Dialysis is a successful,life-saving treatment used to remove water and waste from the blood when a patient's kidneys are no longer able to perform this function. In this renal replacement therapy, blood or body fluid is exposed to special filters that use diffusion across semipermeable membranes to "pull" products such as creatinine and urea out, removing them from the body across a concentration gradient.
Dialysis removes water, salts, proteins, acids, urea and other byproducts of bodily metabolism. For dialysis, the treatment team must surgically create access to the body. For hemodialysis, this means access to the circulatory system so that large amounts of blood can flow out of the patient for hemodialysis and return to the patient. For peritioneal dialysis the team creates catheter access to the abominal cavity.
Maintains and Bridges Patients
Patients who have temporarily or permanently lost their kidney function must avail themselves of this treatment. End-stage kidney failure patients must undergo dialysis over the long term to sustain themselves. Patients whose kidney function has dropped to 10 to 15 percent of normal require this treatment. Each year in the U.S., hundreds of thousands of patients depend on this life-giving form of care.
Kidney transplantation is the only other treatment for patients who have end-stage renal disease. However, many patients can't or don't undergo such transplants because they are not good candidates for the operation (due to overall medical condition) or because they are not matched with an available donor organ (the supply of which is far short of the need).
Adjusting to Dialysis
Patients on dialysis usually have less energy than when they when they were functioning better with their own kidneys, as the treatment and the need for it may create cycles of fatigue. At the same time, patients must adjust to committing substantial amounts of time dialysis. They may have to adapt their lives according to these realities. As a result, they often find they have to cut back on responsibilities at work or at home. Accepting this can be hard on them and their families. Counseling with a social worker or therapist can help.
Other changes include adhering to dietary guidelines that help to reduce theburden on the remaining kidney function and the amount of waste that dialysis must cleanse from the body. This primarily means emphasizing foods low in sodium and phosphorus and high in protein. Patients using dialysis to replace kidney function will likely also need various medications to manage blood pressure, stimulate production of red blood cells, and control the levels of certain nutrients in the blood (including preventing the buildup of phosphorus)
Dialysis is expensive, but usually a combination of federal, state, or private insurance covers most or all of the cost. Dialysis patients can also travel, by taking advantage of the fact that almost every locality of the country has a dialysis clinic or by using portable forms of dialysis (see below).
Choices in Dialysis
The forms of dialysis currently available are:
- Hemodialysis at a dialysis center is the most common form of dialysis. Learn more.
- Home dialysis comes with its own set of requirements and potential advantages, providing options that patients should be aware of and that prove successful for many individuals. Learn more about at-home hemodialysis and peritoneal dialysis.
First-Rate Attention to Indispensable Care
Lourdes Health System takes very seriously its responsibility to provide high-quality dialysis services to patients. Lourdes has a large and well-resourced and organized dialysis service. Among its quality initiatives, it works to assure safety, optimize each patient's venous access for treatment and use lab tests to monitor the effectiveness of treatment. The nephrology and dialysis staffs also support patients who wish to use at-home dialysis. The team meets with patient and family to consider these decisions and elect the best course.
Dialysis is not an easy way of life, but is a routine to which patients can become accustomed. The treatment is time-consuming and expensive, and thus it limits the freedom of those who depend upon it. But, it helps patients maintain the proper balance and composition of blood fluid and helps to control blood pressure. Patients can creatively work around these limitations and adapt to this essential care – a treatment that reliably extends the lives and functionality of many patients sick with kidney disease. Patients can successfully remain active and on dialysis for many years.