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You Have a Choice When It Comes to Dialysis Treatments

By Silvia German, RN, CNN, Education Manager with the DaVita® National Clinical Education Team

If you have been diagnosed with chronic kidney disease (CKD) and are approaching the stage where you require dialysis, there are more treatment modalities available to you than ever before. These days, you have a choice when it comes to finding a dialysis treatment that fits your medical condition, lifestyle and personal preference.

Two types of dialysis: hemodialysis and peritoneal dialysis

There are two different types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis can be performed either at a dialysis clinic or at home; peritoneal dialysis is performed at home or wherever the patient happens to be, such as work or a hotel room during travel.

Hemodialysis uses a dialyzer, or special filter, to clean your blood of waste products, remove excess fluid and normalize the levels of electrolytes such as potassium, chloride, calcium and phosphate in your blood. The dialyzer connects to a machine. During treatment, your blood travels through tubes into the dialyzer to be cleaned and back into your body. Before your first treatment, a vascular access to your blood stream must be surgically created that allows for an adequate amount of blood, about 1-1/2 cups per minute, to be pumped to the dialyzer.

Peritoneal dialysis uses the lining of your abdomen, the peritoneal membrane, to filter your blood. A cleansing solution, called dialysate, is put through a tube into your abdomen were it dwells for several hours. Excess fluid, wastes and electrolytes pass from tiny blood vessels in the peritoneal membrane into the dialysis solution. When the prescribed dwell time is completed, the dialysate is drained from your abdomen, taking wastes and extra fluid with it. You then fill your abdomen with fresh dialysis solution, and the cleaning process begins again. Before your first treatment, a surgeon places a soft tube, the peritoneal dialysis catheter, into your abdomen.

Your dialysis treatment choices

Continuous ambulatory peritoneal dialysis (CAPD)

Continuous ambulatory peritoneal dialysis (CAPD), like other choices of dialyzing at home, allows patients greater flexibility. But unlike home hemodialysis, CAPD does not require a partner. You will learn how to perform the four to six daily manual exchanges yourself.  If you love to travel, you can take your supplies along in your car or have them shipped by the manufacturer to your travel destination. 

Automated peritoneal dialysis (APD)

Automated peritoneal dialysis (APD) is yet another variation of peritoneal dialysis that involves a machine called a cycler that performs the exchanges. You connect to the cycler in the evening and dialyze at night while you sleep. You may also perform one to two manual exchanges during the day to ensure enough wastes and excess fluid are cleared from your blood. The cycler belongs to the manufacturer and it may already come with a traveling case to take it along if you go on a trip. Other manufacturers may ship a cycler to your travel destination as long as you stay within the U.S. and Puerto Rico.

Traditional home hemodialysis

Traditional home hemodialysis is performed at home three times per week with treatment times averaging about four hours. Performing home hemodialysis generally requires a partner, usually a family member or close friend, to assist with the treatment. You and your partner will be trained at your dialysis center to ensure that you are able to perform all aspects of the treatment safely before you are discharged to your home. Your dialysis provider will usually purchase the dialysis machine and water treatment equipment needed for your use at home and assist with any technical questions or problems you may have.

Short daily home hemodialysis

Short daily home hemodialysisis a relatively new treatment method. Short daily home hemodialysis treatments are usually done six times per week. The new portable home hemodialysis machines have built in water purification systems for mixing the dialysis solution or premixed dialysis solution bags can be used. Due to the increased number of weekly treatments, treatment times are usually shorter and range from two to three hours. As with nocturnal dialysis, patients report improved well being, having more energy and often enjoying a more liberal diet and fluid intake because their blood is cleaned on a daily basis. In addition, the new machines are small enough to be taken along in your car when you travel. For air travel, a metal case should be used to protect the machine. Usually it is the patient’s responsibility to purchase a case, which costs about $500.00.

In-center nocturnal hemodialysis

In-center nocturnal hemodialysis is offered in some dialysis centers. Typically at least 10 patients interested in doing this form of dialysis are needed to start an in-center nocturnal hemodialysis program. You will spend an average of eight hours, three nights per week at the clinic dialyzing while you sleep. Because nighttime dialysis is slower and gentler on the body, studies have shown the benefits of it, which include improved well-being and fewer problems during treatment, such as low blood pressure, cramping, nausea and vomiting.

In-center self care hemodialysis

In-center self care hemodialysis teaches you some or all aspects of your treatment and allows you to perform those skills in the presence of trained dialysis nurses who can help with advice if you require it. In-center self care hemodialysis may give you a better understanding of your dialysis treatment and allow you to play a more active role.

In-center hemodialysis

In-center hemodialysis requires that you go to a dialysis center, usually three times per week for at least four hours per treatment. A typical dialysis center offers three different shifts, early morning, afternoon or evening, to accommodate your preferences. The evening shift is often reserved for working patients who come to dialyze after their workday is over. Pros include that all aspects of the treatment are done for you; cons consist of a set schedule to adhere to.

Summary

Talk to your doctor and your family to discuss the different dialysis treatment options and decide which one may be best for you. With all of the choices available, it’s important to choose a dialysis treatment that fits your health needs and your lifestyle.


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