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Treatment Choices

When facing end-stage kidney disease, there are different treatment options to choose from: dialysis, kidney transplantation or no treatment.

Dialysis

There are two types of dialysis: hemodialysis, which uses an artificial membrane between the blood and dialysate, and peritoneal dialysis, which uses the body’s own membrane between the blood and dialysate.

Hemodialysis (HD)
With hemodialysis, the patient is connected to a kidney machine. Blood is pumped to an artificial kidney (dialyzer). Waste products pass from your blood to dialysis solution by diffusion, through very small holes in the fibers of the dialyzer. These holes are big enough to let the potassium, creatinine, blood urea nitrogen (BUN) and water through, yet small enough not to let blood cells through.

Hemodialysis is usually done in a dialysis unit, but can also be done at home. The average treatment lasts from 3 to 5 hours and is usually needed three times a week.

Peritoneal Dialysis (PD)
Peritoneal dialysis uses the lining of your abdomen as the filter for dialysis. This lining is called the peritoneal membrane and it forms a closed sack or cavity inside the abdomen. Blood travels through tiny blood vessels found throughout this membrane. By putting the cleansing fluid (dialysate) into the peritoneal cavity, wastes diffuse out of the blood, through the membrane and into the dialysate fluid. Then the dialysate that now has the wastes in it can be drained out and thrown away. With peritoneal dialysis, no blood is removed from your body. The blood is cleaned inside the body using the body’s own peritoneal membrane as the filter.

Transplantation

Renal (kidney) transplant is the surgical placement of a kidney from another person (donor) into a patient with kidney failure. Kidney transplantation is an elective procedure, not an emergency or life-saving procedure. Patients need to be in the best possible condition prior to transplant to minimize risks. Conditions that place patients at high-risk for problems after transplant include obesity, not taking medications as prescribed, smoking, major depressive or other psychiatric disorders, and lack of family or other social support.

No treatment

If both kidneys completely fail and no treatment choice is selected, waste products and water build up in the body. These waste products become poisonous and are called “uremic toxins.” Uremia literally means urine in the blood. If nothing is done to return the person to good health, such as dialysis or transplantation, death will occur.

Sometimes, circumstances are such that patients facing end-stage kidney failure do not choose to treat with dialysis or transplant. With appropriate end-of-life support, patients with renal failure can be made comfortable even without dialysis. Franciscan Hospice and Palliative Care Services can be very supportive at this time.

Where is dialysis performed?

Peritoneal dialysis is done independently by the patient, and can be done at home or at work. Hemodialysis can also be done at home with the assistance of a specially trained helper. Otherwise, hemodialysis is performed by licensed and specially trained staff at facilities called outpatient dialysis centers. Generally, patients dialyze three times a week, and are assigned to a “Monday, Wednesday and Friday” or “Tuesday, Thursday and Saturday” schedule.

At Franciscan Health System, there are four outpatient dialysis centers. All three centers are staffed with RNs, LPNs, and certified hemodialysis technicians. The home dialysis department, which trains and supports patients doing home hemodialysis and peritoneal dialysis, is centrally located at St Joseph’s Medical Center. Social workers, dietitians and pharmacists are also part of every patient’s care team.

When dialysis-dependent patients are hospitalized, dialysis is performed in the hospital by registered nurses.