Dialysis

Dialysis is a treatment for Chronic Kidney Failure by using an artificial method of removing toxic substances (impurities or wastes) from the blood when the kidneys are unable to remove these substances naturally.

There are two types of dialysis: Hemodialysis and Peritoneal Dialysis. Each type has it's own unique administration and lifestyle. As a result the "best" type of dialysis completely depends on the lifestyle of the patient.

 

Hemodialysis

Hemodialysis is preformed by surgically creating a fistula or implanting a graft into the patient's body (typically in the arm or leg). Then for each treatment two needles are inserted into the fistula or graft and blood is pumped out through a dialysis machine and the impurities are filtered out using a hemodialyzer. The blood is then returned to the body.

Hemodialysis is typically administered in a dialysis clinic under the supervision of trained technicians and a nursing staff. A typical hemodialysis schedule is to have treatments three times a week for 3-4 hours at a time (some dialysis centers offer over-night dialysis; this is done for eight hours every night). Recently there has been more of a movement to do hemodialysis at home. This is a more gentle form of treatment and can be more customized to fit each patient's lifestyle. However a typical at home treatment schedule can be as much as eight hours every night.

***Pro Tip: Ask your doctor about using the buttonhole technique. This is a method of administering hemodialysis in which a channel (similar to an earring hole) is created in the access. The needles are inserted at the same angle and location each time. This can greatly extend the life of your fistula.***

Peritoneal Dialysis

Peritoneal Dialysis is preformed by surgically inserting a catheter into the peritoneal cavity of the abdomen (the space between the internal organs).
 This catheter is a permanent fixture that needs to be cleaned and serialized daily to avoid a serious condition known as peritonitis.

Peritoneal dialysis is typically administered at-home using a machine that fills the peritoneal cavity with a dialysis solution that filters out toxins through the body using osmosis. The treatment usually lasts up to 10 hours each night. First the fresh dialysis solution is infused into the body through the catheter using a dialysis machine. Next the solution sits in the peritoneal cavity for a few hours as it filters out the toxins. Finally the toxic solution is emptied out of the body using the catheter and washed away in either the toilet or into waste bags.

This method can be preferable for people who dislike needles or who are more willing to take charge of their own care in a home setting. Some downsides of peritoneal dialysis is that the catheter must be kept clean at all times. This means daily disinfecting and never being able to sit in standing water (which means no baths, or hot tubs, etc,). If the catheter gets wet in any way it must be cleaned immediately. Also the catheter can get in the way of clothing and can slightly impede movement.

Pros and Cons of In-Clinic vs At-Home Treatments:

In-Clinic Treatment
Pros:

• In-clinic treatment with supervision by trained technicians
• Bloodwork, medications, and vital sign monitoring is all done in-clinic during each treatment.
• Treatments can easily be adjusted to meet the ever-changing needs of the patient immediately.
• Technicians can assist in connecting and disconnecting form the machine as well as inserting needles.
• Regular visits by renal doctors reduces need for out-patient visits to doctor's office.

Cons:

• Absolutely must make in-clinic treatments on time and consistently. (Even in inclement weather)
• Rotating staff can mean inconsistent treatments and administration.
• Crowded centers can be loud and uncomfortable.
• Patients can feel that their dialysis schedule dominates their schedules.

At-Home Treatment
Pros:

• Treatments are in a familiar, comfortable environment.
• Dialysis schedule can be more easily modified. (although time requirements will still have to be met)
• Treatments can be done overnight while sleeping.
• No need to travel to clinic three times a week.

Cons:

• Must have supervision by family member during treatments
• Family member must be trained as a stand-in technician.
• Bloodwork and doctor appointments must be done at hospital
• If any problems occur during treatment, the patients must be taken to the E.R.
• Having treatments at-home can lead to feelings of entrapment and inability to escape from treatments.

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