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Q/A About Dialysis

I am new to dialysis, what are my options?

Most patients receive hemodialysis in dialysis clinics. You can also receive hemodialysis at home. Another option is peritoneal dialysis (PD), also performed at home. If you are a good candidate for a kidney transplant that is another option. With PD you will need to have a tube surgically placed in your abdomen. For hemodialysis, whether in center or at home, you will need to have surgery soon to create a vascular access and allow it to heal. If you want a kidney transplant, talk with your nephrologist about how to get on the transplant list or ask a friend or family member to donate a kidney.

When do I start dialysis?

Your doctor will help you decide, based on lab tests that measure how much kidney function you have left and on your symptoms. National Kidney Foundation (NKF) guidelines recommend you start dialysis when your kidney function drops to 15 percent or less—or if you have severe symptoms caused by your kidney disease, like shortness of breath, fatigue, muscle cramps or nausea and vomiting.

Who pays for dialysis?

Private health insurance generally covers treatment for kidney failure. If you don't have private insurance, you may be able to get coverage through federal or state-funded healthcare programs, such as Medicare or Medicaid. Most people qualify for Medicare when they need dialysis or a transplant, even if they are under age 65. Medicare pays for 80 percent of treatment for kidney disease when ordered by your doctor.

If I can't have a transplant can I do dialysis for the rest of my life?

Yes, dialysis is something you can do for the rest of your life. And, most people on dialysis enjoy a good quality of life. Some people have been on dialysis for 30 years or more without getting a transplant. How long you can live on dialysis, and how well you do, will depend on a number of things, including how healthy you are, your attitude, your quality of healthcare and how much you take an active role in your care.

If I start hemodialysis, how often will I have to get treatments?

The usual schedule for in-center hemodialysis treatments is three times a week. You will likely have the same morning or afternoon time for each treatment. The length of your treatment depends on what is prescribed, three to four hours is common.

If I start PD, how often will I have to get treatments?

PD is usually done each night using an automated cycler machine while a person sleeps. A patient will typically be connected to the cycler for 8 to 10 hours each night and be free of dialysis during the day. Some people do manual PD, which usually involves four to five exchanges per day. Each exchange takes 20 to 30 minutes, and they need to be spread out over the whole day to clean the blood well. Your doctor can inform you about the types of dialysis and help you decide what will be best for your health and lifestyle needs.

How does dialysis work?

Dialysis uses a special fluid called dialysate. Dialysate is a mixture of pure water and chemicals formulated to carefully pull wastes out of your blood without removing substances your body needs. A membrane with microscopic holes that allows only certain types of particles to pass through keeps the blood apart from the dialysate. This membrane lets the wastes and fluid in your blood flow through into the dialysate. There are two main types of kidney dialysis, hemodialysis and peritoneal dialysis (PD).

Hemodialysis

In hemodialysis a man-made membrane or dialyzer, partly does the work of the kidneys to filter waste and remove extra fluid. Blood circulates through the dialyzer for several hours during a treatment, with a machine controlling the speed the treatment is delivered. Hemodialysis is often done three times per week for three to four hours at a dialysis center. Some patients have nocturnal hemodialysis at a dialysis clinic, this involves extended treatments three or more nights a week while you sleep. Patients can also decide to have hemodialysis at home but need a caregiver to assist them with the treatment. Hemodialysis requires a dialysis access to allow blood to flow between your body and the dialyzer. You and your doctor will need to discuss your options to decide which access is right for you and your treatment.

Peritoneal dialysis (PD)

Peritoneal dialysis (PD) treatments happen at home. With PD you fill up your abdominal cavity with dialysate through a soft plastic tube called a catheter. The peritoneal membrane that lines your abdominal cavity has many small blood vessels, so it serves as the semipermeable membrane between your blood and the dialysate. The dialysate stays in your abdomen and absorbs wastes and excess fluid from your blood for several hours. Then you drain it out and replace it with fresh dialysate.
PD is commonly done using an automated machine, called a cycler, which allows fluid to be flushed in and out of the abdomen while a person sleeps at night. Some people choose to do a manual exchange, by performing four to five fill-and-drain exchanges per day depending on their lifestyle and dialysis needs.
Is it possible to sleep at night using a cycler for PD?
Yes. Most people are able to sleep during PD treatments, even if they like to turn over in bed. It may take some time to get used to sleeping while connected to the cycler but most patients find this a good solution. Some patients sleep well right from the start.

How does dialysis work?

Hemodialysis mainly works through two principles: Diffusion, the movement of particles across a membrane with tiny holes in it (semipermeable) until the particle concentration on both sides of the membrane is equal, and Ultrafiltration, squeezing extra fluid out of the blood and through the membrane, under pressure. The pressure is supplied by the blood pump, which pushes blood through the dialyzer. In peritoneal dialysis, there is no pressure pump to cause ultrafiltration. So, to remove fluid, PD works mainly through osmosis by using chemical substances to pull extra fluid across the membrane.
Which is better, peritoneal dialysis (PD) or hemodialysis (HD)?
PD and HD are different options, your doctor will be able to tell you if you are medically better suited for one treatment or the other, but most often, the choice will be yours.
PD is a good choice for patients who are working because you will have more control over your treatment schedule. It’s also easier to travel with PD. Treatments must be done with good hygiene and good technique to avoid infections, your nurse will train you how to correctly initiate and complete treatments.
HD has the advantage that it’s usually only 3 days a week and you have 4 other days each week without treatments.
Keep in mind that you can always change treatments if your needs change.
If I start hemodialysis, the usual schedule is three times a week, either Monday-Wednesday-Friday or Tuesday-Thursday-Saturday. You will have the same morning or afternoon time for each treatment. The length of your treatment depends on what your doctor prescribes for you. Three to four hours is common, plus time to travel to and from the center.

If I start PD, how often will I have to get treatments?

Peritoneal dialysis (PD) is usually performed each night using an automated cycler machine while a person sleeps. A patient will typically be connected to the cycler for 8 to 10 hours each night and be free of dialysis during the day. Another option is manual PD, which usually means doing four to five exchanges per day. Each exchange takes 20 to 30 minutes, and they need to be spread out over the whole day to clean the blood well.

Why do dialysis treatments take so long?

Healthy kidneys work 24 hours a day, 7 days a week. Dialysis replaces only a small amount of your kidney function. If you are not getting adequate dialysis, you will start to have symptoms of kidney failure, such as metallic taste in your mouth, fatigue, itching or loss of appetite.
Your doctor may prescribe a different dialyzer, longer treatments or both to be sure you get as much dialysis as you need to feel good and keep doing the things you enjoy.

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