Dialysis

Dialysis is a treatment that performs the functions of the kidneys when they can no longer work adequately. It filters waste products, excess salt, and water from the blood. Over 550,000 Americans are on dialysis. The two main types are hemodialysis (filtering blood through a machine) and peritoneal dialysis (using the abdominal lining as a filter).

Dialysis is needed for end-stage renal disease (ESRD) when kidneys function at less than 10-15% capacity, and for acute kidney injury. Common causes of ESRD include diabetes, hypertension, glomerulonephritis, and polycystic kidney disease.

For hemodialysis, vascular access is created surgically: an AV fistula (preferred, takes 2-3 months to mature), AV graft, or central venous catheter. For peritoneal dialysis, a catheter is placed in the abdomen. Dietary counseling on fluid, potassium, phosphorus, and sodium restrictions begins.

Hemodialysis: blood is pumped through a dialyzer (artificial kidney) that filters waste and returns clean blood. Sessions last 3-5 hours, 3 times per week at a dialysis center, or more frequently at home. Peritoneal dialysis: a fluid is instilled into the abdomen, absorbs waste, and is drained. It can be done at home daily.

After hemodialysis sessions, fatigue and low blood pressure are common. Between treatments, strict dietary and fluid restrictions must be followed. Peritoneal dialysis allows more flexibility in schedule and diet but requires daily commitment.

Hemodialysis risks include low blood pressure, muscle cramps, infection at access site, blood clots, and cardiovascular complications. Peritoneal dialysis risks include peritonitis (abdominal infection), catheter complications, and weight gain from glucose in dialysis fluid.

Kidney transplant is the best treatment for ESRD, offering better survival and quality of life. Conservative management (no dialysis) may be chosen by elderly patients with multiple comorbidities after careful discussion of goals of care.

Medicare covers dialysis for all ESRD patients regardless of age (Medicare ESRD benefit). Private insurance also covers dialysis. Peritoneal dialysis supplies and home hemodialysis equipment are covered.