Life-Saving Treatments for Kidney Failure
Renal replacement therapy (RRT) is a broad term for the life-saving treatments used in patients with kidneys that are functioning at less than 10-15 percent. Treatment methods for kidney failure include dialysis and kidney transplant.
There are two types of dialysis which offer similar long term survival rates for those facing renal disease.
- Peritoneal dialysis
Hemodialysis is a method by which blood is passed through a filter to remove toxins, excess electrolytes, and extra fluids, so clean blood is then returned to the body.
Blood is removed from the body through an access point where an artery is connected to a vein directly (fistula) or indirectly (graft) underneath the skin, usually in the arm. Fistulas and grafts are created surgically by a vascular surgeon and take time to heal and mature before they can be used. Sometimes, patients with kidney failure do not have an access point created or matured when they begin to require dialysis. Those patients receive hemodialysis through a catheter that is tunneled through the skin in a large vein in the neck. These catheters serve as temporary access until a fistula or graft is available.
Hemodialysis is a treatment that can be performed in a dialysis center – typically three times per week, or at home – typically five days per week. Usually, an in-center dialysis treatment lasts for three to four hours per session. During these treatments, the patient is connected to the machine through their access point while blood is cleaned. Treatment duration depends on the patient’s weight and calculations that indicate how well the blood is cleaned.
Peritoneal dialysis is a modality done entirely at home, usually at night while the patient is asleep and does not involve blood removal. This type of dialysis relies on a membrane called the peritoneal membrane, which is present naturally in the abdomen, to serve as a filter for toxins and fluids. This membrane lines our abdominal organs. In order to use this filter, a catheter is inserted in the abdominal wall by a surgeon. This catheter is used to fill the area between the membrane and abdominal wall with a sterile sugar containing solution. This solution becomes saturated with toxins and pulls extra fluid out from the body into the cavity. This toxin filled solution then is drained from the body through the catheter and a fresh volume of solution is infused. One infusion and drain is considered an “exchange” or “cycle”. The exchanges can be performed manually or the catheter can be connected to a machine called a “cycler” to do the exchanges for the patient while he or she is sleeping.
When choosing to undergo home based peritoneal or hemodialysis the patient and care provider will need to complete dialysis training. Once training is complete, the necessary supplies for home care will be provided. If there is a question or concern, there is an on call nurse and physician available to help.
Kidney transplant is the treatment of choice for patients with kidney failure. In order to receive a transplant, a patient is referred to a kidney transplant center for evaluation. There, patients undergo blood work, cardiac testing, and cancer screening if needed. If the patient is a good candidate for a transplant, then he or she is put on the United Network for Organ Sharing (UNOS) organ transplant waiting list for a kidney from a deceased donor. Organs are allocated based on blood type, tissue type and medical necessity.
A patient can also receive a transplant from a living donor, such as a relative or friend. If someone volunteers to donate a kidney, he or she is evaluated separately to make sure it is safe for them to donate and assure that the kidney is compatible with the recipient. Sometimes, donors and recipients are not a match but could be a match for a different pair of people who are involved in the same process. These pairs then undergo a swap so that both patients with kidney failure receive the appropriate organ. This is called a paired donation.
Survival rates are higher with a kidney transplant than with either type of dialysis.