Treatment Options

Finding out that you have kidney disease can be difficult, and understanding your kidneys is the first step in taking control of your health. Following a kidney-friendly diet, taking good care of diabetes, hypertension and other health conditions and not smoking may help your kidneys function better and longer, even when you have kidney disease. It is also important to realize that you are not alone. DaVita has a caring, compassionate and well-educated team to help you understand kidney disease and the right treatment option for you.

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Hemodialysis

How Is Hemodialysis Done?

In hemodialysis, blood is removed from the body and filtered through a man-made membrane called a dialyzer or artificial kidney, and then the filtered blood is returned to the body. The average person has 4 to 5 liters of blood; during dialysis only half a liter (about two cups) at a time is outside of the body. To perform hemodialysis an access must be created to get the blood from the body to the dialyzer and back to the body. There are three access types for hemodialysis: arteriovenous (AV) fistula, AV graft and central venous catheter. The AV fistula is the access most recommended by the dialysis community; however, you and your doctor will decide which access is best for you.

When a patient goes to hemodialysis, a nurse will check vital signs and get the patient’s weight. The weight gain will indicate how much excess fluid the patient must have removed during the treatment. The patient is then “put on the machine.” A patient with a vascular access (AV fistula or AV graft) will get two needle sticks in the access; one needle takes blood out of the body and the other needle puts it back. Patients with a central venous catheter will have two tubes from the access connected to tubes that lead to the dialyzer and back to the body. The dialysis machine is programmed and then treatment begins.

How Often Is Hemodialysis Done?

Traditional, in-center hemodialysis is generally done three times a week for three to five hours per session, but most common is four hours. Talk to your doctor about how long your hemodialysis sessions should last.

How Is Hemodiafiltration Done?

Hemodiafiltration (HDF) is an alternative blood-purification process that removes larger uremic toxins than those that are removed from hemodialysis. In this process, blood is pumped through a dialyzer at a high rate, causing a significant amount of uremic plasma water (a component of the uremic blood being purified) to be forced across a membrane, removing large, slow-diffusing toxins from the blood. Purified or sterile substitution fluid is then infused back into the blood to replace the flow of uremic plasma water that was pushed across the membrane. Hemodiafiltration is used based on its effective removal of both large and small solutes.

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Peritoneal Dialysis

How Is Peritoneal Dialysis Done?

There is a third type of dialysis, called peritoneal dialysis (PD). PD is done by filling the peritoneum in the abdomen with dialysate, fluid that helps remove the unwanted waste products from your blood, and using the peritoneal membrane as a semipermeable membrane. There are diet and fluid restrictions with peritoneal dialysis; however, these are usually not as limited as those for hemodialysis because this therapy is performed every day. PD treatments are performed at home, and so do not require three visits to a treatment center each week. Peritoneal dialysis also has a nighttime treatment option that makes it easier for patients to work, attend school or travel.

Automated peritoneal dialysis (APD): Home dialysis with PD can be performed using an automated machine known as a cycler. Most patients choose to do their PD with a cycler because it allows dialysis to be done at night and frees up the day for work, school or other activities.

In automated PD, bags of the dialysis solution are hung next to the bed, connected to the cycler machine and then attached to a thin, flexible PD catheter which allows fluid to enter or drain from the abdomen when open, and allows the fluid to remain in place to dwell while clamped closed. The cycler is programmed to perform three to five fluid exchanges while the person sleeps in bed, usually over an 8-to-10-hour time period. Most patients quickly get used to sleeping while on a cycler and have few problems. In the morning, patients detach from the machine and put a small cap onto the end of their tubing. Some people will leave fluid in their abdomen to dwell during the course of the day, and then drain it out when they attach to the cycler machine that evening. Other people can leave their abdomen empty during the day. Depending on dialysis needs, some people may have to do a manual PD exchange during the day in addition to the cycler exchanges at night.

How Often Is PD Done?

Peritoneal dialysis is done daily—either manually during the day, or at night using a cycler machine.

Advantages and Disadvantages of PD

Advantages:

  • PD offers the freedom of dialyzing at home or work rather than in a center.
  • PD allows a person to have more control over their schedule.
  • It is easier to work, attend school or travel.
  • When traveling, the dialysis solution can be delivered to the traveler’s destination.
  • People on PD usually visit the dialysis clinic only once or twice each month.
  • Because peritoneal dialysis is done each day, people on PD may have fewer dietary limitations.

Disadvantages:

  • Because the dialysis solution is made up of dextrose, or sugar, there can be some weight gain and problems with glucose control. If you have diabetes or are obese, ask your doctor if PD is a good choice for you.
  • Since PD is done using the abdomen, it may not be an option if you’ve had previous abdominal operations.
  • Some people feel that the abdominal catheter and fluid in the belly are unattractive.
  • Infection of the PD catheter site isn’t common, but can happen. Your doctor will provide you with instructions on how to keep your catheter site clean to help prevent infections. There is also a risk of peritonitis—an infection in the abdomen—which can be painful, and in serious cases may require a stay in the hospital.
  • PD supplies must be kept at home and a clean environment is necessary to perform exchanges.

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