In-Home Treatments
Home Hemodialysis
Home hemodialysis is the modality of hemodialysis done in the home. During home hemodialysis, blood flows from the patient's vascular access through a dialysis machine (Dialyzer). The dialysis machine cleanses the blood of extra waste and fluids and sends the clean blood back into the body. Patients on home hemodialysis have the option of performing more frequent or longer dialysis treatments, which may contribute to better clinical outcomes and an overall improved quality of life. At-home hemodialysis allows more flexibility and comfort for you treatments, and helps you save time and travel costs.
In order to receive hemodialysis in your home, you will need 4-8 weeks of training, a reliable care partner (like a family member or friend who can accommodate your dialysis schedule) and a place in your home for supplies and equipment.
Home Peritoneal Dialysis
Unlike hemodialysis, peritoneal dialysis (PD) uses the natural membrane from the lining of your abdomen to get the filtering done. PD has a number of advantages to home hemodialysis. You can do PD anywhere clean and dry including, home or even while traveling. PD in general provides a gentler process for your body than hemodialysis . The training for PD is also much less extensive than home hemodialysis.
In-Center Treatments
Hemodialysis Description
During hemodialysis, your blood travels through tubes from your body into a dialysis machine. While your blood is in the machine, it goes through a filter called a dialyzer, which cleans your blood by removing some of the waste and extra fluid. Then, the cleaned blood travels through tubes from the dialysis machine back into your body.
To get your blood into the dialyzer, your doctor needs to make an access, or entry, into your blood vessels. This is called vascular access.
Hemodialysis is a slow, gradual process that requires a consistent time commitment. More than likely, your in-center dialysis treatment will involve at least 3 sessions per week, typically lasting 3-4 hours each.
While arranging transportation and travel-time are concerns, schedules for in-center dialysis are very flexible and helpful. Much of the arrangements will be done with assistance of the staff.
In a dialysis center the treatments will be done for you. Nurses and other clinical staff will monitor your progress and your condition. Unlike home dialysis, you will need no training for in-center treatments.
AV Fistula
An AV fistula is a connection, made by a vascular surgeon, of an artery to a vein. Arteries carry blood from the heart to the body, while veins carry blood from the body back to the heart. Vascular surgeons specialize in blood vessel surgery. The surgeon usually places an AV fistula in the forearm or upper arm.
An AV fistula causes extra pressure and extra blood to flow into the vein, making it grow large and strong. The larger vein provides easy, reliable access to blood vessels. Without this kind of access, regular hemodialysis sessions would not be possible. Untreated veins cannot withstand repeated needle insertions, because they would collapse the way a straw collapses under strong suction.
Graft
If you’re not a candidate for a fistula, a graft works on a similar principle. However, instead of connecting an artery and vein already inside your body, a graft connects them with a soft artificial tube.
Patients might need a graft if the blood vessels in their arms are compromised by prior medical issues.
Port
A catheter entails inserting a tube (or port) through your neck, chest, or groin and into a central vein. This tube then splits into a y-shaped branch that connects to the dialysis machine.
This is the most invasive option, and also the least efficient. Some patients may have to rely on a catheter for the duration of their treatment. However, ports are the least preferred method of access, as they come with a higher risk for complications.
Peritoneal Dialysis
A peritoneal catheter is a soft tube running into your abdomen. It gives you the access you need for peritoneal dialysis treatment. Inserting the catheter is typically a short, painless procedure.
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Kidney Transplant
End-Stage Renal Disease
End-stage renal disease (ESRD) patients require either dialysis or a kidney transplant to stay alive due to their kidney function being almost completely compromised. Dialysis is the more conservative mode of treatment but a transplant gives the patient a chance at a better quality of life. Kidney transplant is a major surgery and that means it comes with risks and costs that patients should consider.
Procedure
A kidney transplant is a surgery done to give the patient a healthy kidney from a donor. The kidney may come from a deceased organ donor or from a living donor. Family members or others who are a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant.
The transplanted kidney will be placed in the abdomen, and connected to the body’s blood vessels and bladder. Your two original kidneys will remain in place, unless they’re causing secondary issues. If the transplant is successful, your new kidney will take over functions from failed kidneys, including producing urine and filtering blood, however for your body to accept the new kidney, you will need to take immunosuppressant drugs. These drugs will be required for the rest of your life.
To obtain a transplant, a patient needs approval from a physician and a donor. Your doctor will have to confirm the extent of your kidney failure and decide if you’re healthy enough for surgery. You will have to complete a series of medical exams and tests to ensure you can withstand the stresses of a major operation.
Unless you have a living donor it is important to remember that the average wait time for a healthy kidney is between 3-5 years and this often means that you will be on dialysis while you wait.
