what is cdk
Which dialysis is right for me?

Which dialysis is right for me?

There are two types of dialysis: peritoneal dialysis and hemodialysis. You can choose to do dialysis at home or in the hospital or dialysis clinic. There are many benefits and considerations for each type of dialysis and how it may affect you. There may be medical or lifestyle reasons for why one type of dialysis is better for you than another. Talk to your doctor about the medical reasons. There are many things to think about when making your decision.

 

Where can I do dialysis?

Dialysis can be done either at home, in a clinic, or in a hospital. Learn about the different forms of dialysis and where they are performed.

 

Dialysis access

In order to do dialysis, an access needs to be created surgically on your body. Depending on the type of dialysis you choose, the location of the access site is different. All of them cause some changes to your body.

 

What to expect

In this section, you can get a better understanding of what to expect with each type of dialysis. You can also learn about the benefits and drawbacks of each option and consider which type of dialysis is best for you.

 

Comparative chart

There are different benefits and considerations for PD and ICHD. Please remember that every patient differs in terms of age, medical condition, physical condition, and lifestyle choices.

Where can I do dialysis?

You can do dialysis in the hospital/clinic setting or you can dialyze at home or on the road with peritoneal dialysis

Home

 

Peritoneal dialysis (PD)

PD cleans your blood continuously inside your body, using your own peritoneum as the filter. Your nurse will fully train you or your caregiver to perform PD at home.

 

Continuous ambulatory peritoneal dialysis (CAPD)

CAPD does not require a dialysis machine. It uses gravity to exchange the fluid several times a day.

 

Automated peritoneal dialysis (APD)

APD uses a machine called a peritoneal dialysis cycler to perform the fluid exchanges. The treatment is done at home, and during the night for 8-10 hours while you sleep.

Hospital/Clinic

 

In-center Hemodialysis

In-center hemodialysis (ICHD) - Hemodialysis filters your blood outside your body using a machine and a manufactured filter called a dialyzer. Nursing staff or technicians at the clinic perform conventional ICHD. You may go to the hospital/clinic 3 times a week for dialysis. Each treatment lasts about 4-5 hours. Commute time to the hospital and wait time at the hospital could be up to 2 hours.

Dialysis access and your body

In order to do dialysis, an access needs to be created surgically on your body. Depending on the type of dialysis you choose, the location of the access site is different. All of them cause some changes to your body.

 

Hemodialysis

There are three types of access options for hemodialysis: Fistula, graft, and central venous catheter.

 

Fistula

fistula

A fistula is a permanent access made by surgically linking your artery to a vein in your arm or sometimes your leg. In hemodialysis, your blood is removed from your body through a needle inserted in the fistula, and then pumped through a dialyzer (filter) to remove the waste and excess fluids from your blood. The clean blood is then returned to your body through a second needle inserted in the fistula. After a fistula is made, it takes at least one month and ideally 3-4 months to heal enough before it is used for HD. Over time, the fistula will get bigger because of the blood pressure in the artery, which is a good sign that the fistula is working well. The fistula is the best access choice for HD and is less prone to infection because it uses your own blood vessels and is under your skin.3 Sometimes the first attempt at making a fistula does not work and other surgeries are needed. A healthy fistula can last decades, but not everyone can have a fistula. Speak with your doctor for more information.

 

Graft

graft

A graft is surgically made by linking one of your arteries and a vein with tubing. Since the tubing (often referred to as artificial vein) is not native to your body, the risk of blood clots and infection is higher than with fistulas. Grafts may need to be replaced at some point as the dialysis needles can cause holes in the graft tubing, which can lead to severe blood loss. Most often the graft site is in one of your arms, but thigh and leg grafts may also be used as other sites are used up over time.4

 

Central venous access

cva

Central Venous Catheter (CVC) is an access or entry to the bloodstream. A small soft tube (catheter) is placed into a large vein in the neck, shoulder, or groin area that feeds towards the heart. CVCs do not require needles for the delivery of hemodialysis. However, CVCs have the highest rate of infection of all HD access options and risk of blood clots.5

 


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. 42-44.
  2. 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. 51.
  3. 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. 53.

Peritoneal dialysis

For peritoneal dialysis to happen, a PD catheter is surgically placed in the abdomen to access the peritoneal membrane. Dialysis solution flows into your abdomen through the PD catheter to clean your blood using your own peritoneum as the filter.

pd catheter

 

PD catheter6

A peritoneal dialysis (PD) catheter is a small tube that is surgically inserted through the wall of your abdomen. The procedure to place the PD catheter is relatively short and is typically done as an outpatient procedure. The tube is about the size of a drinking straw and extends into the peritoneum. The place where the tube comes out of your body is called the exit-site. It is very important to keep your catheter clean and dry to avoid infection and always handle your catheter with care so it does not become damaged.

presternal catheter

One option is to have your exit-site at your chest area. This is called a presternal PD catheter. The catheter tip still reaches down to the abdomen but it is tunneled further under the skin to exit at the chest. The risk of infection is lower with a presternal PD catheter as the skin on the chest moves less and is thinner than on the abdomen and there is less risk of infection.

 


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. 39-40.

 

What to expect for each kind of dialysis

In this section, you can get a better understanding of what to expect with each type of dialysis. You can also learn about the benefits and drawbacks of each option and consider which type of dialysis is best for you.

PD

PD is a treatment that you can do at home. Doing your own treatment allows you some control over your kidney disease. PD can be done in two ways: Continuous Ambulatory Peritoneal Dialysis (CAPD) or Automated Peritoneal Dialysis (APD).

CAPD is the manual exchange of old solution for new solution multiple times a day by gravity. There are three steps to do an exchange:

 

Drain:

The used/old dialysis solution inside the abdomen is drained. This dialysis solution contains waste and excess fluid.

 

Fill:

After the abdomen is completely drained of the old solution, new dialysis solution is placed into the abdomen.

 

Dwell:

When the new solution has been placed, the tubing and bags are disconnected. During the dwell is when the dialysis occurs in the forms of osmosis and diffusion. During this time, the dialysis solution collects waste and excess fluid from your body while you are disconnected from the dialysis supplies and doing your daily activities.

drain fill dwell

APD is an automated form of PD. APD completes PD exchanges (drain, fill, dwell) using a machine, typically while you sleep at night. During the day, you are free to go anywhere and be involved in your normal activities. If you require an additional exchange during the day, your nurse will advise you.

You can be trained by your healthcare provider to do PD on your own. You do not need to insert needles for the delivery of peritoneal dialysis.

In most cases, you and your caregiver can learn it in a week or two. Your healthcare team will schedule training for you and it includes:

  • Setting up an exchange area
  • Hand washing
  • Catheter and exit-site care
  • Doing an exchange
  • Choosing which solution to use
  • Storing and ordering supplies
  • Keeping treatment logs
  • Taking your blood pressure, pulse, temperature and weight
  • Diet and fluid limits
  • Recognizing and reporting problems

Osmosis and diffusion in PD treatment happens continuously. PD solution dwells in your abdomen, continuously collecting waste from your body, while you continue your daily activities. When starting treatment, you may feel full when you put fluid in. Your body will get used to this over the first few weeks.

PD may help you keep your remaining kidney function longer. However, it is important to do PD exactly how you are taught to avoid infections. Since PD is done at home, you can schedule treatment around your lifestyle and have flexibility for your daily activities. PD is portable, so you can still travel and perform your treatment elsewhere.

You, your family member, or caregiver will perform PD at home on a daily basis. You will not do exchanges alone until both you and your nurse are confident in your training that you can do all the steps safely. You will still have appointments with your nephrologist. And if you have questions, or need help with your equipment and supplies, your social worker, nurse, dietitian and technical support will always be just a phone call away.

For CAPD, you do not need a dialysis machine and only require storage space at home for solution and ancillary supplies. The manufacturer of PD supplies will deliver boxes of dialysis solutions to your home every month.

ICHD

In-center hemodialysis (ICHD): Conventional ICHD is always an option and is a backup for other types of treatment. You have to go to your clinic at a scheduled time for ICHD treatment.

If you are on ICHD, arrive early for your treatment time, wear comfortable clothes and bring something to pass the time. A physical assessment is performed and your weight is measured before the treatment to assess how much water to remove during the HD treatment. Connecting to the dialysis machine requires your access site to be cleaned, needles inserted and/or tubing connected. After your prescribed treatment, you are disconnected from the machine and, once your blood pressure meets clinic standards, you can go.

Medical staff is present and will connect you to the machine. ICHD requires a large time commitment. Treatment happens 3 times a week and 4-5 hours are needed for each treatment. With travel time and preparation, this may take much longer. Feeling in control of your treatment can be difficult with ICHD when you are dependent on others or if life changes limit your choices.

You may feel tired or experience discomfort such as nausea, leg cramps, etc. during or after the treatment. Be sure to talk to your medical staff about these symptoms.


References:

  1. Adapted from 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. 64.

Comparing dialysis options

There are different benefits and considerations for PD and ICHD. Please remember that every patient differs in terms of age, medical condition, physical condition, and lifestyle choices. It's best to discuss medical and lifestyle considerations with your healthcare team so you understand all the treatment options and how they might impact you. Below is a quick comparative chart for different types of dialysis.

Type of dialysis Benefits Some points to consider
PD
  • Fit your treatment around your lifestyle (e.g. flexibility for work, school, and other activities)
  • Portable and flexible - easy to take your therapy with you when you travel
  • Continuous therapy is gentler and more like your natural kidney function
  • Fewer visits to the dialysis unit for treatment
  • No needles
  • Independence - you typically perform your therapy yourself
  • Can do dialysis therapy while you sleep
  • Daily exchanges
  • Permanent access catheter
  • Storage space in your home
  • Potential feeling of fullness
ICHD
  • Regular contact with other hemodialysis patients and staff
  • 3 treatments per week
  • No need for keeping equipment/supplies at home
  • Immediate access to medical help during therapy
  • Travel to center/unit 3 times a week, on a fixed schedule for an average of 4 hours each treatment
  • Need for permanent access
  • Insertion of 2 needles for each treatment
  • Possible discomfort such as headache, nausea, leg cramps, tiredness