Kidney Dialysis Foundation

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WHEN IS DIALYSIS REQUIRED?
When a patient has a mild kidney failure where the blood creatinine is less than 400 µmol/L, he may not require renal replacement therapy such as dialysis or kidney transplant. This is due to the fact that he still has enough residual kidney function to sustain life. However he requires certain medications and dietary restriction to further delay damage to the kidney.

When his blood creatinine rises to 900 µmol/ L, this is where he may require dialysis or a kidney transplant.

WHAT IS DIALYSIS?
Dialysis is a form of treatment that removes the body’s waste directly from the blood of a person who have lost their kidney functions. It replaces some of the functions that the kidney can no longer perform.

There are two forms of dialysis. They are haemodialysis and peritoneal dialysis.

WHAT IS HAEMODIALYSIS?

Haemodialysis is a process by which excess waste products and water are removed from the blood. This process requires an access to the patient's blood stream and the use of a haemodialysis machine. An access is a specially created vein in the arm known as arterio-venous (AV) fistula.

In haemodialysis, the blood channels through plastic tubings (blood lines) to the dialyzer which is a bundle of hollow fibres made up from semi-permeable membrane. Here the exchange (diffusion) takes place from blood to the dialysis

solution (dialysate) and vice versa. The dialysate has a salt .composition similar to blood but without any waste products.

Usually one dialysis session takes about 4 hours to complete and patient requires dialysis 3 times a week.

THE ADVANTAGES AND DISADVANTAGES OF HAEMODIALYSIS

ADVANTAGES	DISADVANTAGES
• Staff performs treatment in the dialysis centre	• Requires travel to a dialysis centre
• Three treatments per week in the dialysis centre	• Fixed treatment schedule
• Permanent internal access required	• Two needle sticks for each treatment; tie onto a machine and cannot move about during treatment
• Regular contact with people in the centre	• Diet and fluid intake restriction

WHAT IS PERITONEAL DIALYSIS?
Peritoneal dialysis is a form of dialysis that occurs inside the body. Dialysis solution will flow into the peritoneal (abdominal) cavity through a silastic catheter. The peritoneal membrane (petrionuem) acts as a filter. Waste products and excess water pass from the body through the membrane into the dialysis solution. When the filtering process is completed, the waste filled solution is to be drained from the peritoneal cavity into a bag and is then discarded. Fresh dialysis solution is drained into the abdominal cavity through the catheter again. Each exchange takes about 45 minutes.

THERE ARE TWO FORMS OF PERITONEAL DIALYSIS :
• CAPD or Continuous Ambulatory Peritoneal Dialysis - The patient will perform four exchanges during the day
• APD or Automated Peritoneal Dialysis - The exchanges are performed by the machine during the night while the patient is asleep.

THE ADVANTAGES AND DISADVANTAGES OF PERITONEAL DIALYSIS

ADVANTAGES	DISADVANTAGES
• Patient's involvement in self-care	• Four exchanges per day
• Control over schedule	• Permanent external catheter
• Less diet & fluid restriction	• Change of body image
• More steady physical condition as it provides slow, continuous therapy	• Potential weight gain
• Most similar to original kidneys. Can be done in the night as in automated peritoneal dialysis	• Some risks of infection
• Provide less severe cardiovascular instabilities in patients with underlying heart disease	• If on automated peritoneal dialysis, one will be tie onto a machine in the night
	• Storage space is needed for supplies

WHAT IS A KIDNEY TRANSPLANT?

A kidney transplant is an alternative treatment for kidney failure. In transplantation, a kidney from either a living related or a brain dead person is removed and surgically placed into the kidney failure patient. The patient’s own kidneys do not have to be removed. Living related donors would have to undergo extensive investigations before donation to assess their suitability and fitness.

Not all kidney failure patients are fit to undergo transplantation. They should check with their doctors if they can have a kidney transplant. This is because the medication that is given for the transplant may worsen their general health. Patients who have had a transplant will need to remain on medications which suppress their immunity so that their ‘new’ kidney will not be rejected by their body’s immune system.

THE ADVANTAGES AND DISADVANTAGES OF KIDNEY TRANSPLANTATION

ADVANTAGES	DISADVANTAGES
• Absence of need for frequent dialysis treatment	• Need for frequent physician visits
• Better quality of life	• Pain, discomfort of surgery
• Better health	• Risk of transplant rejection
• Reduced medical cost after first year	• Prone to infections
• No diet and fluid intake restriction	• Some risks of infection
• Provide less severe cardiovascular instabilities in patients with underlying heart disease	• On lifelong medications

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