100 Questions & Answers About Kidney Dialysis


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It is sometimes called a CT scan. Figure 1 Kidney location Source: Robert K. They are located in the abdomen in the lumbar region of the back, right under the lungs Figure 1. They are partially protected by the rib cage. Occasionally a person can be born with one kidney or one normal kidney and another that is small and not working. Another condition, known as horseshoe kidney, occurs when a person is born with a single large kidney.

Most of the time people with one kidney or a horseshoe kidney have no symptoms. Patients who have a horseshoe kidney or a single kidney are often discovered when ultrasound or computed axial tomography CT scans are done for Horseshoe kidney A medical condition in which the right and left kidneys are fused at the upper or lower pole. Ninety percent of horseshoe kidneys are fused at the lower pole. The horseshoe kidney is capable of normal kidney function and is usually found when a CT scan or ultrasound sonogram is performed for abdominal pain or other symptoms.

Patients with a horseshoe kidney are not predisposed to kidney disease. Many times when we have pain in our back, we think it is due to a kidney problem. More likely, back pain is caused by muscle strain or spasm, or a vertebral disc problem. Pain in the back that radiates to the side or into the groin can be due to a kidney stone. What is the glomerulus? Glomerulus The part of the kidney composed of small blood vessels that filters the blood to produce urine.

The kidneys are composed of about two million functional units called nephrons. A nephron is composed of a glomerulus, kidney tubules, and blood vessels. A glomerulus can be thought of as a small filter. It is made up of small blood vessels called capillaries. Source: Robert K. Fluid, salts, sugars, and small substances can pass through the thin wall of the glomerulus, but larger substances such as proteins, red blood cells, and white blood cells are too big to be filtered.

If the glomerulus is damaged, proteins or blood cells can find their way through the glomerulus and into the urine. This problem can be discovered by having a test called a urine analysis, which can be done at any medical laboratory. Often the first sign of kidney problems is discovered because a routine urine analysis done for a yearly physical, an application for life insurance, or for an employment physical contains protein or blood.

We can live a normal life with a reduced number of glomeruli. Diabetes A disease characterized by an elevation of the glucose level in the blood. This can be caused by a decrease in insulin production by the pancreas or a defect in the insulin receptor. Also called systemic lupus erythematosus SLE. Sickle cell anemia An inherited anemia that results in red blood cells forming a crescent shape. Sickle cells block small vessels and can result in injury to the bones, heart, lungs, and kidneys. Atherosclerosis A disease process that involves deposition of cholesterol in the walls of arteries, causing narrowing of the arteries.

This can cause blood to clot, further reducing blood flow. Over a period of time, the remaining glomeruli enlarge or hypertrophy and are able to increase their function. As we age, out glomeruli normally decrease in number due to scarring. This is a silent process without symptoms and signs, and is often overlooked even by doctors. What can damage the kidneys? Hundreds of things can damage the kidneys.

The most common medical problem that causes damage to the kidneys is uncontrolled diabetes. When a diabetic has a high blood glucose, this causes an enlargement of a part of the cell wall of the glomerular capillary filter called the basement membrane. Capillaries and other cells begin to enlarge. This leads to scarring or sclerosis of the glomerulus and results in the glomerulus becoming a damaged filter. Proteins from the blood can leak through the damaged filter and appear in the urine.

This leakage can lead to further kidney scarring and damage. High blood pressure can contribute to further glomerular scarring and damage. Kidney problems can also be caused by urinary tract infections, medications, surgical procedures, kidney stones, as well as certain types of cancer. Diseases such as lupus erythematosus and sickle cell anemia can damage many parts of the body including the kidneys.

Smoking and elevated cholesterol can cause hardening of the arteries or atherosclerosis to occur in the renal arteries that supply the kidneys with blood. HIV infection causes kidney problems in some patients. In many patients, multiple problems have contributed to kidney damage. Our parents have a tremendous influence upon our future health.

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We inherit one copy of each of our genes from each parent. The most common form of inherited kidney disease is autosomal dominant polycystic kidney disease ADPKD. In this disease, we only have to inherit one defective gene from either our father or mother. Most, but not all, people who inherit the gene develop some form of renal disease, which can be mild or severe. The gene causes our kidneys to form multiple cysts that increase in number and size over time. Scientists have found the location of two genes for polycystic kidney disease, one of which is on chromosome 16 called the APCKD1 gene.

It can be diagnosed before birth. Screening for cysts is best done after 30 years of age with a kidney sonogram test, which can detect the cysts. An example of a disease where we need defective genes from both our parents is sickle cell anemia. This genetic disorder is most common in black patients, but can be seen in people of Italian, Indian, Hispanic, and other origins. Diseases such as diabetes, hypertension, systemic lupus erythematosus, and kidney stones are more common in patients with parents who have these disorders.

Most importantly, our parents are role models for our own lifestyles and behaviors. If our parents smoke cigarettes, we are much more likely to smoke ourselves. An overweight parent is more likely Autosomal dominant polycystic kidney disease ADPKD The most common form of inherited kidney disease. Patients inherit the gene from either parent and many cysts form in the kidneys.

HIV can be transmitted through blood transfusion, intravenous drug use, sexual activity, and through a needle stick. HIV cannot be transmitted during dialysis treatments. An elevated BUN can indicate decreased kidney function. Serum creatinine A blood test used to screen patients for kidney disease. Creatinine is a breakdown product of muscle. When the kidney function is decreased, the kidneys filter less creatinine and the serum creatinine level rises. Urine analysis A common screening test that looks for the presence of protein, glucose, and cells in the urine.

It can help determine if further tests for kidney disease are indicated. Microalbumin A test designed to detect very small elevated amounts of the protein albumin in the urine that are not able to be detected by a routine urine analysis. This being said, we are not our parents. Many people are not affected by their genetic heritage. As medical science improves, new medications for diseases make the prognosis for young people with inherited diseases much better than that of their parents.

How do I know I have kidney disease? Kidney disease sneaks up on us. If we develop chest pain, we immediately think of the heart. Cough, fever, and shortness of breath would cause many of us to seek medical attention for pneumonia. Most patients with kidney disease are asymptomatic in the early stages.

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Swelling of the legs, high blood pressure, blood in the urine, foaming of the urine, or a family history of kidney disease cause some people to be tested for kidney problems. The search for kidney disease begins with a visit to your doctor. He or she may be a family practitioner, internist, pediatrician, or gynecologist. A detailed history will be taken and a complete physical examination performed. The initial tests to screen for kidney disease include a complete blood count, a blood urea nitrogen BUN , serum creatinine, and urine analysis.

If all these tests are normal, probably no significant renal disease is present. In diabetic patients, a urine test for microalbumin can detect very small amounts of albumen. A positive test can predict who has a high chance of developing kidney disease and who would benefit from early aggressive treatment.

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Other tests include a hour urine collection for protein and creatinine clearance to accurately measure renal function. How common is kidney disease? Kidney disease is becoming more and more common. This is in part due to our increased lifespan. Due to many advances is public health measures as well as medical treatments for heart disease, hypertension, and diabetes, we are living longer and more productive lives. When I began my education in medical school in the s, it was very special to see a patient in the hospital who was years old. Now it is much more common. As we live longer, the chance that we will develop disease processes that will affect our kidneys goes up.

It is estimated that in patients in the Medicare system in over the age of 75 years, one million people had chronic kidney disease. In the 65to year-old age range, , people suffered from chronic kidney disease. In an additional , people were receiving dialysis treatments. The numbers are much higher today about , patients because kidney disease is growing at a rapid rate.

This is partly due to the rapid increase of new patients with diabetes. As we become more affluent, we have more choices of both type and quantity of food. We are less likely to walk or to engage in physical Dialysis A scientific term for the movement of substances across a membrane by a process called diffusion. If these tests are positive, your doctor may refer you to a kidney specialist. This specialist may be a medical kidney doctor, called a nephrologist, or a urologist, who is a surgeon who specializes in diseases of the kidneys, bladder, and prostate.

The specialist has seen many different kinds of kidney problems. He or she can answer many of your questions and may want to obtain further testing to give you a specific diagnosis of the cause of your problem. We are getting larger. As our weight increases, we increase our chance of developing diabetes. As a result, the number of diabetics in the population has soared. It is estimated that there are over 21 million diabetics in the United States.

Because diabetes is the number one cause of kidney disease in industrialized societies, the number of people with kidney disease is increasing rapidly. Our awareness of kidney disease is also growing. We are more likely to go to the doctor for a routine checkup than our parents. Once we are at the doctor, there is a good chance that blood and urine tests will be ordered. We are targeting those at high risk for kidney disease for screening. Finally, well-known personalities in the media or sports fields, such as Art Buchwald and Alonzo Mourning, have publicly discussed receiving dialysis treatments and a kidney transplant.

We have become more knowledgeable about kidney disease and more willing to discuss it with our family and friends. This communication has led us to a better understanding of kidney disease and the need to take it seriously. Can kidney disease be prevented by diet? Special diets for the treatment of kidney disease have been available for many years.

Before dialysis and modern medications were available, the only available treatment for kidney disease was a special diet. People with kidney disease were placed on low-protein diets in the hope that the progression of kidney disease would be slowed. In addition, intake of salt, potassium, phosphorus, and fluid was restricted. People on these diets could live longer, but the quality of their life was poor.

They often became malnourished. Rats placed on low-protein diets showed a dramatic improvement in their survival compared to rats on high-protein diets. This resulted in a great deal of enthusiasm for protein restriction in the diet. Our normal diet in the United States is heavily weighted toward high-protein foods such as meat, fish, poultry, and milk products. Unfortunately, studies in people on low-protein diets were not as conclusive as the studies in rats. Many doctors still recommend a modest restriction in protein intake in patients with kidney disease.

Many patients believe that cranberry juice can be helpful for kidney disease. This idea comes from the ability of fresh cranberry juice to acidify the urine, which can be helpful in urinary tract infection. Patients with urinary tract infection are treated with antibiotics, which are far superior to cranberry juice. Most people with kidney disease will get no benefit from cranberry juice, but it sure tastes good. Because so many people with kidney disease suffer from hypertension, it is important to consider a lowsalt diet.

A low-fat diet is important in people with an elevated cholesterol or triglyceride level because vascular disease occurs often in people with kidney disease. Patients with diabetes require special diets. There is a great deal of information available in books, in magazines, and on the Internet about diet. Many supplements are available. It is extremely important that professional advice be obtained before going on any diet. Only a health professional can look at your individual case, review your blood tests and medical history, and determine if a particular diet is right for you.

Many people have spent years on restrictive diets only to dis- Advice that is good in general can be the worst advice for a specific person. Advice that is good in general can be the worst advice for a specific person. Angiotensinconverting enzyme inhibitors A class of medications that is useful in treating high blood pressure, stabilizing kidney disease, and improving patients with congestive heart failure. ACE inhibitors stabilize kidney disease by decreasing the amount of protein in the urine and decreasing the damage done by elevated blood pressure.

Angiotensin A polypeptide produced in the kidney, which causes blood pressure to rise. What medications can prevent my kidneys from getting worse? The first medications proven to delay the progression of kidney disease are a class of medications called angiotensin-converting enzyme inhibitors Table 1.

Doctors and other medical professionals call them ACE inhibitors for short. These medications work by blocking an enzyme that activates a protein called angiotensin. ACE inhibitors decrease blood flow to the glomeruli. This decrease in blood flow will prevent scarring of the glomerulus and surrounding tissues. ACE inhibitors lower blood pressure. They are most often taken once or twice a day. They help prevent hardening of the arteries, or atherosclerosis.

ACE inhibitors are also helpful in preventing heart attacks and in the treatment of congestive heart failure. Like ACE inhibitors, these medications are taken orally, lower blood pressure, and help protect the heart. They can raise potassium, cause rashes, and worsen kidney function but they do not cause cough. Because ARBs are newer med- Angioedema A serious allergic reaction characterized by swelling of a body part, often the face or lips. ARBs can treat high blood pressure, stabilize kidney disease, decrease protein in the urine, and treat congestive heart failure.

The cough goes away when the ACE inhibitor is stopped. Skin rash is an uncommon side effect. More severe allergic reactions causing swelling of the face or lips are uncommon. This is called angioedema and must be recognized and treated immediately by your doctor. ACE inhibitors can cause an elevation in the potassium level.

Potassium is an element in the blood and body. Too high or too low a potassium level can affect the function of the heart. Blood tests will be needed after you start ACE inhibitor medication and afterward on a regular basis to watch your potassium level. If your potassium level is too high, your doctor or healthcare professional may recommend that you decrease your intake of potassium-rich foods. He or she may place you on a potassium-lowering medication called Kayexalate to bind the potassium in your gastrointestinal tract. If your potassium is still too high, you may be told to stop taking your ACE inhibitor.

In rare cases, your kidney function may get worse on ACE inhibitors. This is more common in people who have vascular disease or who are dehydrated. Regular blood tests can help your doctor or healthcare professional identify this problem, which will improve after the ACE inhibitor is stopped. Many advertisements by drug companies encourage the belief that their ACE inhibitor or ARB is better than all the others. They will list multiple advantages and often feature smiling models posing as patients or doctors testifying to the superiority of their medication and low number of side effects.

Medical research may help decide this question. Time will tell. If this is done, the patient must come for blood tests and frequent visits to prevent complications. Other medications may be helpful in stabilizing kidney function. Additional medications to control blood pressure and cholesterol are commonly needed. Patients with diabetes must pay special attention to optimize their medication to control their blood sugar level. The advantage of alternative therapies is that they are thought to be less toxic than conventional medical treatments.

They are often derived from plants, fungi, minerals, or other substances found in nature. In reality, the separation of alternative and traditional medicine is an artificial distinction. The first physicians often grew medical herbs in their gardens. In the modern era, cyclosporine, a product of a fungus, revolutionized kidney transplantation. This is almost never mentioned as an alternative treatment.

Physicians interested in kidney diseases have been intrigued with omega-3 fatty acids found in fish oils. They have been used to treat high cholesterol as well as a kidney disease called IgA nephropathy. We are all looking for the next new miracle drug. Hopefully, this new treatment will be natural, nontoxic, and will have few side effects.

Because of the great interest in alternative medical treatments, the US National Institutes of Health established the National Center for Complementary and Alternative Medicine in This center will be supervising much-needed scientific research on complementary and alternative medical treatments to see which are effective. I am often brought advertisements for vitamins or dietary supplements by patients who are interested in alternative medical treatments.

Some of them contain Alternative medicine A medical discipline that uses natural products and diet to treat medical illness. IgA nephropathy A disease of the kidney that often presents with blood and protein in the urine. The immunoglobulin IgA is seen in the kidney on biopsy. It is best to get expert medical advice from a medical professional who is experienced in working with kidney and dialysis patients before taking vitamins or alternative treatments.

What alternative medicine treatments are available for kidney disease? Sonograms Medical tests in which sound waves are used to obtain pictures of organs in the body. A kidney sonogram requires no injections of substances or exposure to radiation. Also known as an ultrasound. Immunosuppressive therapy Immunosuppressive therapy works by suppressing the activity of the cells and antibodies of the immune system.

In the treatment of some kidney diseases, immunosuppressive medicines are given intravenously or orally to decrease the immune response. Kidney transplant patients also need immunosuppressive medications to prevent rejection of the transplant. How can I stabilize my kidney function and stay off dialysis? Many patients feel devastated when diagnosed with a kidney disease. In reality, kidney disease has good treatment options at all stages. Treatment is widely available and is not experimental but proven to be effective. The first step is to look for reversible causes of kidney disease. Medications that cause kidney disease need to be stopped.

Tests to look for blockages of the kidney such as sonograms need to be considered. The accurate diagnosis of the cause of kidney disease by kidney biopsy can determine if the patient is a candidate for immunosuppressive therapy with a variety of medications. Immunosuppressive medications that are available include steroids, cyclosporine, cyclophosphamide, and others. Diet and control of blood pressure, blood sugar, and cholesterol are all important. In many cases, kidney disease can be stabilized and patients can be managed without renal replacement therapy.

He found that I had an elevated creatinine level in my blood and high blood pressure. I was referred to a nephrologist. The nephrologist performed a complete physical exam, sent me for a sonogram of the kidneys, and had me collect my urine for 24 hours. After these tests, I went for a kidney biopsy. The biopsy stung for a few seconds but was not that bad. I was told that both my kidneys were diseased by something called focal segmental glomerular sclerosis. This disease was causing scarring of the kidneys and was causing my high blood pressure.

I took blood pressure medication and a medication called cyclosporine to help prevent the scarring of my kidneys. I had a scary feeling about my future. I knew that dialysis would take a lot of time and effort. My medications were very expensive. I had to wait until the end of December when the new year started and my insurance would pay for the medication again.

It was hard to keep my diet. Despite my kidney disease, I worked full time. I was often tired and sad. My girlfriend gave me good support. In March of , we got married. She was never put off by my kidney disease and encouraged me. When I was sad, she was sad.

My wife became pregnant, and we have a beautiful little girl. My daughter helped take my mind off my problems. I stopped drinking alcohol because I figured that if I had one organ damaged, I needed to keep the rest of my body as healthy as possible. To stay off dialysis you have to stay away from salt and potassium and keep your diet. Take your medications.

Try and work with your doctor. The better you are at taking your medications and keeping your diet, the longer you will stay off dialysis. Can children be treated with dialysis? What will happen if I skip a dialysis treatment? What is dialysis? Dialysis is a scientific term for the movement of substances across a membrane by a process called diffusion. If a great deal of a substance is in one place, some of that substance will tend to move out to where the substance is not present.

If we gently add a teaspoon of milk to a cup of tea, the milk will diffuse out with time to all areas of the cup. In dialysis, we add a barrier or membrane between two liquids. On one side of the membrane is a liquid with a high concentration of a substance. On the other side of the membrane is a liquid without that substance. If the membrane has small holes or pores, the substance on one side of the membrane will travel or diffuse across the membrane to the other side until the amount on each side is equal.

Dialysis membranes are said to be semipermeable. They allow some small substances to pass through while large substances cannot fit through the holes. Dialysate A fluid containing sodium, calcium, bicarbonate, and other substances that is used to remove toxins and poisons during dialysis. Different dialysate solutions are used in hemodialysis and peritoneal dialysis. On the other side of the semipermeable membrane, is another liquid called dialysate.

Substances in the blood, if they are small enough, will move through the membrane into the dialysate. If the dialysate is then discarded and new dialysate is added, more of the substance can be removed. Removal of substances depends on the size of the substance, the electrical charge of the substance, and also the difference in the amount of the substance on one side of the membrane compared to the other.

If we change the amount of substances in the dialysate, we can remove more or less of a substance. We can even add more of a substance to the dialysate than is in the blood. This can be done with substances that can pass through the semipermeable membrane. If we put a high concentration of the sugar glucose in the dialysate, it will move or diffuse across the membrane into the blood and raise the level of glucose in the blood. Dialysis sounds complicated, but it all boils down to the process of diffusion.

Large things such as red blood cells, large proteins, and other large substances are trapped on one side of the membrane in the blood. Small things including salts such as sodium and potassium, water, and small proteins can freely move across the membrane from areas where large amounts are present to areas where they are not present.

When was dialysis invented? The first time dialysis is mentioned in scientific literature was by Thomas Graham, a Scottish chemist, who wrote about dialysis in He used an ox bladder for his membrane. George Haas, working in Germany in the s, was the first person to use dialysis to treat patients. Most kidney doctors consider Dr. Willem J. Kolff to be the father of modern dialysis. Kolff was caring for war casualties who were dying of kidney failure. He decided to design and build an artificial kidney. Because medical supplies were limited, he obtained his membrane for dialysis from a sausage factory.

This sausage skin was made of cellulose acetate. He also used an automobile water pump in his machine. Kolff was able to treat a year-old woman with kidney failure and maintain her on dialysis until her own kidneys recovered. Hemodialysis A medical treatment in which blood is removed from the patient with needles and plastic tubing and pumped past the dialysis membrane. Poisons and toxins cross the dialysis membrane into the dialysate, which is then discarded, and the blood is returned to the patient.

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Heparin An acid that occurs naturally in the liver and lungs that can be purified and used as a medication to prevent blood from clotting. Heparin is used in hemodialysis to prevent blood from clotting in the plastic tubing and when exposed to the dialysis membrane. It can also be injected into the peritoneal dialysis fluid to prevent clots from blocking the peritoneal dialysis catheter. What is hemodialysis? Blood is obtained from the patient with needles and plastic tubing. The blood is then pumped past a semipermeable dialysis membrane. Poisons and toxins that are usually removed by the kidneys pass through the membrane by diffusion into a liquid called dialysate.

The dialysate is then discarded along with the toxins. A blood thinner called heparin is given to prevent the blood from clotting in the plastic tubing or when in contact with the dialysis membrane. The hemodialysis machine has safety equipment to determine if the hemodialysis is going well Figure 3.

These sensors may sound an alarm to help guide the staff. These alarms do not signify danger to the patient.

100 Questions & Answers About Kidney Dialysis

The modern hemodialysis machine has benefitted greatly from the computer age. The electronic chips and integrated circuits in the dialysis machine make dialysis accurate, safe, and reliable. This has improved the quality of care. Neelakantappa, MD What is peritoneal dialysis? The peritoneum is a membrane that covers our intestines inside our abdomen. In hemodialysis, an artificial membrane is used. In peritoneal dialysis, we take advantage of the semipermeable qualities of a naturally occurring membrane. Continuous ambulatory peritoneal dialysis CAPD A home dialysis procedure taught to patients who perform their own peritoneal dialysis, CAPD involves the instillation by gravity of dialysate through a catheter into the abdomen.

The fluid remains in the abdomen for a time, allowing poisons and toxins to accumulate in the dialysate. The dialysate is then drained and discarded, and fresh dialysate is instilled. This tube is called the peritoneal dialysis catheter. After the tissues around the tube have healed, the tube is used to instill dialysate into the abdomen. The dialysate fluid is allowed to remain in the abdomen for several hours. During this time, poisons and toxins leave the blood vessels of the intestine, pass through the peritoneal membrane, and collect in the dialysate fluid.

The dialysate is then drained by gravity through the peritoneal dialysis catheter and collected in a bag. The dialysate fluid containing poisons and toxins can then be discarded into a sink drain or toilet. Another bag of dialysate, usually containing 2 liters of fluid is then infused into the abdomen. Each dialysis drainage and infusion is called an exchange because the fluid is removed and replaced.

Patients usually perform four exchanges every day. The peritoneal dialysis exchanges are initially done by the peritoneal dialysis nurse. The patient on peritoneal dialysis is then trained over a period of weeks to safely perform the dialysis. The exchanges can be done at home, at work, or in any clean, quiet place because no special machine is required. This form of peritoneal dialysis is called continuous ambulatory peritoneal dialysis, or CAPD.

The continuous means that the dialysis will continue throughout the day. Ambulatory refers to the dialysis being done outside of a hospital or medical facility. CAPD is the most popular form of peritoneal dialysis. Which treatment will be best for me, hemodialysis, peritoneal dialysis, or a kidney transplant?

Cycler A machine used to automate peritoneal dialysis by performing the exchange of peritoneal dialysis fluid. Continuous cyclical peritoneal dialysis CPPD A home peritoneal dialysis procedure that uses a cycler to instill and drain fluid into the abdomen. The cycler can perform peritoneal dialysis while the patient is sleeping. When faced with kidney disease and the need for renal replacement therapy, most people are overwhelmed. It is difficult to decide which therapy is best. Initially, most patients are treated with hemodialysis at a dialysis center. At the hemodialysis center, the dialysis is performed by the dialysis staff.

This allows the patient to get used to the hemodialysis treatment, learn about their diet and medications, and grow stronger. The adjustment to dialysis is both physical and emotional. The dialysis staff will help with this adjustment. Other patients in the dialysis center are able to provide support and advice because they have had to cope with a similar adjustment in the past. Hemodialysis is safe, effective, and well tolerated by most patients. Patients 25 Dialysis dialysis, but it can also be done by other family members. In the case of children on dialysis, the parents usually perform the dialysis.

Elderly patients with many health problems can also have family members perform dialysis. Peritoneal dialysis can also be done at night with the aid of a machine called a cycler. It will then automatically perform the exchanges during the night. This form of peritoneal dialysis is called continuous cyclical peritoneal dialysis, or CCPD.

It allows the patient to be free during the day to work or go to school without performing their exchanges. Family members can also set up the cycler at night without interfering with their daytime activities. Peritoneal dialysis done in a dialysis center is not common but is available in a few dialysis units. Most dialysis units are closed on Sunday. Treatments are organized in shifts with many patients beginning and ending at about the same time. Patients have 4 days when they do not have hemodialysis treatments.

They, however, must keep their diet and take medication 7 days a week. Patients on peritoneal dialysis start their treatments at a peritoneal dialysis center or unit. The dialysis staff begins the treatment and trains the patients to perform their own dialysis treatment. This training takes several weeks. Most people can learn how to perform the peritoneal dialysis exchanges. Patients usually require 4 exchanges a day, 7 days a week.

Because peritoneal dialysis is done 7 days a week, fluid and poisons are removed continuously every day. This continuous treatment allows an increased intake of fluid and a more varied diet. Hemodialysis treatments are typically three times a week. Between hemodialysis treatments, fluid, potassium, salt, and phosphorus intake must be limited.

Another advantage of peritoneal dialysis is the ability to vary your dialysis schedule by changing the time or the location of your exchanges. Peritoneal dialysis allows greater flexibility of travel because there is no need to be in a dialysis center or to have a dialysis machine. Kidney transplantation is a very attractive option for renal replacement therapy because no dialysis is needed. A kidney transplant can come from a family member, a person who is not a blood relative like a spouse or a friend, or from a donor who has died.

Most patients need to be treated with some form of dialysis before a kidney transplant can be accomplished. Kidney transplant patients must take immunosuppressive medication to prevent rejection of the kidney transplant for as long as the transplant is working. We are very fortunate to have three good treatments for renal replacement therapy. It is very likely that patients with kidney failure will be treated with more than one kind of treatment modality during their lifetime.

The choice of the initial therapy is less important than we tend to think. If we are unhappy with our choice or experience difficulties with one therapy, we can change to another renal replacement therapy. Children can be treated with hemodialysis or peritoneal dialysis. Between and , over 7, children required renal replacement therapy in the United States. As in adult patients, more children are begun on hemodialysis than on peritoneal dialysis. Kidney transplantation is the preferred treatment in children.

Three out of four children 27 Dialysis We are very fortunate to have three good treatments for renal replacement therapy. Many patients start on hemodialysis as an initial therapy. As they become more knowledgeable, they may switch to peritoneal dialysis when they feel capable of performing their own dialysis treatments. Some patients learn to perform home hemodialysis that also requires special training. Many patients on dialysis plan to receive a kidney transplant. Others prefer to remain on dialysis.

Transplant recipients facing loss of their transplant from rejection can choose to return to hemodialysis or peritoneal dialysis. Transplantation offers the best hope for normal growth and development as well as enabling children to participate in school and athletics. The availability of parents as healthy potential donors makes transplantation a good option. Siblings must be over 18 years of age to donate a kidney.

Where will I go for dialysis? In the early days of dialysis, dialysis units were at major medical centers. As the need for dialysis has grown, many more units have opened. Dialysis has become safer and routine. Instead of being in a hospital, most units are now freestanding.

This means they are in the community closer to home. Your dialysis unit may be in a shopping center, may be a separate building, or may be part of an office building. Many of us pass these units every day unaware of their existence. When you walk into a dialysis unit, you will enter a reception area or waiting room. Nearby is the treatment area, which is a large room containing 10 to 20 dialysis stations. Each dialysis station has a dialysis machine, a reclining chair, and usually an individual television set.

Many dialysis units have computers for record keeping. The stations are in a line to be easily visible to the dialysis staff. There is a central nursing station with telephones, medications, and other equipment. Close to the treatment area but not visible to patients are rooms to purify water, make dialysate, and service equipment. More dialysis units have opened in suburban and rural locations. Who will perform my dialysis treatments? With in-center hemodialysis, the dialysis staff will perform your dialysis.

The role of the physician is to evaluate the patient, determine the specifics of the dialysis treatment, write dialysis orders, and be available for problems and questions. Other staff include registered nurses, licensed practical nurses, and Dialysis which to choose. Units in cities are large, with many able to dialyze 20 or more patients on each dialysis shift. Rural units are smaller and farther apart. When dialysis started, most units were owned by hospitals, single individuals, or not-for-profit organizations. In the s ownership of dialysis units changed. Units owned by hospitals, individuals, and not-for-profit foundations remained about the same.

Units run by large chains began to grow. These chains are owned by large public corporations. Some of these corporations also manufacture dialysis machines or equipment. The large size of these chains has enabled them to take advantage of buying larger quantities of supplies and equipment at a lower price, and enabled them to open large numbers of units. The highest concentration of dialysis units is in the eastern half of the country.

100 Questions & Answers About Kidney Dialysis

Areas along the Gulf coast and eastern seaboard have many more units than in the western portion of the United States. How long you need to travel to the dialysis unit will influence your choice of therapy. If it takes you several hours to reach the nearest unit, home dialysis or transplantation would be a definite advantage. Registered nurse A healthcare professional who has graduated from a nursing program and passed state qualifying examinations.

Licensed practical nurse A healthcare professional who has completed a nursing program and passed a licensing exam. An LPN works under the supervision of registered nurses and physicians. Dialysis technicians can institute hemodialysis by inserting needles into the access, and can also monitor the dialysis treatment, measure blood pressure, and help educate dialysis patients regarding their treatment, but they are not allowed to administer medication. Nurse practitioner A nurse who has received additional training in the diagnosis and treatment of diseases.

The nurse practitioner is able to prescribe medication and perform medical procedures. Physician assistant A member of the healthcare team who works under the supervision of a physician and diagnoses and manages medical problems. State law determines who can perform which functions in the dialysis unit.

In most states, the administration of medications is done by registered nurses. The nurses and technicians connect the patient to the machine and monitor the dialysis treatment. Some units have nurse practitioners and physician assistants as part of the dialysis staff. Dietitians and social workers are important members of the dialysis team. Dialysis units have a large support staff.

Technicians maintain and service equipment. Housekeeping chores such as taking out the garbage and mopping the floors never end. The clerical staff records treatments, orders supplies, and helps submit insurance claims. Patients on peritoneal dialysis perform their own dialysis treatments. At first, they will perform their dialysis under the supervision of the dialysis nurse.

As the patients become more skilled and comfortable with their dialysis, they will be able to perform it alone without help. This adjustment may take 1 to 2 weeks. They will still need to be carefully followed until they are fully comfortable with the peritoneal dialysis procedure.

Patients are also taught to selfadminister medications. When the training has been completed, they need to come to the dialysis unit once a month for evaluation by the peritoneal dialysis nurse and physician. The patient is examined by the nurse and physician. Blood tests are obtained every month to monitor the dialysis, and changes in the dialysis prescription may be made. Home hemodialysis patients usually come to the dialysis unit every month. Home visits are useful to help optimize the dialysis treatments. Who will be on dialysis with me at the dialysis center?

This statistic is due to the aging of the baby boom generation. The median age of patients on dialysis is There are few patients younger than 18 and older than 90 years of age. As people live longer and dialysis treatments improve, older patients are now being offered treatment with dialysis. More men are on dialysis than women, with a ratio of 1. More patients live in urban than rural areas. Culturally, the number of Hispanic patients is growing, as is the Hispanic population of the United States.

Social worker A licensed professional who is part of the multidisciplinary team at the dialysis unit. The social worker assists patients with emotional, financial, and social issues and also provides education and referrals to community resources. A nephrology social worker specializes in services that support patients and families who are adjusting to the major lifestyle changes that are caused by end stage renal disease.

Most of us do not want to travel to receive health care. We may be willing to travel to see a specialist or to have a complicated procedure or operation. Once we are stable and our lives are back to normal, convenience is much more important. Patients on hemodialysis will come to the dialysis center three times a week. If we are able to go to a center close to our home, we will have more time to spend with family or for recreation, or we will be able to keep working at our job.

If a problem arises, it is easier to come in to the dialysis unit to be evaluated by the nursing or medical staff. Rain, snow, storms, tornados, hurricanes are less of a problem if our travel to dialysis is short. Dietitian A registered health professional who has special training in nutrition. Dietitians advise patients on which foods to eat and which to avoid based upon their individual needs. Patients are from all ethnic groups, occupations, religions, and economic backgrounds. The second largest group of patients has hypertension, but the hypertension may be due to many different causes.

Other common causes of renal failure are glomerulonephritis and cystic kidney diseases. A dialysis unit is a microcosm of society. Who will pay for my dialysis treatments? Dialysis treatments are expensive. Home hemodialysis or peritoneal dialysis is less costly because the person on dialysis performs the treatment. Medicare A federally-funded program that provides medical treatments and services to patients over the age of 65 and to patients who are younger than 65 and disabled.

They amended the Social Security Act, making kidney dialysis patients eligible for Medicare regardless of their age.


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This enabled large numbers of patients to receive dialysis treatments, and led to the rapid growth in the number of dialysis units. Patients can qualify for Medicare by working long enough to be insured under Social Security or under other programs such as the Railroad Retirement Board. You may also receive Medicare if you are the husband, wife, or child under 18 years of age of someone who has worked long enough to qualify for Social Security.

You may also be eligible for Medicare based upon a disability before you need dialysis treatments. Medicare has two parts, A and B. More information regarding Medicare can be obtained by calling the Medicare Patient Hotline at , or by visiting the Medicare Web site at www. Many private insurances cover some or all of the costs of dialysis treatments. Recently, many people have enrolled in health maintenance organizations, or HMOs, to provide for their health insurance. Many HMOs have conditions limiting the dialysis unit in which you can obtain treatment. If this happens, it is important to ask the HMO and your dialysis unit to try to obtain approval for your treatment.

Patients without health insurance may be eligible for the Medicaid program. Medicaid is administered by the individual states. Eligibility may be different for patients requiring dialysis treatments than for other patients. Patients who are not United States citizens can also be covered under the Medicaid program.

By now, you are probably totally confused and discouraged by how complicated paying for dialysis treatments seems. You are not alone. Most patients are overwhelmed by the rules and regulations for health insurance. The high cost of dialysis treatments makes Medicaid A federally-funded insurance program that is administered by the states to provide medical services, medications, and transportation to medical treatments for patients who have limited monetary resources. Fortunately, no one is denied dialysis treatments in the United States based on their inability to pay.

All dialysis units have dedicated social workers and other staff who are experts in the insurance process and who are available to guide you with these issues. I have heard that dialysis is painful. Is this true? I often tell people considering dialysis treatments that the worst part of dialysis is thinking about it! Our imaginations are always worse than reality. It is important when considering dialysis treatments to visit a dialysis center, observe treatments, and talk to people actually undergoing treatment. Access A device that is inserted or constructed in a patient which connects the patient to the dialysis tubing and allows dialysis to take place.

We do strive to ensure that each listing is correct and complete—but, we can't guarantee it. We also can't and don't endorse, recommend, or review all of the links you could follow off of this site to another site. We are not responsible if a link you visit harms you or your computer, gives you wrong information, or if any other loss or damange occurs. John Agar, MD, explain how dialysis works; each of the ways to do it; and how your treatment choice may affect your diet, energy level, work, travel, sexuality and fertility, sleep, and survival.

Comprehensive and fully referenced, this book is a must-read if you face the life-changing choices that come with kidney failure. Paperback, pages. This powerful, uplifting pocket book is a simple and effective tool that is an easy read. It confronts so many of the problem areas faced by PD patients, including:. The tips will not only help you with coping with peritoneal dialysis, but also will enlighten your medical team, friends, nurses, family members, and caregivers in their efforts to make life more comfortable for you. If you or your loved one is considering doing peritoneal dialysis or recently started peritoneal dialysis, this book is a must-read!

Sheila Shaw has been living with chronic illnesses for the past 20 years. Sheila has dedicated her life to inspire others to live their lives to their fullest despite living with chronic illness. Paperback Book. ISBN Linda Gromko were presented with two choices: a kidney transplant or kidney dialysis. There was, of course, the option of no treatment—but that would mean certain death for this husband and father of a teenaged daughter.

Steve and Linda eagerly embraced the technology of Home Dialysis—treatments that could be done on their own time and on their own terms. But nothing could have prepared them for the onslaught of medical supplies that descended upon their home, making it seem more like a medical clinic or an ICU! Home Dialysis—while life-saving—was taking over, consuming their lives and redefining their family as one tethered to illness.

Available on Amazon. When Seattle family doctor Linda Gromko receives an implausible inheritence from a former patient, the windfall jolts her life—already out of balance from the demands of her profession. She reshuffles her life priorities and vows to find a life partner once and for all. Known to have diabetes and high blood pressure for years, Steve falls precipitously into the abyss of Acute Kidney Failure. Without a transplant or dialysis, Steve will certainly die within one to two weeks. Gromko exerts the most powerful advocacy of her life. The book is "R" rated: "R" for language, and "R" for reality!

This book by Dr. Steven Guest is a guide to the practice of peritoneal dialysis. Chapters provide a foundational understanding of PD therapy and address real-time challenges faced by providers. Contained in this guide:. For 12 years, Dr. Guest speaks on various PD topics throughout the U. Order this book at Amazon.

100 Questions & Answers About Kidney Dialysis 100 Questions & Answers About Kidney Dialysis
100 Questions & Answers About Kidney Dialysis 100 Questions & Answers About Kidney Dialysis
100 Questions & Answers About Kidney Dialysis 100 Questions & Answers About Kidney Dialysis
100 Questions & Answers About Kidney Dialysis 100 Questions & Answers About Kidney Dialysis
100 Questions & Answers About Kidney Dialysis 100 Questions & Answers About Kidney Dialysis

Related 100 Questions & Answers About Kidney Dialysis



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