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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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Treatment Choice: Hemodialysis |
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 everyday 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 HemodialysisPros
- 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 HemodialysisPros
- 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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Treatment Choice: Peritoneal Dialysis |
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. While the solution is in your body, you
may fold the empty plastic bag and hide it under your clothes, around
your waist, or in a pocket.
- 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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CCPDPros
- 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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Treatment Choice: Kidney
Transplantation |
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 to 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 TransplantationPros
- 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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Conclusion |
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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Paying for Treatment |
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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Organizations That Can Help |
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: http://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: mailto:nkudic@info.niddk.nih.gov
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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 Diabetes Information Clearinghouse
1 Information Way Bethesda, MD 20892-3560 E-mail: ndic@info.niddk.nih.gov
The National Diabetes Information Clearinghouse (NDIC) 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 diabetes and their
families, health care professionals, and the public. NDIC answers
inquiries; develops, reviews, and distributes publications; and works
closely with professional and patient organizations and government
agencies to coordinate resources about diabetes.
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 |