Straight, No Chaser: Dialysis

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We previously discussed kidney function and failure. Today’s Straight, No Chaser focuses on dialysis: a treatment of extreme kidney failure has been performed for approximately 70 years. Unfortunately many of us have friends and/or family members who are on dialysis, and there are always questions, so let’s address some of the more commonly asked questions on dialysis.

What’s the purpose of dialysis?

Dialysis basically is a replacement of normal functions performed by healthy kidneys. It is treatment of severe renal (kidney) failure. Dialysis performs the following:

  • It removes waste, salt, toxins and excess fluids that would otherwise cause harm if allowed to accumulate.
  • It maintains safe level of essential substances in your blood, such as bicarbonate, potassium and sodium.
  • It helps control blood pressure.

Who requires dialysis?

In the last Straight, No Chaser post on renal failure, we discussed acute, chronic and end-stage renal failure. Most often dialysis is needed in patients with end stage disease whose status is roughly equivalent to the loss of 85-90% of kidney function. There are certain causes of acute renal failure (such as certain poisonings) that also are amenable to treatment by dialysis.

Aren’t there different types of dialysis?

Yes, there are two main categories of dialysis: hemodialysis and peritoneal dialysis.

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  • In hemodialysis an external, artificial kidney (hemodialyzer) is used to remove waste, extra chemicals and excess fluid from your blood. This is most often facilitated by a minor surgery to one of your arms or legs to connect the blood to the hemodialyzer.

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  • In peritoneal dialysis, the blood is cleaned inside the body. This is most often done by a minor surgery in which a plastic tube (a catheter) is placed into your abdomen. This creates access for the material inserted (called dialysate) that is used to draw excess fluid and waste products from the blood. An important consideration about peritoneal dialysis is one variety of it, called continuous ambulatory peritoneal dialysis (CAPD) can be done yourself without machines. If you’re fortunate enough to qualify for this type, you are much more able to engage in a more regular life routine.

How long is dialysis necessary?

Unless you are receiving dialysis for acute kidney failure, you should not expect your kidneys to get better and should expect to need dialysis for the rest of your life. Dialysis is not a treatment of your kidneys; it is a treatment that replaces the function of your kidneys. If you are a candidate for a kidney transplant, once that is successfully done, that would eliminate the need for dialysis.

How does dialysis affect the ability to lead a normal life?

It’s important to note that in end stage renal disease you already aren’t leading a normal life. The inconveniences posed by dialysis must be weighed for the longevity in your life produced vs. any limitations caused. Most patients on dialysis who are otherwise healthy are able to lead normal lives within the constraints caused by needing dialysis.

  • Dialysis treatments are painless (except for the initial surgery to create the access fistula, graft or catheter). The procedure does have certain complications, including an occasional lowering of blood pressure related to all the fluid being removed.
  • Most dialysis patients need to be on a special diet (called a renal diet). Limitations are likely to include the amount of salt and fluid intake.
  • One helpful aspect of dialysis is the standardization of treatment. Dialysis centers are located all over the world, so if and when you choose to travel, you can make an appointment at another center in advance through your regular dialysis site.
  • Unless one’s job is heavy on physical labor (no pun intended), many dialysis patients can go back to work once a dialysis routine has been established and patients have become accustomed to the process and any side effects.

What effect on life expectancy does dialysis have?

It is fair to say only that dialysis gives patients with end stage renal disease a longer life than they would have otherwise and gives them the best opportunity to have a normal life expectancy.

Keep in mind that dialysis is a life raft. Its purpose is to prevent toxins and excess fluid from damaging the rest of your body. In some instances it is meant to hold you up until a transplant can be obtained, and in other instances it is your lifeboat for as long as you live. There is no leeway here. Once dialysis is required, it becomes as essential as your kidneys once were. Whether you’re affected or if you care for a loved one going through this, be sure to be supportive and insistent that this vital treatment is obtained as often as necessary.

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