Once a patient is diagnosed with ESRD, three options for renal replacement therapy are possible:
· Peritoneal dialysis
Hemodialysis (HD) is a procedure that cleans and filters your blood. It eliminates the harmful wastes and extra salt and fluids from the body.
HD uses a special filter, a dialyzer, with a semipermeable membrane where the blood is cleaned. This dialyzer is connected to a machine. During treatment, the blood circulates through tubing systems pumped by a machine into the dialyzer. The dialyzer filters out the waste and extra fluids. Then, the cleaned blood flow back to you.
Before the first treatment, an access to the bloodstream must be made. The access provides a way for blood to be carried from your body to the dialysis machine and then back into your body. The three main types of vascular access for HD are the AV fistula, vascular access graft and central venous catheter.
HD can be done at home or at a center. At a center, nurses or trained technicians perform the treatment. At home, you perform hemodialysis with the help of a partner, usually a family member or friend. If you decide to do home dialysis, you and your partner will receive special training.
Hemodialysis usually is done three times a week. Each treatment lasts from 3.5 to 5 hours. During treatment, you can read, write, sleep, talk, or watch TV.
Peritoneal dialysis (PD) is another procedure that replaces the work of your kidneys. It removes extra water, wastes, and chemicals from your body. This type of dialysis uses the peritoneum to filter your blood.
A cleansing solution, called dialysate, travels through a special tube into your abdomen. Fluid, wastes, and chemicals pass from tiny blood vessels in the peritoneal membrane into the dialysate. After several hours of the prescribed dwell time, the dialysate gets drained from your abdomen, taking the wastes from your blood with it. Then you fill your abdomen with fresh dialysate and the cleaning process begins again.
Before your first treatment, a surgeon places a small, soft tube called a catheter into your abdomen. This catheter always stays there. It helps to transport the dialysate to and from your peritoneal membrane.
There are two main types of this PD process of filling and draining:
· CAPD (Continuous Ambulatory Peritoneal Dialysis), manually during the day.
· APD (Automated Peritoneal Dialysis), automatically at night with a cycler.
Kidney transplantation is a procedure that places a healthy kidney from another person into your body. This new kidney does all the work that your two failed kidneys cannot do.
The surgeon places the new kidney inside your body between your upper thigh and abdomen connecting the artery and vein of the new kidney to your artery and vein. Your blood flows through the new kidney and makes urine, just like your own kidneys did when they were healthy. The new kidney may start working right away or may take up to a few weeks to make urine. Your own kidneys are left where they are unless they are causing infection or high blood pressure.
You may receive a kidney from a member of your family. This kind of donor is called a living-related donor. You may receive a kidney from a person who has recently died. This type of donor is called a cadaver donor. Sometimes a spouse or very close friend may donate a kidney. This kind of donor is called a living-unrelated donor. It is very important for the donor’s blood and tissues to closely match yours. This match will help prevent your body’s immune system from fighting off or rejecting, the new kidney. A lab will do special tests on blood cells to find out if your body will accept the new kidney.
The surgery takes from 3 to 6 hours. The usual hospital stay may last from 10 to 14 days. After you leave the hospital, you will go to the clinic for regular follow up visits.
What is the best treatment for me?
Various medical, social and psychological factors should be considered. Your doctor will help you and give you advice on choosing the adequate treatment modality for you.
As a hemodialysis patient, will I be able to keep working?
Absolutely, keeping your life working tempo will keep you in a good condition mentally and physically, while productive to society.
Is dialysis painful?
During the initial vascular access, you may feel a pinch when each of the needles penetrates in. Nonetheless, there are skin numbing drugs that can help. The rest of your dialysis treatment should not hurt.
Can I do sport?
Patients should keep active doing sports. Sport and other activities help you to stay healthy and feel good taking part of games. In any case, ask for advice to your doctor before starting any sport.
Can dialysis patients travel?
Yes. Renal care centers are in most countries of the world. The treatment is standardized. You must make an appointment at another center before you go.