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This e-text is for people whose kidneys fail to work. This
condition is called end-stage renal disease (ESRD).
Today, there are new and better treatments for ESRD that replace
the work of healthy kidneys. By learning about your treatment
choices, you can work with your doctor to pick the one that's
best for you. No matter which type of treatment you choose,
there will be some changes in your life. But with the help of
your health care team, family, and friends, you may be able to
lead a full, active life.
This e-text describes the choices for treatment: hemodialysis,
peritoneal dialysis, and kidney transplantation. It gives the
pros and cons of each. It also discusses diet and paying for
treatment. It gives tips for working with your doctor, nurses,
and others who make up your health care team. It provides a list
of groups that offer information and services to kidney
patients. It also lists magazines, books, and brochures that you
can read for more information about treatment.
You and your doctor will work together to choose a treatment
that's best for you. This e-text can help you make that
choice.
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Healthy kidneys clean the blood by filtering out extra water and
wastes. They also make hormones that keep your bones strong and
blood healthy. When both of your kidneys fail, your body holds
fluid. Your blood pressure rises. Harmful wastes build up in
your body. Your body doesn't make enough red blood cells. When
this happens, you need treatment to replace the work of your
failed kidneys.
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 Purpose
Hemodialysis is a procedure that cleans and filters your blood.
It rids your body of harmful wastes and extra salt and fluids.
It also controls blood pressure and helps your body keep the
proper balance of chemicals such as potassium, sodium, and
chloride.
How it Works
Hemodialysis uses a dialyzer, or special filter, to clean your
blood. The dialyzer connects to a machine. During treatment,
your blood travels through tubes into the dialyzer. The dialyzer
filters out wastes and extra fluids. Then the newly cleaned
blood flows through another set of tubes and back into your
body.
 Getting Ready
Before your first treatment, an access to your bloodstream must
be made. The access provides a way for blood to be carried from
your body to the dialysis machine and then back into your body.
The access can be internal (inside the body -- usually under
your skin) or external (outside the body).
Who Performs It
Hemodialysis can be done at home or at a center. At a center,
nurses or trained technicians perform the treatment. At home,
you perform hemodialysis with the help of a partner, usually a
family member or friend. If you decide to do home dialysis, you
and your partner will receive special training.
The Time it Takes
Hemodialysis usually is done three times a week. Each treatment
lasts from 2 to 4 hours. During treatment, you can read, write,
sleep, talk, or watch TV.
Possible Complications
Side effects can be caused by rapid changes in your body's fluid
and chemical balance during treatment. Muscle cramps and
hypotension are two common side effects. Hypotension, a sudden
drop in blood pressure, can make you feel weak, dizzy, or sick
to your stomach.
It usually takes a few months to adjust to hemodialysis. You can
avoid many of the side effects if you follow the proper diet and
take your medicines as directed. You should always report side
effects to your doctor. They often can be treated quickly and
easily.
Your Diet
Hemodialysis and a proper diet help reduce the wastes that build
up in your blood. A dietitian can help you plan meals according
to your doctor's orders. When choosing foods, you should
remember to:
- Eat balanced amounts of foods high in protein such as meat
and chicken. Animal protein is better used by your body than the
protein found in vegetables and grains.
- Watch the amount of potassium you eat. Potassium is a
mineral found in salt substitutes, some fruits, vegetables,
milk, chocolate, and nuts. Too much or too little potassium can
be harmful to your heart.
- Limit how much you drink. Fluids build up quickly in your
body when your kidneys aren't working. Too much fluid makes your
tissues swell. It also can cause high blood pressure and heart
trouble.
- Avoid salt. Salty foods make you thirsty and cause your body
to hold water.
- Limit foods such as milk, cheese, nuts, dried beans, and
soft drinks. These foods contain the mineral phosphorus. Too
much phosphorus in your blood causes calcium to be pulled from
your bones. Calcium helps keep bones strong and healthy. To
prevent bone problems, your doctor may give you special
medicines. You must take these medicines every day as
directed.
Pros and Cons
Each person responds differently to similar situations. What
may be a negative factor for one person may be positive for
another. However, in general, the following are pros and cons
for each type of hemodialysis.
In-Center Hemodialysis
Pros
- You have trained professionals with you at all times.
- You can get to know other patients.
Cons
- Treatments are scheduled by the center.
- You must travel to the center for treatment.
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Home Hemodialysis
Pros
- You can do it at the hours you choose. (But you still
must do it as often as your doctor orders.)
- You don't have to travel to a center.
- You gain a sense of independence and control over your
treatment.
Cons
- Helping with treatments may be stressful to your family.
- You need training.
- You need space for storing the machine and supplies at home.
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Working With Your Health Care Team
Questions You May Want To Ask:
- Is hemodialysis the best treatment choice for me? Why or why
not?
- If I am treated at a center, can I go to the center of my
choice?
- What does hemodialysis feel like? Does it hurt?
- What is self-care dialysis?
- How long does it take to learn home hemodialysis? Who will
train my partner and me?
- What kind of blood access is best for me?
- As a hemodialysis patient, will I be able to keep working?
Can I have treatments at night if I plan to keep working?
- How much should I exercise?
- Who will be on my health care team? How can they help me?
- Who can I talk with about sexuality, family problems, or
money concerns?
- How/where can I talk to other people who have faced this
decision?
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 Purpose
Peritoneal dialysis is another procedure that replaces the work
of your kidneys. It removes extra water, wastes, and chemicals
from your body. This type of dialysis uses the lining of your
abdomen to filter your blood. This lining is called the
peritoneal membrane.
How it Works
A cleansing solution, called dialysate, travels through a
special tube into your abdomen. Fluid, wastes, and chemicals
pass from tiny blood vessels in the peritoneal membrane into the
dialysate. After several hours, the dialysate gets drained from
your abdomen, taking the wastes from your blood with it. Then
you fill your abdomen with fresh dialysate and the cleaning
process begins again.
Getting Ready
Before your first treatment, a surgeon places a small, soft tube
called a catheter into your abdomen. This catheter always stays
there. It helps transport the dialysate to and from your
peritoneal membrane.
Types of Peritoneal Dialysis
There are three types of peritoneal dialysis:
- Continuous Ambulatory Peritoneal Dialysis
(CAPD)
CAPD is the most common type of peritoneal dialysis. It needs no
machine. It can be done in any clean, well-lit place. With CAPD,
your blood is always being cleaned. The dialysate passes from a
plastic bag through the catheter and into your abdomen. The
dialysate stays in your abdomen with the catheter sealed. After
several hours, you drain the solution back into the bag. Then
you refill your abdomen with fresh solution through the same
catheter. Now the cleaning process begins again.
- Continuous Cyclic Peritoneal Dialysis (CCPD)
CCPD is like CAPD except that a machine, which connects to your
catheter, automatically fills and drains the dialysate from your
abdomen. The machine does this at night while you sleep.
- Intermittent Peritoneal Dialysis (IPD)
IPD uses the same type of machine as CCPD to add and drain the
dialysate. IPD can be done at home, but it's usually done in the
hospital. IPD treatments take longer than CCPD.
Who Performs It
CAPD is a form of self-treatment. It needs no machine and no
partner. However, with IPD and CCPD, you need a machine and the
help of a partner (family member, friend, or health
professional).
The Time It Takes
With CAPD, the dialysate stays in your abdomen for about 4 to 6
hours. The process of draining the dialysate and replacing fresh
solution takes 30 to 40 minutes. Most people change the solution
four times a day.
With CCPD, treatments last from 10 to 12 hours every night.
With IPD, treatments are done several times a week, for a total
of 36 to 42 hours per week. Sessions may last up to 24 hours.
Possible Complications
Peritonitis, or infection of the peritoneum, can occur if the
opening where the catheter enters your body gets infected. You
can also get it if there is a problem connecting or
disconnecting the catheter from the bags. Peritonitis can make
you feel sick. It can cause a fever and stomach pain.
To avoid peritonitis, you must be careful to follow the
procedure exactly. You must know the early signs of peritonitis.
Look for reddening or swelling around the catheter. You should
also note if your dialysate looks cloudy. It is important to
report these signs to your doctor so that the peritonitis can be
treated quickly to avoid serious problems.
Your Diet
Diet for peritoneal dialysis is slightly different than diet for
hemodialysis.
- You may be able to have more salt and fluids.
- You may eat more protein.
- You may have different potassium restrictions.
- You may need to cut back on the number of calories you eat.
This limitation is because the sugar in the dialysate may cause
you to gain weight.
Pros and Cons
There are pros and cons to each type of peritoneal dialysis.
CAPDPros
- You can perform treatment alone.
- You can do it at times you choose.
- You can do it in many locations.
- You don't need a machine.
Cons
- It disrupts your daily schedule.
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CCPD
Pros
- You can do it at night, mainly while you sleep.
Cons
- You need a machine and help from a partner.
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IPDPros
- Health professionals usually perform treatments.
Cons
- You may need to go to a hospital.
- It takes a lot of time.
- You need a machine.
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Working With Your Health Care Team
Questions You May Want To Ask:
- Is peritoneal dialysis the best treatment choice for me? Why
or why not? Which type?
- How long will it take me to learn peritoneal dialysis?
- What does peritoneal dialysis feel like? Does it hurt?
- How will peritoneal dialysis affect my blood pressure?
- How do I know if I have peritonitis? How is peritonitis
treated?
- As a peritoneal dialysis patient, will I be able to continue
working?
- How much should I exercise?
- Who will be on my health care team? How can they help me?
- Who can I talk with about sexuality, finances, or family
concerns?
- How/where can I talk to other people who have faced this
decision?
Dialysis Is Not a Cure
Hemodialysis and peritoneal dialysis are treatments that try to
replace your failed kidneys. These treatments help you feel
better and live longer, but they are not cures for ESRD. While
patients with ESRD are now living longer than ever, ESRD can
cause problems over the years. Some problems are bone disease,
high blood pressure, nerve damage, and anemia (having too few
red blood cells). Although these problems won't go away with
dialysis, doctors now have new and better ways to treat or
prevent them. You should discuss these treatments with your
doctor.
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 Purpose
Kidney transplantation is a procedure that places a healthy
kidney from another person into your body. This one new kidney
does all the work that your two failed kidneys cannot do.
How it Works
A surgeon places the new kidney inside your body between your
upper thigh and abdomen. The surgeon connects the artery and
vein of the new kidney to your artery and vein. Your blood flows
through the new kidney and makes urine, just like your own
kidneys did when they were healthy. The new kidney may start
working right away or may take up to a few weeks to make urine.
Your own kidneys are left where they are, unless they are
causing infection or high blood pressure.
 Getting Ready
You may receive a kidney from a member of your family. This kind
of donor is called a living-related donor. You may receive a
kidney from a person who has recently died. This type of donor
is called a cadaver donor. Sometimes a spouse or very close
friend may donate a kidney. This kind of donor is called a
living-unrelated donor.
It is very important for the donor's blood and tissues to
closely match yours. This match will help prevent your body's
immune system from fighting off, or rejecting, the new kidney. A
lab will do special tests on blood cells to find out if your
body will accept the new kidney.
The Time It Takes
The time it takes to get a kidney varies. There are not enough
cadaver donors for every person who needs a transplant. Because
of this, you must be placed on a waiting list to receive a
cadaver donor kidney. However, if a relative gives you a kidney,
the transplant operation can be done sooner.
The surgery takes from 3 to 6 hours. The usual hospital stay may
last from 10 to 14 days. After you leave the hospital, you will
go to the clinic for regular followup visits.
If a relative or close friend gives you a kidney, he or she will
probably stay in the hospital for one week or less.
Possible Complications
Transplantation is not a cure. There is always a chance that
your body will reject your new kidney, no matter how good the
match. The chance of your body accepting the new kidney depends
on your age, race, and medical condition.
Normally, 75 to 80 percent of transplants from cadaver donors
are working one year after surgery. However, transplants from
living relatives often work better than transplants from cadaver
donors. This fact is because they are usually a closer match.
Your doctor will give you special drugs to help prevent
rejection. These are called immunosuppressants. You will need to
take these drugs every day for the rest of your life. Sometimes
these drugs cannot stop your body from rejecting the new kidney.
If this happens, you will go back to some form of dialysis and
possibly wait for another transplant.
Treatment with these drugs may cause side effects. The most
serious is that they weaken your immune system, making it easier
for you get infections. Some drugs also cause changes in how you
look. Your face may get fuller. You may gain weight or develop
acne or facial hair. Not all patients have these problems, and
makeup and diet can help.
Some of these drugs may cause problems such as cataracts, extra
stomach acid, and hip disease. In a smaller number of patients,
these drugs also may cause liver or kidney damage when used for
a long period of time.
Your Diet
Diet for transplant patients is less limiting than it is for
dialysis patients. You may still have to cut back on some foods,
though. Your diet probably will change as your medicines, blood
values, weight, and blood pressure change.
- You may need to count calories. Your medicine may give you a
bigger appetite and cause you to gain weight.
- You may have to limit eating salty foods. Your medications
may cause salt to be held in your body, leading to high blood
pressure.
- You may need to eat less protein. Some medications cause a
higher level of wastes to build up in your bloodstream.
Pros and Cons
There are pros and cons to kidney transplantation.
Kidney Transplantation
Pros
- It works like a normal kidney.
- It helps you feel healthier.
- You have fewer diet restrictions.
- There's no need for dialysis.
Cons
- It requires major surgery.
- You may need to wait for a donor.
- One transplant may not last a lifetime. Your body may reject
the new kidney.
- You will have to take drugs for the rest of your life.
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Working With Your Health Care Team
Questions You May Want To Ask
- Is transplantation the best treatment choice for me? Why or
why not?
- What are my chances of having a successful transplant?
- How do I find out if a family member or friend can donate?
- What are the risks to a family member or friend if he or she
donates?
- If a family member or friend doesn't donate, how do I get
placed on a waiting list for a kidney? How long will I have to
wait?
- What are the symptoms of rejection?
- Who will be on my health care team? How can they help me?
- Who can I talk to about sexuality, finances, or family
concerns?
- How/where can I talk to other people who have faced this
decision?
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It's not always easy to decide which type of treatment is best
for you. Your decision depends on your medical condition,
lifestyle, and personal likes and dislikes. Discuss the pros and
cons of each with your health care team. If you start one form
of treatment and decide you'd like to try another, talk it over
with your doctor. The key is to learn as much as you can about
your choices. With that knowledge, you and your doctor will
choose a treatment that suits you best.
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Treatment for ESRD is expensive, but the Federal Government
helps pay for much of the cost. Often, private insurance or
state programs pay the rest.
Medicare
Medicare pays for 80 percent of the cost of your dialysis
treatments or transplant, no matter how old you are. To
qualify,
- you must have worked long enough to be insured under Social
Security (or be the child of someone who has) or
- you already must be receiving Social Security benefits.
You should apply for Medicare as soon as possible after
beginning dialysis. Often, a social worker at your hospital or
dialysis center will help you apply.
Private Insurance
Private insurance often pays for the entire cost of treatment.
Or it may pay for the 20 percent that Medicare does not cover.
Private insurance also may pay for your prescription drugs.
Medicaid
Medicaid is a state program. Your income must be below a
certain level to receive Medicaid funds. Medicaid may pay for
your treatments if you cannot receive Medicare. In some states,
it also pays the 20 percent that Medicare does not cover. It
also may pay for some of your medicines. To apply for Medicaid,
talk with your social worker or contact your local health
department.
Veterans Administration (VA) Benefits
If you are a veteran, the VA can help pay for treatment.
Contact your local VA office for more information.
Social Security Income (SSI) and Social Security Disability
Income (SSDI)
These benefits are available from the Social Security
Administration. They assist you with the costs of daily living.
To find out if you qualify, talk to your social worker or call
your local Social Security office.
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There are several groups that offer information and services to
kidney patients. You may wish to contact the following:
American Kidney Fund
Suite 1010
6110 Executive Boulevard
Rockville, MD 20852
(800) 638-8299
American Association of Kidney Patients
100 S. Ashley Drive
Suite 280
Tampa, FL 33602
(800) 749-2257
E-mail: AAKPnat@aol.com
Home page: www.aakp.org
National Kidney Foundation, Inc.
30 East 33rd Street
New York, NY 10016
(800) 622-9010
National Kidney and Urologic Diseases Information
Clearinghouse
3 Information Way
Bethesda, MD 20892-3560
E-mail: National Kidney and Urologic Diseases Information Clearinghouse
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Additional Reading |
If you would like to learn more about ESRD and its treatment,
you may be interested in reading:
Your New Life With Dialysis--A Patient Guide for
Physical and Psychological Adjustment
Edith T. Oberley, M.A., and Terry D. Oberley, M.D., Ph.D.
Fourth edition, 1991
Charles C. Thomas Publishers
2600 South First Street
Springfield, IL 62794-9265
Understanding Kidney Transplantation
Edith T. Oberley, M.A., and Neal R. Glass, M.D., F.A.C.S.
Charles C. Thomas Publishers, 1987
2600 South First Street
Springfield, IL 62794-9265
Kidney Disease: A Guide for Patients and Their
Families
American Kidney Fund
Suite 1010
6110 Executive Boulevard
Rockville, MD 20852
(800) 638-8299
National Kidney Foundation Patient Education
Brochures
Includes information on treatment, diet, work, and exercise.
National Kidney Foundation, Inc.
30 East 33rd Street
New York, NY 10016
(800) 622-9010
Medicare Coverage of Kidney Dialysis and Kidney Transplant
Services: A Supplement to Your Medicare Handbook
Publication Number HCFA-02183
U.S. Department of Health and Human Services Health Care
Financing Administration
Suite 500
1331 H Street, NW
Washington, DC 20005
(301) 966-7843
Renalife Magazine
American Association of Kidney Patients (AAKP)
Suite LL1
1 Davis Boulevard
Tampa, FL 33606
(813) 251-0725
Published quarterly.
Family Focus Newsletter
National Kidney Foundation, Inc.
30 East 33rd Street
New York, NY 10016
(800) 622-9010
For Patients Only Magazine
Suite 400
20335 Ventura Boulevard
Woodland Hills, CA 91364
(818) 704-5555
Published six times per year.
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National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3560
E-mail: National Kidney and Urologic Diseases Information Clearinghouse
The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC) is a service of the National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK
is part of the National Institutes of Health under the U.S.
Public Health Service. Established in 1978, the clearinghouse
provides information about diabetes to people with kidney and
urologic diseases and their families, health care professionals,
and the public. NKUDIC answers inquiries; develops, reviews,
and distributes publications; and works closely with
professional and patient organizations and government agencies
to coordinate resources about kidney and urologic diseases.
Publications produced by the clearinghouse are reviewed
carefully for scientific accuracy, content, and readability.
This e-text is not copyrighted. The clearinghouse encourages
users of this e-pub to duplicate and distribute as many copies
as desired.
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NIH Publication No. 94-2412
June 1994
e-text last updated: 17 October 1997
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