End-Stage Renal Disease: Choosing a
Treatment That's Right for You
|
End-Stage Renal Disease: Choosing a Treatment That's Right for You |
This e-text is for people whose kidneys fail to work. This condition is called end-stage
renal disease (ESRD).
Today, there are new and better treatments for ESRD that replace the work of healthy
kidneys. By learning about your treatment choices, you can work with your doctor
to pick the one that's best for you. No matter which type of treatment you choose,
there will be some changes in your life. But with the help of your health care team,
family, and friends, you may be able to lead a full, active life.
This e-text describes the choices for treatment: hemodialysis, peritoneal dialysis,
and kidney transplantation. It gives the pros and cons of each. It also discusses
diet and paying for treatment. It gives tips for working with your doctor, nurses,
and others who make up your health care team. It provides a list of groups that offer
information and services to kidney patients. It also lists magazines, books, and
brochures that you can read for more information about treatment.
You and your doctor will work together to choose a treatment that's best for you.
This e-text can help you make that choice.
Healthy kidneys clean the blood by filtering out extra water and wastes. They also
make hormones that keep your bones strong and blood healthy. When both of your kidneys
fail, your body holds fluid. Your blood pressure rises. Harmful wastes build up in
your body. Your body doesn't make enough red blood cells. When this happens, you
need treatment to replace the work of your failed kidneys.
Purpose Hemodialysis is a procedure that cleans and filters your blood. It rids your
body of harmful wastes and extra salt and fluids. It also controls blood pressure
and helps your body keep the proper balance of chemicals such as potassium, sodium,
and chloride.
How it Works
Hemodialysis uses a dialyzer, or special filter, to clean your blood. The dialyzer
connects to a machine. During treatment, your blood travels through tubes into the
dialyzer. The dialyzer filters out wastes and extra fluids. Then the newly cleaned
blood flows through another set of tubes and back into your body.
Getting Ready
Before your first treatment, an access to your bloodstream must be made. The access
provides a way for blood to be carried from your body to the dialysis machine and
then back into your body. The access can be internal (inside the body -- usually
under your skin) or external (outside the body).
Who Performs It
Hemodialysis can be done at home or at a center. At a center, nurses or trained technicians
perform the treatment. At home, you perform hemodialysis with the help of a partner,
usually a family member or friend. If you decide to do home dialysis, you and your
partner will receive special training.
The Time it Takes
Hemodialysis usually is done three times a week. Each treatment lasts from 2 to 4
hours. During treatment, you can read, write, sleep, talk, or watch TV.
Possible Complications
Side effects can be caused by rapid changes in your body's fluid and chemical balance
during treatment. Muscle cramps and hypotension are two common side effects. Hypotension,
a sudden drop in blood pressure, can make you feel weak, dizzy, or sick to your stomach.
It usually takes a few months to adjust to hemodialysis. You can avoid many of the
side effects if you follow the proper diet and take your medicines as directed. You
should always report side effects to your doctor. They often can be treated quickly
and easily.
Your Diet
Hemodialysis and a proper diet help reduce the wastes that build up in your blood.
A dietitian can help you plan meals according to your doctor's orders. When choosing
foods, you should remember to:
Eat balanced amounts of foods high in protein such as meat and chicken. Animal protein
is better used by your body than the protein found in vegetables and grains.
Watch the amount of potassium you eat. Potassium is a mineral found in salt substitutes,
some fruits, vegetables, milk, chocolate, and nuts. Too much or too little potassium
can be harmful to your heart.
Limit how much you drink. Fluids build up quickly in your body when your kidneys
aren't working. Too much fluid makes your tissues swell. It also can cause high blood
pressure and heart trouble.
Avoid salt. Salty foods make you thirsty and cause your body to hold water.
Limit foods such as milk, cheese, nuts, dried beans, and soft drinks. These foods
contain the mineral phosphorus. Too much phosphorus in your blood causes calcium
to be pulled from your bones. Calcium helps keep bones strong and healthy. To prevent
bone problems, your doctor may give you special medicines. You must take these medicines
every day as directed.
Each person responds differently to similar situations. What may be a negative
factor for one person may be positive for another. However, in general, the following
are pros and cons for each type of hemodialysis.
In-Center Hemodialysis
Pros
You have trained professionals with you at all times.
You can get to know other patients.
Cons
Treatments are scheduled by the center.
You must travel to the center for treatment.
Home Hemodialysis
Pros
You can do it at the hours you choose. (But you still must do it as often as
your doctor orders.)
You don't have to travel to a center.
You gain a sense of independence and control over your treatment.
Cons
Helping with treatments may be stressful to your family.
You need training.
You need space for storing the machine and supplies at home.
Is hemodialysis the best treatment choice for me? Why or why not?
If I am treated at a center, can I go to the center of my choice?
What does hemodialysis feel like? Does it hurt?
What is self-care dialysis?
How long does it take to learn home hemodialysis? Who will train my partner
and me?
What kind of blood access is best for me?
As a hemodialysis patient, will I be able to keep working? Can I have treatments
at night if I plan to keep working?
How much should I exercise?
Who will be on my health care team? How can they help me?
Who can I talk with about sexuality, family problems, or money concerns?
How/where can I talk to other people who have faced this decision?
Purpose
Peritoneal dialysis is another procedure that replaces the work of your kidneys.
It removes extra water, wastes, and chemicals from your body. This type of dialysis
uses the lining of your abdomen to filter your blood. This lining is called the peritoneal
membrane.
How it Works
A cleansing solution, called dialysate, travels through a special tube into your
abdomen. Fluid, wastes, and chemicals pass from tiny blood vessels in the peritoneal
membrane into the dialysate. After several hours, the dialysate gets drained from
your abdomen, taking the wastes from your blood with it. Then you fill your abdomen
with fresh dialysate and the cleaning process begins again.
Getting Ready
Before your first treatment, a surgeon places a small, soft tube called a catheter
into your abdomen. This catheter always stays there. It helps transport the dialysate
to and from your peritoneal membrane.
There are three types of peritoneal dialysis:
1.Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD is the most common type of peritoneal dialysis. It needs no machine. It can
be done in any clean, well-lit place. With CAPD, your blood is always being cleaned.
The dialysate passes from a plastic bag through the catheter and into your abdomen.
The dialysate stays in your abdomen with the catheter sealed. After several hours,
you drain the solution back into the bag. Then you refill your abdomen with fresh
solution through the same catheter. Now the cleaning process begins again.
2.Continuous Cyclic Peritoneal Dialysis (CCPD)
CCPD is like CAPD except that a machine, which connects to your catheter, automatically
fills and drains the dialysate from your abdomen. The machine does this at night
while you sleep.
3.Intermittent Peritoneal Dialysis (IPD)
IPD uses the same type of machine as CCPD to add and drain the dialysate. IPD can
be done at home, but it's usually done in the hospital. IPD treatments take longer
than CCPD.
Who Performs It
CAPD is a form of self-treatment. It needs no machine and no partner. However, with
IPD and CCPD, you need a machine and the help of a partner (family member, friend,
or health professional).
The Time It Takes
With CAPD, the dialysate stays in your abdomen for about 4 to 6 hours. The process
of draining the dialysate and replacing fresh solution takes 30 to 40 minutes. Most
people change the solution four times a day.
With CCPD, treatments last from 10 to 12 hours every night.
With IPD, treatments are done several times a week, for a total of 36 to 42 hours
per week. Sessions may last up to 24 hours.
Possible Complications
Peritonitis, or infection of the peritoneum, can occur if the opening where the catheter
enters your body gets infected. You can also get it if there is a problem connecting
or disconnecting the catheter from the bags. Peritonitis can make you feel sick.
It can cause a fever and stomach pain.
To avoid peritonitis, you must be careful to follow the procedure exactly. You must
know the early signs of peritonitis. Look for reddening or swelling around the catheter.
You should also note if your dialysate looks cloudy. It is important to report these
signs to your doctor so that the peritonitis can be treated quickly to avoid serious
problems.
Your Diet
Diet for peritoneal dialysis is slightly different than diet for hemodialysis.
You may be able to have more salt and fluids.
You may eat more protein.
You may have different potassium restrictions.
You may need to cut back on the number of calories you eat. This limitation is because
the sugar in the dialysate may cause you to gain weight.
There are pros and cons to each type of peritoneal dialysis.
CAPD
Pros
You can perform treatment alone.
You can do it at times you choose.
You can do it in many locations.
You don't need a machine.
Cons
It disrupts your daily schedule.
CCPD
Pros
You can do it at night, mainly while you sleep.
Cons
You need a machine and help from a partner.
IPD
Pros
Health professionals usually perform treatments.
Cons
You may need to go to a hospital.
It takes a lot of time.
You need a machine.
Is peritoneal dialysis the best treatment choice for me? Why or why not? Which
type?
How long will it take me to learn peritoneal dialysis?
What does peritoneal dialysis feel like? Does it hurt?
How will peritoneal dialysis affect my blood pressure?
How do I know if I have peritonitis? How is peritonitis treated?
As a peritoneal dialysis patient, will I be able to continue working?
How much should I exercise?
Who will be on my health care team? How can they help me?
Who can I talk with about sexuality, finances, or family concerns?
How/where can I talk to other people who have faced this decision?
Dialysis Is Not a Cure
Hemodialysis and peritoneal dialysis are treatments that try to replace your failed
kidneys. These treatments help you feel better and live longer, but they are not
cures for ESRD. While patients with ESRD are now living longer than ever, ESRD can
cause problems over the years. Some problems are bone disease, high blood pressure,
nerve damage, and anemia (having too few red blood cells). Although these problems
won't go away with dialysis, doctors now have new and better ways to treat or prevent
them. You should discuss these treatments with your doctor.
Purpose
Kidney transplantation is a procedure that places a healthy kidney from another person
into your body. This one new kidney does all the work that your two failed kidneys
cannot do.
How it Works
A surgeon places the new kidney inside your body between your upper thigh and abdomen.
The surgeon connects the artery and vein of the new kidney to your artery and vein.
Your blood flows through the new kidney and makes urine, just like your own kidneys
did when they were healthy. The new kidney may start working right away or may take
up to a few weeks to make urine. Your own kidneys are left where they are, unless
they are causing infection or high blood pressure.
Getting Ready
You may receive a kidney from a member of your family. This kind of donor is called
a living-related donor. You may receive a kidney from a person who has recently died.
This type of donor is called a cadaver donor. Sometimes a spouse or very close friend
may donate a kidney. This kind of donor is called a living-unrelated donor.
It is very important for the donor's blood and tissues to closely match yours. This
match will help prevent your body's immune system from fighting off, or rejecting,
the new kidney. A lab will do special tests on blood cells to find out if your body
will accept the new kidney.
The Time It Takes
The time it takes to get a kidney varies. There are not enough cadaver donors for
every person who needs a transplant. Because of this, you must be placed on a waiting
list to receive a cadaver donor kidney. However, if a relative gives you a kidney,
the transplant operation can be done sooner.
The surgery takes from 3 to 6 hours. The usual hospital stay may last from 10 to
14 days. After you leave the hospital, you will go to the clinic for regular followup
visits.
If a relative or close friend gives you a kidney, he or she will probably stay in
the hospital for one week or less.
Possible Complications
Transplantation is not a cure. There is always a chance that your body will reject
your new kidney, no matter how good the match. The chance of your body accepting
the new kidney depends on your age, race, and medical condition.
Normally, 75 to 80 percent of transplants from cadaver donors are working one year
after surgery. However, transplants from living relatives often work better than
transplants from cadaver donors. This fact is because they are usually a closer match.
Your doctor will give you special drugs to help prevent rejection. These are called
immunosuppressants. You will need to take these drugs every day for the rest of your
life. Sometimes these drugs cannot stop your body from rejecting the new kidney.
If this happens, you will go back to some form of dialysis and possibly wait for
another transplant.
Treatment with these drugs may cause side effects. The most serious is that they
weaken your immune system, making it easier for you get infections. Some drugs also
cause changes in how you look. Your face may get fuller. You may gain weight or develop
acne or facial hair. Not all patients have these problems, and makeup and diet can
help.
Some of these drugs may cause problems such as cataracts, extra stomach acid, and
hip disease. In a smaller number of patients, these drugs also may cause liver or
kidney damage when used for a long period of time.
Your Diet
Diet for transplant patients is less limiting than it is for dialysis patients. You
may still have to cut back on some foods, though. Your diet probably will change
as your medicines, blood values, weight, and blood pressure change.
You may need to count calories. Your medicine may give you a bigger appetite and
cause you to gain weight. You may have to limit eating salty foods. Your medications
may cause salt to be held in your body, leading to high blood pressure. You may need
to eat less protein. Some medications cause a higher level of wastes to build up
in your bloodstream.
There are pros and cons to kidney transplantation.
Kidney Transplantation
Pros
It works like a normal kidney.
It helps you feel healthier.
You have fewer diet restrictions.
There's no need for dialysis.
Cons
It requires major surgery.
You may need to wait for a donor.
One transplant may not last a lifetime. Your body may reject the new kidney.
You will have to take drugs for the rest of your life.
Is transplantation the best treatment choice for me? Why or why not?
What are my chances of having a successful transplant?
How do I find out if a family member or friend can donate?
What are the risks to a family member or friend if he or she donates?
If a family member or friend doesn't donate, how do I get placed on a waiting list
for a kidney? How long will I have to wait?
What are the symptoms of rejection?
Who will be on my health care team? How can they help me?
Who can I talk to about sexuality, finances, or family concerns?
How/where can I talk to other people who have faced this decision?
It's not always easy to decide which type of treatment is best for you. Your decision
depends on your medical condition, lifestyle, and personal likes and dislikes. Discuss
the pros and cons of each with your health care team. If you start one form of treatment
and decide you'd like to try another, talk it over with your doctor. The key is to
learn as much as you can about your choices. With that knowledge, you and your doctor
will choose a treatment that suits you best.
Treatment for ESRD is expensive, but the Federal Government helps pay for much of
the cost. Often, private insurance or state programs pay the rest.
Medicare
Medicare pays for 80 percent of the cost of your dialysis treatments or transplant,
no matter how old you are. To qualify,
you must have worked long enough to be insured under Social Security (or be the child
of someone who has) or you already must be receiving Social Security benefits.
You should apply for Medicare as soon as possible after beginning dialysis. Often,
a social worker at your hospital or dialysis center will help you apply.
Private Insurance
Private insurance often pays for the entire cost of treatment. Or it may pay for
the 20 percent that Medicare does not cover. Private insurance also may pay for your
prescription drugs.
Medicaid
Medicaid is a state program. Your income must be below a certain level to receive
Medicaid funds. Medicaid may pay for your treatments if you cannot receive Medicare.
In some states, it also pays the 20 percent that Medicare does not cover. It also
may pay for some of your medicines. To apply for Medicaid, talk with your social
worker or contact your local health department.
Veterans Administration (VA) Benefits
If you are a veteran, the VA can help pay for treatment. Contact your local VA office
for more information.
Social Security Income (SSI) and Social Security Disability Income (SSDI)
These benefits are available from the Social Security Administration. They assist
you with the costs of daily living. To find out if you qualify, talk to your social
worker or call your local Social Security office.
There are several groups that offer information and services to kidney patients.
You may wish to contact the following:
American Kidney Fund
Suite 1010
6110 Executive Boulevard
Rockville, MD 20852
(800) 638-8299
American Association of Kidney Patients
100 S. Ashley Drive
Suite 280
Tampa, FL 33602
(800) 749-2257
E-mail: AAKPnat@aol.com
Home page: www.aakp.org
National Kidney Foundation, Inc.
30 East 33rd Street
New York, NY 10016
(800) 622-9010
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3560
E-mail: nkudic@info.niddk.nih.gov
If you would like to learn more about ESRD and its treatment, you may be interested
in reading:
Your New Life With Dialysis--A Patient Guide for Physical and Psychological
Adjustment
Edith T. Oberley, M.A., and Terry D. Oberley, M.D., Ph.D.
Fourth edition, 1991
Charles C. Thomas Publishers
2600 South First Street
Springfield, IL 62794-9265
Understanding Kidney Transplantation
Edith T. Oberley, M.A., and Neal R. Glass, M.D., F.A.C.S.
Charles C. Thomas Publishers, 1987
2600 South First Street
Springfield, IL 62794-9265
Kidney Disease: A Guide for Patients and Their Families
American Kidney Fund
Suite 1010
6110 Executive Boulevard
Rockville, MD 20852
(800) 638-8299
National Kidney Foundation Patient Education Brochures
Includes information on treatment, diet, work, and exercise.
National Kidney Foundation, Inc.
30 East 33rd Street
New York, NY 10016
(800) 622-9010
Medicare Coverage of Kidney Dialysis and Kidney Transplant Services: A Supplement
to Your Medicare Handbook
Publication Number HCFA-02183
U.S. Department of Health and Human Services Health Care Financing Administration
Suite 500
1331 H Street, NW
Washington, DC 20005
(301) 966-7843
Renalife Magazine
American Association of Kidney Patients (AAKP)
Suite LL1
1 Davis Boulevard
Tampa, FL 33606
(813) 251-0725
Published quarterly.
Family Focus Newsletter
National Kidney Foundation, Inc.
30 East 33rd Street
New York, NY 10016
(800) 622-9010
For Patients Only Magazine
Suite 400
20335 Ventura Boulevard
Woodland Hills, CA 91364
(818) 704-5555
Published six times per year.
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3560
E-mail: nkudic@info.niddk.nih.gov
The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a
service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).The
NIDDK is part of the National Institutes of Health under the U.S. Public Health Service.
Established in 1978, the clearinghouse provides information about diabetes to people
with kidney and urologic diseases and their families, health care professionals,
and the public. NKUDIC answers inquiries; develops, reviews, and distributes publications;
and works closely with professional and patient organizations and government agencies
to coordinate resources about kidney and urologic diseases.
Publications produced by the clearinghouse are reviewed carefully for scientific
accuracy, content, and readability.
This e-text is not copyrighted. The clearinghouse encourages users of this e-pub
to duplicate and distribute as many copies as desired.
NIH Publication No. 94-2412
June 1994
e-text last updated: 17 October 1997
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