In end-stage renal disease, kidney functions can be replaced only by dialysis or
transplantation. See the Transplant section for more information
about transplants. There are two types of dialysis (1) hemodialysis and (2)
Hemodialysis involves circulation of blood through a filter on a dialysis
machine. Blood is cleansed of waste products and excess water. The acid levels
and the concentration of various minerals such as sodium and potassium in the
blood are normalized. The blood is then returned to the body.
Long-term dialysis requires access to a
vessel so that the machine has a way to remove and return blood
to the body. This may be in the form of a dialysis catheter or an arteriovenous
fistula or graft.
A catheter may be either temporary or permanent. These catheters are either
placed in the neck or the groin into a large blood
vessel. These catheters are prone to infection and may also cause blood
vessels to clot or narrow.
The preferred access for hemodialysis is an arteriovenous fistula wherein an
artery is directly joined to a vein. The vein takes two to four months to
enlarge and mature before it can be used for dialysis. Once matured, two needles
are placed into the vein for dialysis. One needle is used to draw blood
and run through the dialysis machine. The second needle is to return the
An arteriovenous graft is placed in patients who have small veins or in whom a
fistula has failed to develop. The graft is made of artificial material and the
dialysis needles are inserted into the graft directly.
These venous access devices usually can be placed with local anesthesia on an
Hemodialysis typically takes three to five hours and is needed three times a
You will need to travel to a dialysis center for hemodialysis.
Home hemodialysis is possible in some situations. A care partner is needed to
assist you with the dialysis treatments. A family member or close friend are the
usual options, though occasionally patients may hire a professional to assist
with dialysis. Home hemodialysis may be performed as traditional three times a
week treatments, long nocturnal (overnight) hemodialysis, or short daily
hemodialysis. Daily hemodialysis and long nocturnal hemodialysis offer
advantages in quality of life and better control of high
blood pressure, anemia
, and bone disease.
Peritoneal dialysis utilizes the lining membrane (peritoneum) of the
abdomen as a filter to clean blood and remove excess fluid. A catheter is
implanted into the abdomen by a minor surgical procedure. Peritoneal dialysis
may be performed manually or by using a machine to perform the dialysis at
About 2 to 3 liters of dialysis fluid are infused into the abdominal cavity
through this catheter. This fluid contains substances that pull wastes and
excess water out of neighboring tissues.
The fluid is allowed to dwell for two to several hours before being drained,
taking the unwanted wastes and water with it.
The fluid typically needs to be exchanged four to five times a day.
Peritoneal dialysis offers much more freedom compared to hemodialysis since
patients do not need to come to a dialysis center for their treatment. You can
carry out many of your usual activities while undergoing this treatment. This
may be the preferable therapy for children.
Most patients are candidates for both hemodialysis and peritoneal dialysis. There
are little differences in outcomes between the two procedures. Your physician
may recommend one kind of dialysis over the other based on your medical and
surgical history. It is best to choose your modality of dialysis after
understanding both procedures and matching them to your life style, daily
activities, schedule, distance from the dialysis unit, support system, and
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