What Are My Dialysis Choices?

Too many people learn they need dialysis when they wind up in the hospital emergency room because their kidneys have failed. When this happens, a catheter is generally placed under a person’s collarbone and hemodialysis is performed to clean the blood while in the hospital. It is common that a more permanent form of dialysis access will also be placed during that initial hospitalization. This might be an arteriovenous (AV) fistula or synthetic graft in the arm (for hemodialysis), or a peritoneal dialysis catheter in the abdomen (for peritoneal dialysis).

After being discharged from the hospital, most patients will be assigned to a dialysis center near his or her home and will go for treatments three times each week for about four hours per hemodialysis treatment. Once the more permanent hemodialysis access has healed and has begun to be used, the temporary catheter can then be removed.

In a better situation, a person will be aware that he or she has chronic kidney disease and can prepare for dialysis by meeting with their nephrologist (kidney doctor) to learn about the different dialysis choices and decide which one meets their health and lifestyle needs.

In-center and at-home dialysis choices

Perhaps the biggest impact on lifestyle is whether or not a person has dialysis in a center or does it at home. Dialysis in a center requires the patient go to a dialysis center for treatment three times a week for about four hours each treatment. Treatments in a center need to be scheduled and the patient needs to arrive at their appointment time. Dialysis at home provides more flexibility because the patient can perform dialysis at their convenience. For people who work or go to school, have children to care for, live active lifestyles or just want more freedom and control over their time, home dialysis may be a better option.

Diet is another factor to consider when choosing a modality. For people on dialysis, diet is part of their treatment. Foods containing the minerals phosphorus, potassium and sodium are usually limited on the dialysis diet, although a greater intake of potassium-containing foods is usually allowed for patients on peritoneal dialysis. Fluid consumption is also restricted. Renal dietitians work with their dialysis patients to counsel and educate them about a healthy diet and modify nutrient intake based on their monthly lab results. Dialysis patients who perform their treatments more often than three times a week may have more liberal diets than those patients who perform treatments three times per week.

Travel is another consideration. While people who choose in-center hemodialysis are free to travel, they will need to plan ahead and make arrangements to receive dialysis in a center where they are visiting. Although large and bulky, many home hemodialysis machines are portable, and people on home hemodialysis usually have a choice of bringing their equipment to their destination or going to a dialysis center in the place they are visiting to get treatment. Peritoneal dialysis cycler machines are smaller and portable, and PD supplies can be delivered directly to a vacation destination. Therefore, peritoneal dialysis patients can generally travel with greater ease.

Hemodialysis and peritoneal dialysis

Hemodialysis is a treatment for kidney failure that removes the blood from the body so it can be filtered through a dialzyer (artificial kidney) and then returned to the body. The blood is removed from and returned to the body through an access — either a catheter or vascular access, such as an arteriovenous (AV) fistula or AV graft. The blood is filtered many times during a four-hour treatment to remove wastes and extra fluid. Hemodialysis can be performed in a dialysis center or at home. There are several hemodialysis choices including: in-center hemodialysis, in-center self care hemodialysis, in-center nocturnal hemodialysis, traditional home hemodialysis and short daily home hemodialysis. In-center self care, in-center nocturnal hemodialysis and the home hemodialysis options may not be available in some areas throughout the U.S.

Peritoneal dialysis (PD) removes wastes and extra fluid; however, it is performed within the body. The peritoneal cavity in the abdomen holds dialysis solution called dialysate, and the peritoneum, the membrane around the cavity, acts as a filter. A PD catheter, which is a small, flexible tube, is placed in the abdomen so the peritoneal cavity can be filled with dialysate. Waste passes through the peritoneum into the dialysate, which is then drained and replaced after an amount of time prescribed by the doctor. PD is performed at home, but can also be performed at work or in any other clean environment. The types of PD include: automated peritoneal dialysis (APD), which consists of continuous cycling peritoneal dialysis (CCPD) performed with a machine called a cycler, and continuous ambulatory peritoneal dialysis (CAPD), which is performed manually. PD is a dialysis option wherever home dialysis is offered.

In-center hemodialysis options

Some patients and their physicians choose in-center hemodialysis for their treatment. One of the benefits includes having health care professionals close by to administer or help with treatment. People may also enjoy the social interaction of seeing other patients and health care professionals on a regular basis.

In-center self care hemodialysis

For people who enjoy having more control over their treatment and still like the security of having health care professionals nearby, in-center self care is a dialysis option. Patients can do as little or as much of their treatment as they feel comfortable. Some people use self care as a stepping stone to doing dialysis at home.

In-center nocturnal hemodialysis

In areas where in-center nocturnal hemodialysis is available, patients arrive at the dialysis center in the evening and receive treatment for six to eight hours during typical sleep time. People who do in-center nocturnal hemodialysis experience a longer treatment, generally twice as long as traditional in-center hemodialysis. Because patients dialyze longer, the treatment is gentler on the body. Because fluid is removed from the body at a slower pace, many in-center nocturnal patients report that they feel better after nighttime treatment and don’t experience the “washed out feeling” they had experienced during traditional daytime hemodialysis.

Home dialysis options

There are two types of home dialysis treatments: hemodialysis and peritoneal dialysis. People performing home dialysis don’t have to visit the dialysis center every other day; instead they generally go twice a month for lab work and to talk with their health care professionals.

Home hemodialysis (HHD) has several choices: traditional, short daily and nocturnal. For HHD, the patient will have a hemodialysis machine in their home along with the supplies necessary to perform dialysis. People on HHD usually have a care partner to help them with their treatment.

Peritoneal dialysis patients also need to have room in their home for their supplies, and for a cycler if they are performing automated peritoneal dialysis. Usually the cycler is placed bedside so patients can dialyze while they sleep. PD patients usually do not need to have a trained care partner to help them.

Traditional home hemodialysis

Traditional home hemodialysis is performed three times per week, typically for about four hours per session similar to in-center hemodialysis. The difference is that the patient and his or her care partner will perform the treatment at home on their own schedule.

Short daily home hemodialysis

Short daily home hemodialysis is done five or six times a week, typically for two to three hours per treatment. Because the patient dialyzes on more consecutive days, each treatment time is generally shorter than in-center or traditional home hemodialysis. These more frequent treatments usually allow people to have a more liberal diet than those who do in-center or traditional home hemodialysis.

Peritoneal dialysis

While all hemodialysis treatments only differ in the amount of time and where the person dialyzes, peritoneal dialysis is a much different type of treatment. Some people prefer PD because no needles are required for treatment. It does, however, involve having a catheter implanted in the abdomin. Peritoneal dialysis is similar to the home hemodialysis offerings because it offers the patient flexibility regarding their dialysis schedule. Most patients choose to use an automated cycler machine at night, which frees up the day for work, travel or other activities. Because PD is performed daily, wastes and fluid are removed more frequently than with hemodialysis so there are usually fewer diet and fluid restrictions.

Summary

Many dialysis patients may not be aware they have choices when it comes to their dialysis treatment. Sometimes patients on one modality switch to another modality as their health or lifestyle needs change. Talk to your doctor to find out which treatment may be right for you.

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