Dialysis

If you are in stage 4 or 5 of chronic kidney disease (CKD) your transplant team may recommend dialysis.

Dialysis is a treatment for kidney failure that removes the waste and extra fluid from the blood using a specialized machine and filter that mimics the role of the kidney.

In general, there are usually two options for type of dialysis treatment:

1. Peritoneal dialysis

2. Hemodialysis

Peritoneal dialysis uses the lining of your abdomen to filter your blood. Because of this, post-this type of dialysis is usually not recommended for post-intestinal transplant patients. (1)

Hemodialysis is when your blood goes through a filter, called a dialyzer, outside your body. A dialyzer is sometimes called an “artificial kidney.”

You will require a special line for your hemodialysis. There are 3 types of vascular access possible for dialysis (2), and the appropriate method will be decided by your transplant team and nephrologist:

Fistula: Formed by sewing an artery to a vein, usually in your arm (“arteriovenous or AV” fistula).
Pros: Less prone to infections or blood clots than other types of access.
Your veins and arteries self-heal after each needle stick, so a fistula can last a long time.
Cons: You may not have adequate vascular access to create a fistula due to previous IV lines and blood draws.
Graft: A graft hooks a vein and artery together with a synthetically made piece of tubing, such as Gore-Tex.
Second-best kind of access for dialysis.
Cons: Downside is that can become infected and/or clotted more easily due to the foreign synthetic material in the body.
Can also develop holes, because the synthetic material does not self-heal after needle punctures.
Catheter: Plastic tube placed in a large central vein, usually in the internal jugular in the neck region, the subclavian in the chest, or temporarily the femoral vein in the groin may be used.
Catheters usually are only used as temporary access, for weeks or months, until a fistula or graft is ready.
For some people, a catheter can be more permanent.

Hemodialysis Treatment

Two needles are placed in your arm using sterile technique.
The dialysis machine pumps blood through the filter and returns the blood to your body.
During the process, the machine is checking your blood pressure. It controls how quickly blood flows through the filter and how quickly the fluid is removed from your body.
Each session lasts around 4 hours, but can vary by individual and dialysis center.

Treatment can usually make you feel better and have more energy, however, it does not last forever nor does it cure your kidney disease. The stage and severity of chronic kidney disease will determine how often you will require dialysis per week. In general, people usually require it at least 3-4 times per week on a set schedule. Some people also need to have PRN (as needed) orders just in case they start feeling really sick or their bloodwork becomes unstable.

Want to learn more?

Kideny School: Full online instructional modules about kidney health, disease, treatments, and lifestyle visit “Kidney School.” A completely free and comprehensive online tutorial.

National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)

Educational information on the types of dialysis as well as kidney transplant, financial support, and kidney disease.

Davita Kidney Care

Major dialysis provider that has many educational materials on the subject.

References:

1. Hemodialysis. (2018, January 01). Retrieved June 14, 2020, from https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis

2. Medical Education Institute, Inc. (n.d.). Kidney School™. Retrieved June 14, 2020, from https://www.kidneyschool.org/