Dialysis

Dialysis is a treatment that cleans your blood and removes excess fluid from your body when your kidneys are no longer healthy enough to do these important jobs.  This type of therapy is available at home or in a hospital or clinic and there are two main types: peritoneal dialysis and hemodialysis.

Dialysis will help you to live a life as similar as possible to the one you had before your kidneys failed. Still, it’s important to understand that dialysis is a treatment, not a cure.  It can’t repair your kidneys, nor can it fully replace a healthy kidney.  Usually once people begin dialysis treatments, they will be on some form of dialysis for the rest of their lives, unless they have a successful kidney transplant.

Your dialysis treatment can be independent or dependent.  Independent dialysis involves treatments you can do at home, and dependent dialysis takes place in a hospital or clinic.  The path you choose will depend on your overall health, your lifestyle goals, and your personal circumstances.  Either way, your health care team will be there to support you.

Independent dialysis (home based)

Because independent dialysis takes place at home, most people get more hours of dialysis than they would have access to at a hospital or clinic.  While about 12 hours of dialysis per week is generally enough to control your symptoms, the more hours of treatment you get, the better you’re likely to feel.  People who do their dialysis at home typically have:

• More energy
• Better health outcomes
• Fewer fluid and dietary restrictions
• Fewer medications

Independent dialysis can be a great choice for people who want to continue to work, go to school, or even travel.  It’s also convenient for people who live far away from the closest dialysis clinic.  There are two types of dialysis you can do at home:

• Home Peritoneal Dialysis
  In peritoneal dialysis (PD), the lining of your abdominal wall is used as a filter to clean the blood.  To get access to the inside of your abdomen, your doctor will insert a catheter, which is a tube made of soft plastic, near your navel.  This catheter will remain in place as long as you’re on peritoneal dialysis. 
   
  During a PD treatment you will fill your abdominal cavity with dialysis fluid using your catheter.  Waste and excess fluid in your blood pass from the blood through the lining of your abdominal wall and into the dialysis fluid.  The fluid is then drained and discarded, and the abdomen is refilled.  This process happens several times a day and is called an exchange.
  
  With PD, you will almost always have fluid in your abdomen, so your blood is constantly being cleaned.  There are two main types of peritoneal dialysis:
  
  CAPD (Continuous Ambulatory Peritoneal Dialysis)
  
  CAPD is a manual therapy that involves connecting your catheter to a set of bags to empty your abdomen and then refill it with fresh solution.  Typically, people do four exchanges per day at regularly spaced intervals (e.g., early morning, lunchtime, late afternoon, bedtime).  Each exchange takes 20 to 45 minutes, and when it’s complete, you can disconnect yourself and carry on with your normal activities.
  
  APD (Automated Peritoneal Dialysis)
  
  With APD, your exchanges are performed while you sleep by a machine called a cycler.  You’ll connect yourself to your cycler when you go to bed at night and disconnect in the morning when you get up.  Most people remain connected to the cycler for 8 to 10 hours every night, and during that time an average of four exchanges are performed. Once you disconnect from the cycler in the morning, you’re free to go about your daily activities.
• Home Hemodialysis
  People who do home hemodialysis learn to use the dialysis machine themselves.  Often your caregiver or partner will learn as well, so they can support you.  Training for this type of therapy usually takes about 6 weeks.  When you’re comfortable, you’ll be able to perform your treatments in the comfort of your home, either at night while you sleep, which is called nocturnal hemodialysis, or during the day. 
  
  If nocturnal hemodialysis is the best option for you, you’ll connect to your hemodialysis machine 4 to 6 nights a week at bedtime.  Each treatment lasts 6 to 8 hours, so you’ll disconnect yourself in the morning when you get up.  This type of therapy frees up your day for other activities.

Dependent dialysis (clinic or hospital based)

For those people who aren’t able to do dialysis at home, treatments can be performed in a hospital or clinic.  This is a good choice for people who are physically or mentally unable to manage the treatment themselves.  It may also be for you if you lack the support needed to do your treatment, or if you don’t have the type of housing that can accommodate home therapy.

The only dependent dialysis therapy available is hemodialysis.  With this therapy, you’ll travel to your hospital or clinic 3 times per week, where a trained nurse or technician will connect you to a hemodialysis machine.  Your treatment will normally take 4 to 5 hours.  You’ll have a daily fluid limit and a restricted diet to help you manage the buildup of waste and fluids between dialysis treatments.

• Hemodialysis
  In hemodialysis, your blood is pumped through a dialysis machine, where waste and excess fluid are removed before the cleaned blood is returned to your body.  Only a small amount of blood, about 250 ml (or 1 cup), is outside your body at any given time.  Most people have about 5 to 6 litres of blood in their body.
  In order to have this type of dialysis, your bloodstream needs to be easily accessible.  For most people the best way to access the bloodstream is through a fistula or graft, usually in your arm.  Your doctor will create this access during a minor surgery. 
  
  Then, for each treatment, needles are inserted into the fistula or graft.  Your blood is withdrawn from your body and circulated through a dialysis machine attached to a dialyzer, which is sometimes called an artificial kidney.  Inside the dialyzer, blood and dialysis fluid are separated by a membrane and flow in opposite directions.  During this process, toxins and excess fluid move from your blood through the membrane and into the dialysate.  The cleaned blood is then returned to your body.