the patient sleeps. Four to five bags of solution is attached to the machine, and the cycler will automatically filter the solution throughout the night as the patient sleeps.

Patients who prefer to have more personal control over their treatment may choose peritoneal dialysis, but they must remain vigilant to keep the catheter and their stomach surface disinfected before and after every treatment, in order to prevent infection of the insertion site and stomach cavity. This can become a problem if the proper precautions are not taken by the patient or caregiver.

doctor research microscope

Dialysis restrictions

While undergoing dialysis, patients are typically subject to dietary and fluid restrictions from their physicians. Following these guidelines can help dialysis be more effective and can improve the patient’s overall health. Patients usually have dietary guidelines drawn up by their physician or a special dietitian. In addition, dialysis patients typically require medication to keep them healthy.

The Choice

Selecting a type of dialysis is a decision that a patient should only make with the guidance  of his or her physician. In addition, in some cases, the patient may not have a choice as to which type of dialysis will work best, given his or her medical condition and physical mobility.