CKD treatment and care

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

Hemodialysis

When is dialysis needed?

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.

Your doctor is the best person to tell you when you should start dialysis.

How does hemodialysis work?

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.

How does the dialyzer clean my blood?

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.

Where is hemodialysis done?

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.

How long will each hemodialysis treatment last?

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.

Can I have hemodialysis at home?

Possibly. Many patients have their hemodialysis treatments at home.

Do I need to eat a special diet?

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.

Can dialysis cure my kidney disease?

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.

Will I be uncomfortable on hemodialysis?

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:

• Slow down your fluid removal, which could increase your dialysis time.
• Increase the amount of sodium in your dialysate.
• Check your high blood pressure medications.
• Adjust your dry weight, or target weight.
• Cool the dialysate a little.
• Use a special medication to help prevent low blood pressure during dialysis.

I have heard I might have to reuse my dialyzer each treatment. Is this safe?

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.

Can dialysis patients travel?

Yes. Dialysis centers are located in every part of the country and in many foreign countries.

Before you travel, you must make an appointment for dialysis treatments at another center.

Can dialysis patients continue to work?

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.

Peritoneal Dialysis

How does peritoneal dialysis work?

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.

There are two kinds of peritoneal dialysis:

• 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.

What kind of peritoneal dialysis is best?

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.

What are the pros and cons about being on peritoneal dialysis?

• 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.
• 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.