Dialysis
In end-stage renal disease, kidney function can only be replaced through dialysis or kidney transplantation. See the Transplant section for more details on transplants. There are two main types of dialysis: (1) hemodialysis and (2) peritoneal dialysis.
Hemodialysis
Hemodialysis involves passing blood through a dialysis machine's filter. The machine cleanses the blood by removing waste products and excess water. It also normalizes acid levels and the concentration of minerals like sodium and potassium. After purification, the blood is returned to the body.
Long-term hemodialysis requires access to a blood vessel, providing a pathway for blood to be removed and returned to the body. This access can be a dialysis catheter or an arteriovenous fistula or graft.
A catheter can be temporary or permanent and is placed in the neck or groin, connecting to a large blood vessel. However, catheters can be prone to infection and may lead to clotting or narrowing of blood vessels.
The preferred access for hemodialysis is an arteriovenous fistula, where an artery is directly connected to a vein. It takes a few months for the vein to mature before it can be used for dialysis. Once matured, two needles are inserted into the vein for the dialysis processβone to withdraw blood and run it through the machine and the other to return the purified blood.
If a fistula can't develop, an arteriovenous graft made of artificial material can be used, with dialysis needles inserted directly into the graft.
Placement of these venous access devices typically involves local anesthesia and can be done on an outpatient basis. Hemodialysis sessions generally last three to five hours and are usually required three times a week. Patients need to travel to a dialysis center for treatment.
In some cases, home hemodialysis is an option, but it requires a care partner to assist with the treatments. This can be a family member, friend, or a hired professional. Home hemodialysis can be performed three times a week, as traditional treatments, or as long nocturnal (overnight) hemodialysis or short daily hemodialysis. The latter two options offer benefits in terms of improved quality of life and better control of high blood pressure, anemia, and bone disease.
Peritoneal Dialysis
Peritoneal dialysis utilizes the abdominal lining (peritoneum) as a natural filter to cleanse blood and remove excess fluids. This method involves implanting a catheter into the abdomen through a minor surgical procedure. Peritoneal dialysis can be performed manually or by using a machine, often at night.
About 2 to 3 liters of dialysis fluid are introduced into the abdominal cavity via the catheter. This fluid contains substances that pull waste and excess water from the surrounding tissues.
The fluid is allowed to dwell for a few hours before being drained, carrying away unwanted waste and water. This exchange typically needs to be done four to five times a day.
Peritoneal dialysis offers more flexibility compared to hemodialysis, as it doesn't require regular visits to a dialysis center. Patients can continue with their usual activities during treatment. This method may be preferred, especially for children.
Most patients are eligible for both hemodialysis and peritoneal dialysis, and there are little differences in outcomes between the two. Your physician may recommend one based on your medical history and surgical background. It's best to choose your dialysis modality after understanding both procedures and considering your lifestyle, daily activities, schedule, proximity to the dialysis unit, support system, and personal preference.