Why undergo dialysis?
One of your kidneys' main functions is to get rid of toxins, primarily from food, and also excess fluid in your body.
Chronic kidney disease gets worse over time, and eventually leads to end-stage renal disease, also known as kidney failure. Diabetes and high blood pressure are two of the most common causes of chronic kidney disease.
Your doctor might recommend you begin dialysis treatments once you reach the point where you have only 10 to 15 percent of kidney function left.
With kidney failure, the toxins and excess fluid that your kidneys should be releasing begin to build up in your body. People suffering from kidney failure begin dialysis to help their bodies remove these wastes, salts and fluid.
Diabetes, high blood pressure, kidney inflammation and polycystic kidney disease can all cause kidney failure. Serious health problems, such as a severe injury or heart attack, can also cause acute kidney failure.
What happens during dialysis?
Hemodialysis and peritoneal dialysis are the two main types of dialysis.
Hemodialysis is typically performed at dialysis centers or hospitals, but a growing number of clinics are offering home hemodialysis. Smaller devices are making home hemodialysis more practical.
With hemodialysis, patients generally have an access point, usually in their arm, added through minor surgery. While at a dialysis center, you're hooked up to a dialysis machine for about four hours. During this time, your blood is being drawn from your body, cleaned through a filter in the machine and returned to your body.
With home-based peritoneal dialysis, you will have a soft tube known as a catheter placed in your stomach through a minor surgery. There are two main types of peritoneal dialysis — continuous ambulatory peritoneal dialysis and continuous cycling peritoneal dialysis.
You generally undergo continuous cycling peritoneal dialysis at night. Before going to bed, you'll attach tubing that's attached to your dialysis machine to your catheter. A dialysis solution is pumped through your catheter, filling your stomach. The fluid will stay in your stomach for a few hours, depending on your size and the amount of waste that needs to be removed. Your stomach will act as a natural filter, allowing waste and fluid from your blood to pass through it into the solution.
Continuous ambulatory peritoneal dialysis doesn't require a machine. Rather, you'll drain dialysis solution into your abdomen through a catheter. After four to six hours, you will drain the waste-filled solution into a bag. Your doctor will recommend the number of times you do this per day.
Does it hurt?
With hemodialysis, you'll likely feel pain when two needles are inserted into your arm through your access point. The process itself should not hurt, but you might feel nauseated.
With peritoneal dialysis, you generally should not feel pain. If you are experiencing pain, you should talk with your doctor because you could be suffering from an infection in your stomach.
What are the risk factors?
There are several risk factors associated with dialysis, including problems with anemia, bone disease, high blood pressure and depression. Some patients on hemodialysis might have also have problems with low blood pressure.
Patients undergoing peritoneal dialysis are at risk of developing peritonitis, an infection of the peritoneum, the lining of the stomach. This generally occurs when germs enter through your catheter. Symptoms of peritonitis include a cloudy dialysis bag while draining used fluid, unusual mild or severe stomach pain and fever or chills. Your doctor will likely prescribe antibiotics to clear up the infection.
Infection around your exit site, the place where your catheter exits your body, can also become infected. If you notice any swelling, bulging or pus in this area, it's important to tell your doctor.
What's the recovery time?
Some people who receive dialysis at a medical facility say they feel like they ran a race. Others simply feel fatigued. Because of the stress dialysis can place on your body, you might feel tired and want to rest for a few hours. Usually after a nap or a night's sleep, you will recover.
With home-based peritoneal dialysis, many patients report feeling rested after a good night's sleep. If you are on the right treatment regime, you should feel well and have energy. If you're feeling too tired to do daily activities and have a poor appetite, you should talk with your doctor.
Ideally, a person is on dialysis until they're able to receive a kidney transplant. Not everyone is a candidate for kidney transplant, and even people who make good candidates remain on dialysis. This is because the waiting list for a kidney transplant is long, with more than 93,000 people on the kidney transplant waiting list.
What's the follow-up?
Once you begin dialysis, you will likely see your nephrologist or primary care physician on a regular basis, generally once a month.
People suffering from sudden kidney failure might only need dialysis for a short period of time. Without a kidney transplant, dialysis generally does not end for people with chronic kidney disease that has progressed to kidney failure.
Dialysis is a serious and expensive responsibility. A year of dialysis care costs between $65,000 and $70,000 per year. Medicare pays 80 percent of all costs for most patients. It's important to listen to your doctor. Medicaid and private insurance sometimes pays for part of the cost.
It's important to listen to your doctor and also ask any questions you might have. Your doctor can potentially help you make dietary and lifestyle changes that can help you keep what kidney function you have left.
Sources: Dr. Zahid Ahmad, medical director at Davita in Oklahoma City; the National Kidney and Urologic Diseases Information Clearinghouse; MedlinePlus; The Mayo Clinic; Living Kidney Donors Network; National Kidney Foundation