Let’s face it: most of us pay about as much attention to our kidneys as we do our internet access – about a grain of salt – until things slow down or stop working.
Not being able to get online can be frustrating but life without properly-functioning kidneys is in a whole other league of inconvenience and pain. While a power outage or hardware failure can crash your computer, kidney disease is often a preventable condition that develops over time.
When one or both of our paired, bean-shaped kidneys shut down, the body can no longer remove liquid wastes through normal urination. Going to the bathroom is something healthy people take for granted but a urinary condition can change all that.
Healthy kidneys work together to filter about one-half cup of blood every minute. Two thin, muscular tubes (ureters) connect the kidneys to the left and right sides of the bladder, which stores urine for elimination.
In addition to removing wastes and excess fluid from the body, the kidneys flush acid produced by cells in the body. These vital organs regulate levels of water, salts, and minerals (such as sodium, calcium, phosphorus, and potassium) in the blood.
Kidney failure can damage nerves, muscles, and other tissues. They produce hormones that help control blood pressure, make red blood cells, and ensure good bone health.
When diseased kidneys lose from 85 to 90 percent of their ability to process bodily waste fluids, the condition is called Chronic Kidney Disease (CKD).
Symptoms of kidney failure include nausea, fatigue, swelling, and vomiting. Lab tests can confirm dangerous levels of waste present in the blood.
Patients with CKD typically need to start dialysis while waiting for a suitable donor kidney for kidney transplant surgery.
Dialysis solves the problems that diseased kidneys create. The medical process removes waste, salt and extra water to prevent them from building up in the body, maintains safe levels of blood chemicals (such as potassium, sodium, and bicarbonate), and helps to control blood pressure.
Almost all kidney failure is permanent. Once on dialysis, always on dialysis unless or until a replacement kidney can be secured and the body accepts it postoperatively.
There are two types of dialysis: hemodialysis and peritoneal.
Hemodialysis uses an artificial kidney (hemodialyzer) to filter waste and extra chemicals and fluid from the blood. A surgeon performs a minor operation to connect blood vessels with an external hemodialyzer which cleans the blood before returning it.
Direct access to the bloodstream can be achieved in one of three ways:
- An arteriovenous fistula (or A-V fistula) is an abnormal connection between an artery (a blood vessel that carries blood away from the heart to other parts of the body) and a vein (a blood vessel that carries blood back to the heart from other parts of the body). Usually, an A-V fistula is done under the skin of the arm the patient doesn’t write with. It can take 6 weeks or more for the surgical area to heal enough for dialysis to begin.
- An arteriovenous graft or A-V graft takes less time to heal than an A-V fistula, about 2 weeks. An artery and vein are connected under the skin using a plastic tube. The downside is that an A-V graft doesn’t hold up as long as a fistula. Another graft can be expected within a few years. Also, there is an increased risk of infection using a graft.
- A central venous catheter is a flexible tube inserted into a neck vein, below the collarbone, or next to the groin area. This quick-start procedure is intended only for short-term use. Blood comes out of one port of the catheter and then, once purified, returns through a second port.
Patients receive hemodialysis at a hospital, dialysis facility or at home. Hemodialysis sessions in a dialysis facility last 3 to 5 hours each. Most patients need three sessions a week. Home hemodialysis sessions are about 2 to 3 hours each time, usually required 6 or 7 days each week.
Some patients read or watch television during dialysis treatments. At home, it may be possible to perform life-sustaining dialysis while sleeping.
Peritoneal dialysis (PD) is an internal process to clean blood wastes. A special fluid which contains water with salt and other additives is put into the abdomen. The fluid soaks up the waste from the blood that passes through small vessels in your stomach cavity. After a few hours, the fluid is drained into a separate bag. This process is called an “exchange.”
Most patients need four to six exchanges each day. Patients usually receive peritoneal dialysis facility at home.
Although life-prolonging, dialysis is quite time-consuming. During hemodialysis, the patient sits or lies back in a chair. A tech inserts two needles in the arm fistula or graft. A pump in the hemodialysis machine slowly extracts the blood, sends it through one of the needles to the external dialyzer, cleans the blood, and returns it through the second needle.
There are two types of PD:
- Continuous cycling peritoneal dialysis (CCPD) uses a machine to perform blood exchanges.
- Continuous ambulatory peritoneal dialysis (CAPD) is done with manual exchanges (by hand).
Dialysis itself should not hurt. Report any physical discomfort experienced during or after any dialysis treatment to a doctor or qualified healthcare provider. However, there are common side effects which include:
- Low blood pressure
- Nausea or vomiting
- Dry or itchy skin
- Muscle cramps
- Extreme fatigue
Dialysis is quite expensive. However, the federal government covers 80 percent of all dialysis costs for most patients. Private health insurance or state Medicaid programs may also help pay the costs.
For CKD patients who travel, standardized treatment is available at dialysis centers everywhere in the U.S. and in many foreign countries. Travelers must make an appointment ahead of time for dialysis treatments at another center. Patients are advised to ask the staff at their dialysis center to help set up out-of-town appointments.
Dialysis may not be appropriate for very ill patients or those of extremely advanced age. Consult your family and physicians to discuss options for dealing with kidney failure.