Dialysis

The causes of kidney disease are many. Most prominent among them however are:

1) Diabetes
2) Hypertension
3) Infection
4) Shock

If left untreated or improperly treated, the kidney becomes severely involved in the process and end stage renal disease can ensues. To avoid end stage renal disease, the underlying disease process must therefore be adequately treated. Most patients however are unaware of impending renal failure until it is too late. Once end stage renal disease takes hold, treatment options becomes limited to dialysis or transplantation. There are two kinds of dialysis:

1) Hemodialysis
2) Peritoneal Dialysis

Be sure to discuss in detail with the nephrologist (Kidney specialist) what option is best for you.

HEMODIALYSIS

Hemodialyis, the most common of the two, is a mechanism of cleansing and filtering the blood of harmful waste and extra salts and fluids while maintaining the proper balance of Sodium, Potassium and other salts. Most hemodialysis uses a connector called a catheter of artificial fistula to exchange blood between the venous, the machine and the arterial blood. The machine acts like a filter (just like the kidney does). The connector is usually under the skin of the arm for ease accessibility. Hemodialysis is usually performed at a center where trained nurses and technicians work under the guardianship of a kidney physician. Dialysis is usually three times a week, each lasting three to four hours. Common side effects are:

1) Muscle cramps
2) Hypotension
3) Chest pains
4) Clogged connector

Most side effects can be treated with immediate cessation of dialysis and adequate therapeutic intervention. Newer clot busters can unclog a clogged connector.

PERITONEAL DIALYSIS
Here, dialysis is done through the abdomen using special tubes containing a cleansing solution called dialysate. The blood lining of the abdomen is here used for filtration. A permanent tube called catheter is placed into the peritoneum (abdominal area outside the bowel). The tube can then be used to dialyze at home by either of the following mechanisms:

1) Continuously (CAPD) Continuous Ambulatory Peritoneal Dialysis
2) Cyclically (CCPD) Continuous Cyclical Peritoneal Dialysis
3) Intermittently (IPD) Intermittent Peritoneal Dialysis

The patient alone can do CAPD, with no machine but CCPD and IPD need a machine and assistant from a partner. Most common side effect of peritoneal dialysis is peritonitis (an infection in the peritoneum). Powerful antibiotics are now available for treatment of peritonitis.