Chronic Kidney Disease Treatment Options

Why discuss options? Learning about options will better assist you in making the best decision that suits your health and lifestyle. You will have to discuss with family about all options and decide what fits best in your lifestyle. You want to be able to maintain your lifestyle, hobbies and have time with your family. During the course of ESRD, pt may initially pick one option and have to switch to another based on health or lifestyle issues.

Why discuss options? Not every treatment option will work for every person and there are many factors that determine which option is best. Discussing pros and cons is helpful. It is important to describe all the pros and cons of each treatment option. This will aid the pt in making the best decision for their lives.

Why now? Patients are educated on their options usually when their kidney function is around 15%. Which is Stage 4 - 5 kidney disease which is Pre ESRD or CKD. This is the time between diagnosis until you need to choose renal replacement therapy. It maybe a short time or months to yrs. ESRD is when you need renal replacement therapy in which kidney function doesn’t return or pt will die.It is important to explain that deciding on options early give you more control. Furthermore, once an option is decided upon then vascular access can be evaluated.

What are my options? Peritoneal Dialysis Hemodialysis In dialysis unit Home Kidney Transplantation PD is a home option. HD can happen in the dialysis unit, or at home. Kidney transplant can occur before dialysis or while on dialysis. For most people, either form of dialysis will work well. There maybe medical reasons why one therapy is better for you than another.

What do kidneys do? Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. Also make hormones that keep your bones strong and your blood healthy. But before discussing all your options you should remember what your kidneys do and why you need renal replacement therapy

What happens when they fail? Harmful wastes build up in the body, blood pressure may rise, and you may retain excess fluid and not make enough red blood cells. Dialysis is then needed.

What is Dialysis? A treatment that filters the blood of wastes and extra fluid when the kidneys are no longer able to perform this function using a semipermeable membrane (filter). Kidneys main functions are to remove waste products from the blood, remove extra fluid, adjust levels of electrolytes such as potassium, sodium, calcium and phosphorus, and produce hormones to help make red blood cells. It is process in which the blood is being cleansed by artifical means. It occurs through a semipermeable membrane that allows small particles through such as waste and keeps large particles such as red blood cells. Dialysate is a special fluid which is made up of many electrolytes we have in our bodies. The waste products flow through the membrane and then into the dialysate.

Type of Dialysis Peritoneal Dialysis  filter inside the body Hemodialysis  filter outside the body

Peritoneal Dialysis Uses a space inside your belly called peritoneum as a filter to clear wastes and extra fluid from your blood. You will need to have a catheter placed in your belly before you begin dialysis. The catheter is placed by a surgeon outpatient and will take a few weeks to heal before starting dialysis.

Exchange The process of doing peritoneal dialysis is called an exchange. You will usually complete 4 to 6 exchanges each day.

How does it work? Fill: Dialysis fluid enters your peritoneal cavity. Dwell: While the fluid is in your peritoneal cavity, extra fluid and waste travel across the peritoneal membrane into the dialysis fluid. Drain: After a few hours, the dialysis fluid is drained and replaced with new fluid.

Example of Exchange National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

Types of Peritoneal Dialysis CAPD – Continuous Ambulatory Peritoneal Dialysis CCPD – Continuous Cycling Peritoneal Dialysis Two options are offered to fit into pts lifestyles. Initially, patients will learn CAPD and then be transitioned to CCPD. However, some pts like CAPD and will not transition.

CAPD Happens during the day as the person goes about their daily life at home, work, or while traveling. Normally four exchanges usually morning, lunch, dinner and at bedtime. An exchange takes about 30 - 40 minutes. The solution is left in the peritoneal cavity between exchanges and overnight.

CAPD National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

CCPD The dialysate solution is changed by a machine, at night for 8 to 10 hours, while you are asleep. In the morning, clean solution is left in the peritoneal cavity during the day. Patients may have to do a an extra daytime exchange if needed. Pts connect the PD catheter to the cycler. Usually 8 to 14 liters over 8 to 10 hrs.

CCPD National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

Hemodialysis Procedure that allows blood to flow through a machine and enter an artificial filter called the "dialyzer" to remove wastes and excess water from body and let clean blood flow back to the patient.

Hemodialysis You will need to have dialysis access placed prior in your arm or neck before starting treatment. It is normally done in an outpatient dialysis unit three times per week for 3-4 hours each session. Access – preferrably a pt would start with a AVF for HD however in emergent situations then central venous catheter to the neck will have to be placed. Explain that this is only temporary b/c risk of infection. Most HD sessions run from 3 to 4 hrs three times per week. They can be done during the day or at night. More options are becoming available to do nocturnal in-center hemodialysis or home hemodialsyis.

This diagram explains how the blood leaves the pt enter the dialysis machine goes through the filter (dialyzer) and then back to the patient. You can see the two tubes one takes blood away from the pt to machine and the other brings blood back to the pt. National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

Home Hemodialysis Hemodialysis can be done at home either during the day or at night. A machine is placed in your home and you and a partner are trained to learn how to do the procedure. It is normally done 5 - 6 days/nights a week.

Transplantation A kidney transplant places a healthy kidney from another person into your body. Transplants can come from living or non-living (cadaveric) donors.

Transplantation The new kidney is placed in your lower abdomen. Most people need to be hospitalized for 1-2 weeks after their transplant. A successful transplant can help return you to a state of good health.

Transplantation Transplant is a treatment, not a cure. Will need to take medicine and see a doctor regularly. You may need to wait for a kidney to be available. A donor kidney must be a “match” for your body. Complete medical evaluation to determine if you are a transplant candidate