Dialysis is a medical procedure that removes waste products and excess fluid from the blood when the kidneys can no longer function adequately. It is a life-sustaining treatment for individuals with kidney failure, preventing the dangerous buildup of toxins and fluids in the body that would otherwise lead to severe health complications.
Understanding Dialysis Types
Two primary types of dialysis exist: hemodialysis and peritoneal dialysis. Hemodialysis involves diverting blood from the body to an external machine, an artificial kidney. This machine filters the blood, removing waste and extra fluids, before returning the cleaned blood to the body. Hemodialysis is performed at a clinic three times a week, with each session lasting approximately three to five hours.
Peritoneal dialysis utilizes the lining of the abdomen, the peritoneum, as a natural filter. A special cleansing fluid, called dialysate, is introduced into the abdominal cavity through a catheter. This fluid remains in the abdomen for several hours, allowing waste products and excess fluids to pass from the blood into the dialysate through the peritoneal membrane. The used fluid is then drained and replaced with fresh dialysate. Peritoneal dialysis can be done daily at home, either manually (continuous ambulatory peritoneal dialysis or CAPD) with several exchanges, or overnight using an automated cycler (automated peritoneal dialysis or APD).
Factors Affecting Dialysis Duration
The duration an individual remains on dialysis is influenced by several factors, including the underlying cause of kidney failure, overall health, and adherence to treatment. For some, dialysis may be temporary, particularly in cases of acute kidney injury where kidney function can recover. However, for most with chronic kidney disease that progresses to end-stage kidney disease, dialysis becomes a long-term necessity unless a kidney transplant is received.
The specific kidney disease causing the failure, such as diabetes, high blood pressure, or genetic conditions, impacts the prognosis. A patient’s general health status, including other medical conditions (comorbidities) and age, affects their ability to tolerate long-term treatment. Managing potential complications, such as infections or cardiovascular problems, is important for extending the duration and quality of life on dialysis. Adherence to the prescribed treatment schedule, dietary restrictions, and medication regimen significantly impacts the effectiveness of dialysis and a patient’s long-term survival.
Life on Long-Term Dialysis
Life on long-term dialysis involves significant adjustments to daily routines and requires continuous medical management. Individuals on dialysis must adhere to strict dietary guidelines and fluid intake limits to manage waste and fluid buildup between sessions. This often impacts social activities and travel, though home dialysis can offer more flexibility. Patients may also experience fatigue, which can be a result of anemia or the dialysis process itself.
Ongoing medical monitoring is part of long-term dialysis, involving regular blood tests to assess treatment effectiveness and adjust medication. This consistent oversight helps manage the complex physiological changes that occur with kidney failure. Patients on long-term dialysis can develop specific complications, including cardiovascular issues, bone disease, and anemia. These are managed through careful blood pressure control, fluid balance, dietary adjustments, and supplements. Support from family, friends, and the healthcare team plays an important role in helping patients manage the physical and psychological demands of living with a chronic condition.
Kidney Transplant Considerations
For many individuals with end-stage kidney disease, a kidney transplant is a preferred long-term treatment option. A successful transplant can offer a better quality of life and potentially longer survival compared to remaining on dialysis indefinitely. The process involves a comprehensive evaluation to determine suitability, followed by placement on a waiting list for a donor kidney or coordinating with a living donor.
Following transplant surgery, patients require ongoing medical care, including immunosuppressive medications to prevent the body from rejecting the new kidney. If a transplanted kidney functions successfully, it eliminates the need for continued dialysis and often allows for fewer dietary and fluid restrictions. However, if a transplanted kidney fails, dialysis may become necessary again.