Treatment Choices

There are three treatment options available for kidney failure: transplantation, dialysis or no treatment. Each has its own benefits and drawbacks and offers options to meet individual needs.

• Kidney transplantation Kidney transplantation is an operation that places a healthy kidney into the body. It is not a cure, but a treatment that is supported by daily medications and physician follow-up.
• Dialysis Dialysis is the process of removing wastes and excess fluids from the body when the kidneys have failed. There are two types of dialysis: peritoneal dialysis and hemodialysis (see below).
• No Treatment Some people decide to not seek any kind of treatment to replace their failed kidneys. Selecting the no treatment option will lead to death.

Peritoneal Dialysis (PD)

Peritoneal dialysis occurs inside the body and uses the body’s natural peritoneal membrane (the lining of the abdomen) as the filter. A catheter is surgically placed in the abdomen and a fluid called peritoneal dialysate enters into the abdomen through the catheter. While the fluid is in the abdomen, waste products and excess fluids pass from the blood through the peritoneal membrane and into the fluid through a natural filtering process. The fluid is exchanged and replaced several times a day.

PD is a procedure performed by the individual in their home. Training is done in an outpatient PD facility with a nurse for approximately two weeks. Upon completion of training, you will perform dialysis in the comfort of your own home. You will typically visit the PD facility twice a month for routine lab work and to meet with your healthcare team.

There are two types of PD: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycler-Assisted Peritoneal Dialysis (CCPD). The type you choose will depend on the schedule of exchanges you would like to follow, as well as other factors. You may start with one type of PD and switch to another, or you may find that a combination of automated and non-automated exchanges suits you best. Work with your health care team to find the best schedule and techniques to meet your lifestyle and health needs.

• If you choose CAPD, you’ll drain a fresh bag of dialysis solution into your abdomen. After four to six hours of dwell time, you’ll drain the solution, which now contains wastes, into the bag. You then repeat the cycle with a fresh bag of solution. You don’t need a machine for CAPD; all you need is gravity to fill and empty your abdomen. Your doctor will prescribe the number of exchanges you’ll need which is typically three or four exchanges during the day and one evening exchange with a long overnight dwell time while you sleep.
• CCPD uses an automated cycler to perform three to five exchanges during the night while you sleep. In the morning, you perform one exchange with a dwell time that lasts the entire day.

Hemodialysis

Hemodialysis replaces lost kidney function through a process that filters your blood via an artificial kidney known as a dialyzer. The dialyzer removes toxins and excess fluids from the blood. The clean blood then returns to the body. The procedure is typically performed three times a week for approximately four hours each time.

Hemodialysis treatments may be done at home with the help of a partner or at an outpatient facility. In the outpatient facility, you can request to learn how to care for yourself with assistance from the facility staff or have the staff perform all the tasks.