Kidney dialysis is a life-saving treatment given to people whose kidneys are failing. Dialysis may be a short or long-term treatment, depending on the type of kidney disease, and your suitability to receive a transplanted kidney. There are two forms of dialysis, each with its own advantage and disadvantages.
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Dialysis does the work that your kidneys are no longer able to perform. During dialysis, your blood is filtered to remove excess fluids and waste products. Dialysis is usually recommended when only 10 to 15 per cent of your kidney tissue is functioning and you have developed end stage kidney failure. Dialysis may also be needed as a short-term treatment for infections or to remove poisons or drugs from the kidneys.
Before hemodialysis treatments begin, minor surgery is performed to make an opening to a blood vessel in the arm or leg. This opening is used to connect the kidney dialysis machine to your body. Hemodialysis treatment is usually performed at a dialysis centre, either in a hospital or at a freestanding centre. Treatment lasts for approximately four hours and is usually needed 3 times per week. Hemodialysis can also be done at home, with either daily or nightly treatments, although it can be challenging to find a dialysis centre that offers this option and can provide training.
Peritoneal dialysis uses dialysate, a solution that draws waste products and fluids out of the blood through a catheter placed in your abdominal, or peritoneal, cavity. Continual Ambulatory Peritoneal Dialysis (CAPD) can be done at home without a dialysis machine. During this type of dialysis, a bag of dialysate is hooked up to your catheter and gradually enters your body. The dialysate remains in your peritoneal cavity for approximately four hours and then is drained back into the same bag. This procedure takes approximately 30 minutes to complete and must be done four or five times every day with a fresh bag of dialysate.
Continuous Cycling Peritoneal Dialysis (CCPD) can also be done at home, but requires a special machine known as a cycler. During CCPD, the cycler circulates dialysate in and out of the peritoneal cavity for 8 to 10 hours during the night. Dialysate remains in the body during the day and is removed at night when cycling begins again.
If you undergo hemodialysis at a centre, you will have regular access to a team of medical professionals who can help answer questions about your care and explain the dialysis process. If you are not comfortable handling the dialysis process yourself or are elderly or disabled, this type of hemodialysis may be a better option for you. Home-based hemodialysis can enable you to reduce the amount of medication needed to control anaemia, blood pressure and regulate phosphorus.
Since peritoneal dialysis is performed during the night while you sleep, you have much more flexibility during the day and can engage in your normal daily activities, including going to work. Your diet and fluid intake won't be as restricted as it is for hemodialysis patients, and there will be less stress to your heart because of the lower fluid accumulation.
The dialysis access site on your body can become infected no matter what type of dialysis you choose. People who undergo hemodialysis can have complications relating to narrowing of the blood vessels and may eventually need to use peritoneal dialysis if several access sites fail. Repeated infections at the access site, whether bacterial or fungal, can result in a need to switch from peritoneal dialysis to hemodialysis. Malnutrition and elevated cholesterol and triglyceride levels can occur in peritoneal dialysis patients. Increased abdominal pressure because of peritoneal fluid can result in an abdominal hernia or back pain in peritoneal dialysis patients.
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