Dialysis Options

The information provided is not intended to be a substitute for professional medical advice. A licensed healthcare professional should be consulted for diagnosis and treatment of any medical conditions.

Dialysis

Dialysis is a method of removing waste products and excess fluid from your body after your kidneys have failed.1 Kidney dialysis is an artificial process that performs the two main functions of the kidneys:

  • filtering waste from the blood; and
  • balancing the body’s fluid levels.

There are two types of dialysis: peritoneal dialysis (PD) and haemodialysis (HD).2

Your clinical condition is only one factor in determining which dialysis treatment is best suited to you. Often the decision depends on a number of external factors including your lifestyle and support available.

It is important that you seek information on dialysis from a range of sources before choosing a suitable method. You should also discuss your options with your doctor, renal healthcare team and family.

If, after starting dialysis treatment, you feel you’ve made an incorrect choice or your circumstances have changed, it is usually possible to change your treatment methods. Asking your doctor or renal healthcare team about new treatments is the best way to keep up-to-date with your treatment options.

Filtering waste from the blood

During dialysis waste and excess water pass from the blood into a liquid called dialysate for removal from the body by a process called diffusion.

A thin layer of natural tissue (in peritoneal dialysis) or of synthetic plastic (in haemodialysis), known as the dialysis membrane, keeps the blood separate from the dialysis fluid. Blood cells are too large to pass through the dialysis membrane, though waste and water can diffuse into the dialysis fluid. Wastes are then removed from the body by extracting the dialysis fluid.

Balancing the body's fluid levels

In both haemodialysis and peritoneal dialysis, a process called ultrafiltration removes excess fluid.

In haemodialysis, the fluid is simply drawn from the blood by the dialysis machine. The amount of water to be removed can be varied by changing the dialyser’s settings.

In peritoneal dialysis a substance (most commonly glucose) is added to the blood to draw water out in a process called osmosis. Peritoneal dialysis solution containing a lot of glucose will draw out more fluid than a weaker solution.

Peritoneal dialysis (PD)

Peritoneal dialysis (PD) uses the peritoneum, a natural membrane lining the cavity of your abdomen. The membrane has tiny holes that allow waste products and fluid to filter from your blood.

Bags of dialysis fluid (dialysate) are attached to your body with a small, soft plastic tube, called a PD catheter. The catheter is inserted into your abdomen in a minor procedure. Approximately 18 centimetres of the catheter remain outside your body allowing you to easily change your dialysate as often as your doctor prescribes.

During the dwell phase (the time dialysate remains in the abdomen) excess water and waste products from the blood are drawn across your peritoneal membrane into the dialysate. The process of waste removal, as in haemodialysis, is called diffusion. The removal of excess water, osmosis, is aided by another substance within the dialysis fluid, usually glucose.

The substance (eg. glucose) is added to your blood and draws excess fluid from it. A thin layer of natural tissue, your peritoneal membrane, separates the blood from the dialysate. While your blood cells are too large to pass through the semi-permeable membrane, excess water is drawn into the dialysate by the glucose. Ultrafiltration is complete. The excess water now in the dialysate needs to be changed in a process called an exchange.

Your doctor will prescribe the number of exchanges to be performed each day and the amount and type of dialysate to be used.

There are two types of PD – continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). At renal units, specialist nurses will train you to perform CAPD or APD treatments safely, so you may continue your treatment at home, returning regularly to the renal unit for check-ups.

Both types of PD allow you to be relatively independent and manage your own care at home. Travel for business or pleasure may also be arranged with a little pre-planning.

PD in brief

Advantages Disadvantages
  • Fit your treatment around your lifestyle
  • Independence – mostly you perform the treatment yourself
  • Fewer visits to the dialysis unit (usually once a month)
  • Works during sleep time for some people
  • Continuous therapy is gentler and more like your natural kidney function
  • Portable and flexible – easy to take your treatment with you when you travel
  • Less fluid and diet restrictions
  • No needles
  • Better blood pressure control
  • You need to be well trained
  • Permanent catheter access required
  • Some risk of infection
  • May show a slightly larger waistline (due to carrying fluid)
  • Storage space required in your home
  • Possible changes in your appearance due to medications side effects

Continuous Ambulatory Peritoneal Dialysis (CAPD)

If you choose to treat your kidney failure with Continuous Ambulatory Peritoneal Dialysis (CAPD) you will be required to perform your PD manually (dialysate fluid is drawn in and out of the body with the aid of gravity and a system of tubing and bags connected to you externally) with three-to-five exchanges per day.

CAPD allows gravity to draw dialysate in and out of the peritoneal cavity, using a system of tubing and bags.

CAPD requires you to connect tubing and a bag of sterile dialysate to the peritoneal catheter. The bag is elevated to shoulder level, allowing the solution to flow into the peritoneum.

It is during the dwell phase (when the fluid remains in the peritoneum cavity) that the dialysis or transfer of waste into fluid occurs. Waste products and excess fluid pass from the blood, through your peritoneal membrane (lining of the abdomen), which acts as a filter, and into the dialysate.

Once diffusion is complete, you are required to drain all fluid and waste from your peritoneal cavity and replace the dialysate with fresh solution in a process called an “exchange”.

How does a CAPD exchange work?

An exchange of dialysis fluid in CAPD is simple and you will be trained over a week or two to perform exchanges on yourself.

The basic steps are:

  • Connect the tubing set to the catheter
  • Drain out the used solution
  • Fill with fresh solution
  • Disconnect tubing set from the catheter
  • Discard the used solution and disposable tubing and bags

An exchange takes about 30 minutes, with most CAPD people requiring three to five exchanges a day.

If you have limited eyesight or decreased use of your hands there are devices available to make performing exchanges easier. Ask your renal care team about devices that may help you.

Automated peritoneal dialysis (APD)

Automated peritoneal dialysis (APD) is performed by a machine, called a cycler, while you sleep.

Like CAPD, APD uses your peritoneal membrane as a filter to draw waste and excess fluid from your blood into a dialysate solution.

The APD machine automatically controls the timing of exchanges, drains the used solution and fills the peritoneal cavity with new solution, based on the prescribed number of exchanges.

For extra treatment, dialysis solution remains in your peritoneal cavity during the day. The peritoneal cavity of most adults can comfortably hold two-to-three litres of fluid.2

How does APD work?

  • When you go to bed, connect your PD catheter to the APD machine and switch on the machine.
  • The APD machine carries out exchanges automatically overnight while you are sleeping. The machine carefully measures the amount of fluid that goes into your peritoneal cavity and the amount that comes out. This usually continues for eight-to-10 hours, with a last fill that remains throughout the day.
  • In the morning, you disconnect from the machine and go about your day.

APD is a simple procedure, the machines are easy to operate and have built-in safety devices. They are portable (around the size of a small suitcase) and may be used wherever there is an electricity supply.

Haemodialysis (HD)

Haemodialysis (HD) is a machine-assisted blood filtration method which removes waste and excess fluid from your blood in a dialyser (or artificial kidney) outside your body.

HD requires a doctor to surgically create permanent access to your blood stream, via your arm or thigh, allowing blood to be diverted from your body, through the dialyser and back into your blood stream.

There are two types of permanent access – a fistula and a graft. A fistula is the surgical linking of an artery to a vein, providing access to blood vessels. A graft is a tube surgically placed under the skin linking an artery to a vein.

During HD treatment two needles are inserted into the access point. Plastic tubes attached to these needles connect them to a dialyser.3 The blood, about 200mL at any one time, is drawn from your body via one needle and pumped through the dialyser. An artificial membrane separates the blood from the dialysis fluid but allows waste and excess water to diffuse through from the blood.

The clean blood is then returned to your body via the second needle or tube and the needles are removed at the end of each session. Each session lasts three-to-six hours and is usually performed three times a week.

It is likely you will feel tired and weak following HD treatment.

Haemodialysis treatments may be administered:

  • In hospital – in a renal unit within the hospital campus
  • Satellite centre – in a minimal care unit where you are more involved in the treatment process.
  • At home – where you are largely responsible for your treatment sessions and have more flexibility in the timing of each treatment.

Hospital and Satellite Haemodialysis

If you choose to under-go hospital or satellite HD you must be committed to participating in a dialysis session at least three times a week for four-to-five hours at a time. Activities during dialysis are limited to watching television, reading, talking or sleeping.

Nurses at the unit will prepare the equipment, insert the needles and supervise you during each session, however most units will encourage you to play an active role in your own treatment. This may involve checking your own blood pressure, inserting needles or getting yourself on and off the dialysis machine.

If you perform your dialysis at a minimal or self-care satellite centre, you will be even more involved in your treatment. Under medical supervision you may prepare the dialysis machine, insert the needles, adjust pump speeds and machine setting and chart your own progress.

Hospital and Satellite HD in brief

Advantages Disadvantages
  • Regular contact with other dialysis patients and staff
  • 3 treatments per week (4 days off)
  • No equipment or supplies kept at home
  • Immediate access to medical help during therapy
  • Travel to clinic 3 times/week on a fixed schedule
  • Permanent access required, usually in your arm
  • Insertion of 2 needles for each treatment
  • Restricted diet/limited fluid intact
  • Possible discomfort such as headache, nausea, leg cramps, tiredness

Home haemodialysis (Home HD)

HD machines are sometimes available for use at home if your Haemodialysis team decides you are suitable for this method of treatment. These machines have many built-in safety features and require you to have someone around (a partner or family member) each time you are on the machine.

Some renal units have a designated home Haemodialysis nurse, who provides education and support for people using home HD. These specialist nurses will also monitor your treatment and provide a link between you and the staff at the renal unit. This nurse will spend one-to-three months thoroughly training you to use the home dialysis machine, as there are many technical aspects that you must fully understand before you can perform dialysis unsupervised.

Home HD treatments may be performed three times a week under the supervision of another person in your home. You will have considerable freedom in deciding when to dialyse and will not have to travel to a renal unit for treatment sessions. For these reasons, home haemodialysis may be an ideal option for you if you value your independence or need to fit your treatments into a busy schedule.

To undergo home HD you will need a special water supply at home, space to accommodate the Haemodialysis machine and stocks of dialysis supplies.

Home HD in brief

Advantages Disadvantages
  • Help from family members
  • More control overtimes to dialyse
  • No travel to clinic for treatment
  • Works during sleep time for some people
  • 3 treatments per week (4 days off)
  • You need to be well trained
  • Permanent access required, usually in your arm
  • Insertion of 2 needles for each treatment
  • Restricted diet/limited fluid intact
  • Possible discomfort such as headache, nausea, leg cramps, tiredness
  • Storage space required for equipment and supplies
  • Call 000 (Australia) or 111 (New Zealand) in the event of an emergency during treatment

Choosing the dialysis that is best for you

APD and CAPD Clinic HD Home HD

Can I do dialysis at home?

Yes

No

Yes

Can I still work or attend school full-time?

Yes

Not always

Yes

Can I still travel?

Yes

Possibly

Possibly

Do I need to have needles inserted every time?

No

Yes

Yes

Will it make me tired?

Possibly

Possibly

Possibly

Can I arrange my dialysis at convenient times?

Yes

Possibly

Yes

Do I need to have equipment/supplies at home?

Yes

No

Yes

 

References

  1. Daugirdas, J., Blake, P. & Ing, T. 2007, Handbook of Dialysis, Lippincott Williams & Wilkins, Philadelphia, USA, p. 165-8.
  2. Cutler, R. 2003, Kidney Failure in The Merck Manual of Medical Information, 2nd Edition, West Point, PA, USA, p. 833.
  3. Stein, A, Wild, J. & Auer, J. 2002, Kidney Dialysis and Transplants, Class Publishing, London, UK, p. 90.

Home Dialysis Information by Kidney Health Australia

Baxter Healthcare believes that any person requiring treatment for renal disease should make an informed choice about the different treatment options available to themselves or their loved ones.

Baxter Healthcare recommends the Kidney Health Australia websites for detailed unbiased patient information on Kidney Disease and treatment options available.

Kidney Disease Resources

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