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Kidney Dialysis

Dialysis is the filtering of waste out of the blood when your kidneys aren't able to do their job. Adults are more likely to have hemodialysis prescribed, and kids peritoneal dialysis. Learn more here.

Dialysis

What is dialysis?

Dialysis is a procedure that is done routinely on people who have acute or chronic kidney (renal) failure. The process involves removing waste substances and fluid from the blood that are normally eliminated by the kidneys. Dialysis may also be used for people who have been exposed to or ingested toxic substances to prevent kidney failure from occurring. There are 2 types of dialysis that may be done on your child: peritoneal or hemodialysis:

  • Peritoneal dialysis. Peritoneal dialysis is done by surgically placing a soft, hollow tube into your child's lower abdomen near the navel. After the tube is placed, a solution called dialysate is instilled into the peritoneal cavity. The peritoneal cavity is the space in the abdomen that houses the organs and is lined by two special membrane layers called the peritoneum. The dialysate is left in the abdomen for a designated time that will be determined by your child's doctor. The dialysate fluid absorbs the waste products and toxins through the peritoneum. The fluid is then drained from the abdomen, measured, and discarded. There are two different types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD):

    • CAPD does not require a machine. Exchanges, often referred to as passes, can be done 3 to 5 times a day, during waking hours.

    • CCPD requires the use of a special dialysis machine that can be used in the home. This type of dialysis is done automatically, even while your child is asleep.

  • Hemodialysis. Hemodialysis is done in a dialysis center or hospital by trained health care professionals. A special type of access, called an arteriovenous (AV) fistula, is placed surgically, usually, in your child's arm. This involves joining an artery and a vein together. An external, central, intravenous (IV) catheter may also be inserted, but is less common for long-term dialysis. After access has been established, your child will be connected to a large hemodialysis machine that drains your child's blood, bathes it in a special dialysate solution that removes waste substances and fluid, then returns it to your child's bloodstream. Hemodialysis is usually done several times a week and each session lasts for 4 to 5 hours. Because of the length of time hemodialysis takes, it may be helpful to bring games or reading materials for your child to keep him or her busy during this procedure.

Your healthcare provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

Treatment may include hospitalization and:

  • Intravenous (IV) fluids
  • Diuretic therapy (medicines to increase urine output)
  • Closely watching electrolytes such as potassium, sodium, and calcium and heart rhythm, as the heart muscle is at risk for changes in these electrolytes
  • Medicines (to control blood pressure)
  • Specific diet needs

In some cases, you can have electrolyte problems and toxic levels of waste products normally removed by the kidneys. You may also develop fluid overload. Dialysis may be needed in these cases.

Treatment of chronic kidney failure depends on the how much kidney function you still have.

Dialysis

Dialysis is used to treat both acute and chronic kidney failure. It involves removing waste substances and fluid from the blood that are normally removed by the kidneys. Dialysis may also be used for people who have been exposed to or ingested toxic substances. In this case, dialysis is used to prevent kidney failure. There are 2 types of dialysis; peritoneal and hemodialysis.

Peritoneal dialysis

Peritoneal dialysis is done by surgically placing a soft, hollow tube, called a catheter, into the lower abdomen near the navel. A solution called dialysate is passed through the tube into the peritoneal cavity. This is the space in the abdomen that houses the organs. It is lined by 2 membrane layers called the peritoneum. The solution is left in the abdomen for a certain amount of time. There, it soaks up the waste products and toxins through the peritoneum. The fluid is drained from the abdomen, measured and discarded. There are 3 different types of peritoneal dialysis:

  • Continuous ambulatory peritoneal dialysis (CAPD). This type does not need a machine. Exchanges, often referred to as passes, can be done 3 to 5 times a day during waking hours.
  • Continuous cyclic peritoneal dialysis (CCPD). This type needs a dialysis machine that can be used in the home. This type of dialysis is done automatically, even while you are asleep.
  • Intermittent peritoneal dialysis (IPD). IPD uses the same type of machine as CCPD, but treatments take longer. IPD can be done at home, but usually is done in the hospital.

    Possible complications of peritoneal dialysis include an infection or inflammation of the peritoneum. This is called peritonitis. It causes fever and stomach pain.

A dietitian will help you plan your meals based on your healthcare provider's orders. Generally:

  • You may have special protein, salt, and fluid needs.
  • You may have special potassium restrictions.
  • You may need to cut calories. The sugar in the dialysate may cause weight gain.

Hemodialysis

Hemodialysis can be done at home or in a dialysis center or hospital. An access site is surgically made, usually in your arm. This involves joining an artery and a vein together. After access has been made, you will be connected to a large hemodialysis machine that drains the blood. The blood is bathed in a dialysate solution which removes waste substances and fluid. Then the clean blood is returned to your bloodstream.

Hemodialysis is usually done several times a week and lasts for 4 to 5 hours. During treatment you can read, write, sleep, talk, or watch TV.

At home, hemodialysis is done with the help of a partner, often a family member or friend. If you choose to do home hemodialysis, you and your partner will get training.

Possible complications of hemodialysis include muscle cramps and a sudden drop in blood pressure. This may cause you to feel dizzy or weak, or sick to your stomach.

By following the proper diet and taking medicines, as prescribed by your healthcare provider, you may be able to avoid complications. A dietitian will work with you to plan your meals, according to your healthcare provider's orders. Generally:

  • You may eat foods high in protein such as meat and chicken (animal proteins).
  • You may need to limit foods containing potassium.
  • You may need to limit the amount you drink.
  • You may need to avoid salt.
  • You may need to limit foods containing mineral phosphorus (such as milk, cheese, nuts, dried beans, and soft drinks).

Other treatment choices may include:

  • Medicines (to help with growth, prevent bone density loss, and/or to treat anemia)
  • Diuretic therapy (medicines to increase urine output)
  • Specific diet changes
  • Kidney transplant