Kidneys - What do they do?
You have two kidneys, which are located on either side of your spine, near the bottom of your rib cage.
The kidneys have five major functions:
Body fluid balance
Chemical balance Waste removal
Blood pressure control (through the production of the hormone, Renin)
Erythropoietin production (which triggers production of red blood cells)
With the loss of kidney function and the subsequent start of dialysis, partial replacement of these functions is achieved.
When your kidneys fail, they stop working altogether or function at a rate of less than 10 percent. Because of this, waste products and fluid build up in the body. You may begin to feel weak or tired. You may also lose your appetite and feel nauseated. Sometimes your kidneys may stop working so slowly that you might not notice any of these symptoms.
What is Dialysis?
Dialysis is a process that artificially removes waste products and excess fluids from the body. There are different types of dialysis available.
Choices of Treatment
Hemodialysis uses a dialysis machine and an artificial kidney to remove waste products and excess fluids from the body. The artificial kidney/dialyzer performs two major functions that your kidneys are no longer able to perform:
It filters waste particles from your blood by using a process called diffusion.
It removes extra fluid from your blood by using a process called Ultrafiltration.
Your blood is accessed through a special vein in your arm called a fistula or a piece of Gortex surgically placed in your arm called a graft. Blood can also be accessed through a temporary soft tube that is placed in a blood vessel in your chest that is called a catheter. Fistulas, grafts, and catheters are all accesses that are surgically created.
Once your blood is accessed, it flows outside the body through special tubing. This blood then passes through an artificial kidney called a dialyzer. The dialyzer acts as a filter which carries waste products and excess fluid out of the body. After your blood is cleansed by the dialyzer, it is returned to your body.
During your dialysis treatment you may experience dizziness and/or nausea as a result of a drop in blood pressure. Muscle cramping in the calves and feet may also occur. These problems can be minimized or eliminated with various supportive measures. So remember, during your dialysis treatment communication between you and the nurses is important!
Sometimes problems can begin at home. You will need to know how to recognize potential problems, such as fluid overload, infection, or low blood pressure, so you can communicate them to the medical staff. Additional potential problems and their treatments are included in this booklet. You are a very important member of the treatment team. If you understand what can happen to you, you can work with us to prevent or correct problems early.
Hemodialysis takes place in a dialysis unit. Most people need hemodialysis three times a week. If you receive hemodialysis, your treatment days will be either Monday/Wednesday/Friday or Tuesday/Thursday/ Saturday. Most treatments are between three and four hours. Your specific treatment time will depend on your medical needs, and will be scheduled by the Scheduling Committee staff.
You may still be wondering where you will receive dialysis treatments. Usually, a patient will start his or her dialysis treatments at the Lancaster General Hospital. You will then receive your treatments as an out-patient at Dialysis Center. Trained professionals – doctors, registered nurses, licensed practical nurses and technicians- will be at there to assist in your treatment. These professionals will monitor your dialysis treatment and are present if have any medical problems.
Like hemodialysis, peritoneal dialysis also removes waste products and excess fluid from the blood. The difference in the process is this: hemodialysis uses a machine and artificial kidney and peritoneal dialysis uses the body! Peritoneal dialysis (or P. D. for short), is done inside the body, continuously, every day, seven days a week. And, you can learn to do peritoneal dialysis yourself, at home. There are two types of peritoneal dialysis- C.A.P.D. (Continuous Ambulatory Peritoneal Dialysis) and C.C.P.D. (Continuous Cycling Peritoneal Dialysis).
Both C.A.P.D. and C.C.P.D. use the peritoneum, a thin membrane inside your body that surrounds and helps protect many of your internal organs. Like all the other tissues in the body, it has its own blood supply. The process of peritoneal dialysis uses this natural membrane to filter the impurities from the blood in much the same way as hemodialysis does. All the filtering of the blood is done inside the body, so there is no need to connect to a hemodialysis machine.
How do I begin P. D.?
The first thing is to have a small tube or catheter inserted into your abdomen near your navel. This requires a minor surgical procedure usually done as an out-patient. A tiny incision is made and the catheter is placed into your abdominal cavity inside the peritoneum. Once it's in, you will find it easy to live with.
It is through this small tube that the dialysis solution will be instilled into your abdominal cavity so that it can come into contact with the peritoneum.
If you are a new peritoneal dialysis patient, you will probably use small amounts of dialysis solution in the beginning, in order to become used to the volume of fluid in your abdomen.
C.A.P.D. (Continuous Ambulatory Peritoneal Dialysis)
Once you are ready for C.A.P.D. (Continuous Ambulatory Peritoneal Dialysis), the dialysis solution will stay in your abdomen about four to six hours, and then will be drained before instilling fresh dialysate. The process of draining and filling your abdomen with dialysis solution is called making an "exchange.” Between exchanges, the dialysis solution is doing its work within your peritoneum, cleansing your blood.
There are many benefits to C.A.P.D.
You can do it yourself and/or have a partner learn. (You and a partner will be trained by the Peritoneal Dialysis Staff.)
The exciting result is that you are being continuously dialyzed as you move, travel, work, watch a movie...even go fishing!
That the whole procedure requires no bloodlines, no nurses, no fancy machinery...just fluid working within your own body.
C.C.P.D. (Continuous Cycling Peritoneal Dialysis)
C.C.P.D. or Continuous Cycling Peritoneal Dialysis requires the use of a peritoneal dialysis machine, often called a cycler. Portable cyclers are available, and C.C.P.D can be done conveniently in your home. All of your exchanges are done automatically as you sleep. Before you go to sleep at night you will set up the cycler and connect your catheter to the tubing on the cycler. The cycler will automatically do your exchanges for you, making sure that your peritoneum is filled with fresh solution and then drained several times a night. It requires you to be connected to the cycler 8 ½ hours per night. Except for the cycler's mechanical way of doing exchanges, C.C.P.D. and C.A.P.D. use the same basic process.
So far you have been introduced to two treatment options for your kidney disease: Hemodialysis and Peritoneal dialysis. There is one option yet to be discussed. That option is transplantation.
Renal or kidney transplantation involves placing a healthy kidney inside the body. This occurs when a person's existing kidneys can no longer function. If you are interested in receiving a kidney transplant, you first need to speak with your physician. If your physician feels that you are healthy and strong enough for transplantation, the process will begin.
To be evaluated for a transplant, your physician will refer you to a transplant facility. If the transplant facility feels you are medically stable, the transplant work-up will begin. You will go through a series of medical tests to determine your overall health. You will be placed on the transplant waiting list if your test results are acceptable.
If someone close to you (usually a blood relative, spouse, or close friend) is interested in donating a kidney to you, that person will also undergo an evaluation. This evaluation will determine whether or not he or she is a suitable donor for you. This information only touches the surface of what you should know about transplantation. A great deal is involved in this process.