what is CKD
Treatment options

Treatment options

Once you've been diagnosed with chronic kidney disease, it can seem like everything changes. Waste starts to build up in your blood and you may feel sick, experiencing symptoms that can include headaches, nausea, swelling and even bad breath. There is no cure for kidney failure, but there are treatments that can take over the work your kidneys can no longer do.

These treatments are dialysis, kidney transplantation, and conservative care.

 

Dialysis

Dialysis is the medical term for removing the waste and extra fluid from your blood that your kidneys can no longer remove themselves. When the waste is gone, you may feel better.

 

Kidney transplantation

A kidney transplant is an option that requires a major operation. During a transplant, a healthy donor kidney is placed into your body. The healthy kidney then takes over the work that your kidneys can no longer do.

 

Conservative care

Conservative care is a treatment option focusing on comfort. The decision to let kidney disease run its course will eventually result in death from kidney failure.

 

Treatment options videos

Watch the Life Choices video series to learn about treatment options and to help choose what’s right for you.

 

Dialysis

Dialysis is the medical term for removing the waste and extra fluid from your blood that your kidneys can no longer remove themselves. When the waste is gone, you may feel better.

 

Principles of dialysis

Dialysis removes the waste products and extra fluid from your blood by filtering them through a membrane/filter, similar to the way healthy kidneys would. During dialysis, blood is on one side of the membrane/filter and a special fluid called dialysate (containing water, electrolytes, and minerals) is on the other. Small waste products in your blood flow through the membrane/filter and into the dialysate.

The three principles that make dialysis work are diffusion, osmosis, and ultrafiltration.

 

Diffusion

During diffusion, particles in the areas of high concentration move towards the area of low concentration. Picture how a tea bag works - the leaves stay in the bag and the tea enters the hot water. In dialysis, waste in your blood moves towards dialysate, which is a drug solution that has none (or very little) waste. How much waste is removed depends on the size of the waste, the size of the pores (holes) in the membrane, what's in the dialysate, and like a tea, the length of treatment.1

 

Osmosis

During osmosis, fluid moves from areas of high water concentration to lower water concentration across a semi-permeable membrane until equilibrium is reached. In dialysis, excess fluid moves from blood to the dialysate through a membrane until the fluid level is the same between blood and dialysate

 

Ultrafiltration

Ultrafiltration is the removal of fluid volume from a patient. In dialysis, ultrafiltration removes waste and excess fluids from the blood.2


References:

  1. Schatell, Dori MS, and Agar, John MD. Help, I Need Dialysis! How to have a good future with kidney disease. Madison, WI: Medical Education Institute, Inc.; 2012. P. 34-38.
  2. National Kidney Foundation, 2013. https://www.kidney.org/blog/ask-doctor/could-you-please-difference-between-hemodialysis-and-ultrafiltration-laymans-terms Accessed February 28, 2013.

Types of dialysis treatment options

The two forms of dialysis treatment are Peritoneal Dialysis and Hemodialysis.

 

What is peritoneal dialysis?

Peritoneal Dialysis (PD) uses a special solution (dialysate) and your own peritoneal membrane - the lining of your abdomen - as the filter to help clean the blood and remove excess fluids. This method is like your regular kidney where fluid removal is continuous inside your body.

PD catheter

A PD catheter is placed in the abdomen in surgery and is used to access the peritoneal membrane to allow for dialysis.

A special solution (dialysate, or dialysis solution) is placed in the abdomen through the PD catheter and is in contact with the peritoneal membrane. Waste in the blood and bodily fluids then pass through the peritoneal membrane, which acts as a natural filter for the solution.

diffusion and osmosis

Waste products and extra water in the blood are pulled into the solution by means of diffusion and osmosis. The used dialysis solution is then drained out through the PD catheter into a collection bag or other means of disposal. This process is called an exchange.

The small particles of waste float out of the blood, through the tiny holes in the peritoneum, the membrane lining the walls of the abdominal and pelvic cavities, and into the dialysis solution.|

The waste particles float from the blood side where it is more crowded to the solution side that is less crowded.

The dialysis solutions that are used do several things: they help your body remove extra fluid, help with nutrition, replace some of the lost protein, and balance blood acid levels. Your doctor will determine your personal dialysis prescription (the right type of solution and number of exchanges) to meet your needs.

pd at home

Peritoneal dialysis is done at home so that you have more flexibility to arrange your daily activities and schedule. You can even perform PD at work or on the road. This may allow you more time to enjoy your favorite things like travelling, school, work, hobbies, sports, visiting with friends and a full family life. You, your family members, or caregivers carry out the procedures for PD. Your healthcare team will train you and/or your caregiver on how to complete your treatments.

What is hemodialysis?

The word "hemo" refers to blood. Hemodialysis (HD) filters your blood outside your body using a machine and a manufactured filter, called a dialyzer. This dialyzer acts as an artificial kidney. The machine makes the dialysis solution, which is needed to remove excess water and waste from your blood.

During HD, a machine removes blood from your body using a needle or a central venous catheter. Your blood is then pumped through the dialyzer and cleaned. After this, the clean blood is returned to your body through a second needle or a second branch of catheter.

hemodialysis

Hemodialysis is usually performed during a scheduled time at the hospital or in a dialysis clinic, and is referred to as in-center hemodialysis (ICHD). Most people require hemodialysis 3 times a week, with each treatment session lasting about 4 hours, depending on the dialysis prescription the doctor has recommended.

Please click here if you would like to read more detailed information about different types of dialysis and different ways of doing dialysis.

It's important to note that each person is different, so not every type of dialysis is suitable for you. There are different ways of doing peritoneal dialysis and hemodialysis.

Different types of dialysis may have different risks; please speak with your healthcare team about which therapy may be right for you.

Kidney transplantation

A kidney transplant is an option that requires a major surgery. During a transplant, a healthy donor kidney is placed into your body. The healthy kidney then takes over the work that your kidneys can no longer do.

Dialysis may be needed while waiting for your transplant. Transplantation is a treatment, not a cure - it requires lifelong medications and the risk of your body rejecting the new kidney is a possibility.

 

Where do donor kidneys come from?

The healthy donor kidney can be from a suitable living donor, or a cadaver donor, which is an organ donor who has decided to donate their organs when they die. Living donors must be free of any health problems, and their blood type must match the patient's. Your transplant team will order procedures and tests to determine if you can accept the donor kidney.

Not everyone is eligible for a kidney transplant. Your doctor and healthcare team can help determine if transplantation is possible for you.

 

Placing a new kidney

During the surgery, a healthy kidney is placed deep under the muscle of the abdomen, near your hipbone. Typically, the diseased kidney(s) are not removed. In rare cases, the non-working kidneys may be removed to control infection or high blood pressure. Rejection can be a major complication of kidney transplantation. Unfortunately, even drugs can sometimes fail to stop the body from rejecting a transplanted kidney. If this happens, you need to go back on dialysis and possibly wait for another donor kidney.

 

How do I take care of my transplanted kidney?

  • Take your medicine every day
  • See your doctors regularly
  • Follow your doctors' guidelines
  • Control your diet
  • Keep active

Conservative care

Conservative care is a treatment option focusing on comfort. The decision to let kidney disease run its course may eventually result in death from kidney failure.

Some people feel that continued life with kidney disease and the burden of treatment outweighs the benefits. People have the right to decide not to start treatment or to stop if already on treatment and continue with conservative care.

With conservative care, your healthcare team will help control both your physical and emotional symptoms until death occurs. Medications and treatments can be given to lessen the symptoms that may arise. Emotional support for you and your family is key.

You have the right to choose conservative care. However, when choosing any treatment option, it is important to discuss your feelings fully and openly with your doctor and family.

If you choose the conservative care treatment option, you and your family will work with your healthcare team to develop a treatment plan that honors your wishes and helps you and your family obtain the support and comfort you need.

 

Treatment options videos

Watch the Life Choices video series to learn about treatment options and to help choose what’s right for you.

Click here to watch the videos