How to Relieve Swelling for Dialysis Patients at Home

Dialysis can help replace impaired kidneys to filter blood and remove extra fluid, waste products and toxins. In most cases, patients’ swelling can be eased through dialysis, but some dialysis patients still have swelling. Then, patients may want to know how to relieve dialysis patients’ swelling at home.

Swelling for dialysis patients

Swelling is caused by fluid retention or a large amount of protein leakage. Generally, swelling may appear in ankles, stomach, legs, feet, face, and so on. If dialysis can’t help manage patients’ swelling effectively, it is more likely to indicate inadequate dialysis or excessive fluid intake during dialysis sessions.

In addition to taking some medicines or medical therapies, dialysis patients can also take some home remedies to deal with this problem.

Try to relieve swelling for dialysis patients at home

- Control fluid intake during dialysis tightly

Controlling fluid intake can help keep dry weight and guarantee the adequacy of dialysis treatment. Therefore, these patients should consider their fluid intake and manage their problems effectively.

- Follow a low-sodium diet plan

Sodium is one mineral that can cause extra fluid to collect in the body. In view of this, patients should follow a low-sodium diet plan.

- Lift the swollen region

Elevating the swollen region can help ease patients’ problems. For example, if patients have leg swelling, they need to elevate their legs when sleeping.

- Massage

With the guidance of professional doctors, patients can do massage at their own home. This remedy can help improve blood circulation and take away more extra fluid out of the body.

In summary

Although the above therapies can help improve patients’ overall health condition, they are unable to replace medical therapies. That is to say, patients still need to take some medicines or therapies. -kidneyservicechina.com

Coping with Common Side Effects of Kidney Dialysis

While dialysis is a life-saving treatment for many people with end stage renal disease, it is often accompanied by side effects. Depending on the type of treatment – hemodialysis or peritoneal dialysis – and severity of condition, a patient may require additional medical assistance or lifestyle changes to address one or more of the following.

Low Blood Pressure

Low blood pressure (also known as hypotension) is a common side effect of dialysis. It generally occurs when patients add too much fluid weight between treatments or when too much fluid is removed during dialysis. The best ways to limit the risks of dialysis-related low blood pressure are to follow fluid intake recommendations and avoid salty foods that can make you extra thirsty. If you feel nauseous or dizzy during a treatment, the dialysis machine can be adjusted for the right fluid removal level. If you take medication for high blood pressure, ask your doctor how and when you should take it while undergoing dialysis.

Nausea and Vomiting

Patients can feel nauseous or experience vomiting for a number of reasons during and after dialysis treatments. First of all, these symptoms are commonly associated with kidney disease. Add low blood pressure and fluid weight gain to the mix and they are much more likely. Unfortunately, nausea and vomiting are sometimes uncomfortable enough to cause some patients to avoid further dialysis treatments. This just makes matters worse. Talk to your dialysis team about any such symptoms. They may be able to better regulate fluid removal levels and/or prescribe anti-nausea medication. You should also closely follow all guidelines provided by your dietician.     

Dry or Itchy Skin

Many dialysis patients experience dry or itchy skin, a condition believed to be related to build ups of phosphorous and potassium in the body. Following your dietician’s guidelines should limit your intake of these minerals. She may also recommend taking a phosphorous binder before meals. When and if you develop dry or itchy skin, a combination of non-drying soaps and standard moisturizing lotions should help. Avoid fragranced lotions as they can make skin more sensitive. You should also avoid excessively hot showers as they can further dry out your skin.

Restless Leg Syndrome

Restless leg syndrome (RLS) is another common side effect. People with RLS experience tingling, itchiness or discomfort in the legs or feet when relaxing or falling asleep. These sensations often cause the person to kick out or move their legs suddenly. Such motions usually relieve the discomfort but only temporarily. RLS is associated with conditions from kidney disease to vitamin B deficiency, so it’s important to see your doctor for a diagnosis. She may prescribe medications or home therapies such as massage, warm baths, compresses, exercise or relaxation techniques.

Muscle Cramps

Dialysis patients sometimes experience uncomfortable or even painful muscle cramps, most frequently in the lower legs. While muscle cramps can result from numerous factors, it is often the quick loss of fluid from the body or excessive loss of overall fluid that triggers them during dialysis. Stretching the muscles or applying hot packs are usually enough to relieve pain within a few minutes. In some cases, however, a prescription medication may be necessary to treat recurring episodes.

With so many associated health conditions, it’s important for people undergoing dialysis to wear medical ID jewelry to alert first responders in the event of a medical emergency. Knowledge of your condition and the associated side effects will help them deliver the best possible care. 

-hopepaige.com

Kidney dialysis: When is it time to stop?

My 82-year-old husband has been on kidney dialysis for a year. He is not a good candidate for a kidney transplant. How will we know when dialysis is no longer working and should be discontinued?

Answers from Erik P. Castle, M.D.

Kidney dialysis does some of the work of your kidneys when your kidneys aren't healthy enough to do it. This includes removing excess fluids and waste products from your blood, restoring electrolyte levels, and helping to control your blood pressure.

To determine how well kidney dialysis is working, your husband's doctor can check his weight and blood pressure before and after each session. Regular blood tests, such as those measuring urea and creatinine levels, and other specialized evaluations also help assess the effectiveness of the treatment.

Kidney dialysis is only part of your husband's treatment. He must also adjust to fluid and dietary restrictions and take medications. In addition, dialysis affects his time and schedule. Activities must be scheduled around the treatments. Dialysis may leave your husband feeling "washed out." Worsening health, depression and complications of dialysis may also affect how your husband feels about continuing treatment.

If the dialysis medical team doesn't periodically review your husband's overall situation, ask them to do so. These periodic reviews — which should include input from your husband and you — are important in determining how well the treatment is working.

If your husband is frustrated with a specific treatment or another medical problem, discuss it with his doctor. His doctor may be able to make some changes in the treatment that could improve his situation.

There may come a time when your husband feels he wants to stop kidney dialysis. Although he has the right to discontinue treatment, it's important to discuss the decision carefully with loved ones as well as your husband's treatment team. -mayoclinic.org

Removal of waste and water control of a Dialysis Patient

Kidney dialysis

Kidney failure has serious consequences as it means that the water and ionbalance cannot be regulated, and the levels of toxic urea build up in the body. This would ultimately be fatal if not treated.

One method of treatment is kidney dialysis. In this procedure, patients are connected to a dialysis machine which acts as an artificial kidney to remove most of the urea and restore/maintain the water and ion balance of the blood.

How dialysis works

‘Dirty’ blood (high in urea) is taken from a blood vessel in the arm, mixed with blood thinners to prevent clotting, and pumped into the machine. Inside the machine - separated by a partially permeable membrane the blood flows in the opposite direction to dialysis fluid, allowing exchange to occur between the two where a concentration gradient exists.

How dialysis works

Dialysis fluid contains:

• a glucose concentration similar to a normal level in the blood
• a concentration of ions similar to that found in normal blood plasma
• no urea

As the dialysis fluid has no urea in it, there is a large concentration gradient - meaning that urea moves across the partially permeable membrane, from the blood to the dialysis fluid, by diffusion.

As the dialysis fluid contains a glucose concentration equal to a normal blood sugar level, this prevents the net movement of glucose across the membrane as no concentration gradient exists.

And, as the dialysis fluid contains an ion concentration similar to the ideal blood plasma concentration, movement of ions across the membrane only occurs where there is an imbalance.

• If the patient’s blood is too low in ions , they will diffuse from the dialysis fluid into the blood, restoring the ideal level in the blood.
• If the patient’s blood is too high in ions , the excess ions will diffuse from the blood to the dialysis fluid.

Dialysis summary

The overall effect of this is that the blood leaving the machine and returning into the patient’s arm will have:

• greatly reduced levels of urea – it is ‘cleaned blood’
• no overall change in blood glucose levels
• the correct water and ion balance maintained or restored (with only excess ions removed)

Kidney dialysis requires highly specialised and expensive machinery. The patient must be connected to this machinery 2-3 times a week for periods (on average) of between 4-6 hours at a time.

As the filtration only works when they are connected, kidney patients must monitor their diet carefully in between dialysis sessions. They need to avoid eating foods with a high salt content or a high protein content as excess amino acids are broken down into urea.

So although dialysis is a life-saving treatment, it does have a significant effect on a person’s lifestyle. -bbc.co.uk

Can a Person Live a Good Long Life on Dialysis?

As a patient suffering from End Stage Renal Disease (ESRD), you should know all about the average life expectancy with Kidney Dialysis Treatment. In general mortality rates are much higher in ESRD patients than those of the larger population. Although based on statistics the average life expectancy appears to be low (3-5 years), you should know that many people live long and happy lives (25+ years) while on dialysis so you can reasonably hope for a good long life even without a donor kidney.

Life expectancy on dialysis varies depending on other underlying medical conditions as well as expected reduced survival rates due to age. However, additional medical challenges or old age itself is not a barrier to doing well on dialysis. Some hate these statistics and in reality they mean very little, in fact most statistics of this kind are used for funding and budgetary purposes. In the real world, those with ESRD often lead long, productive, and enjoyable lives while on dialysis.

There is no question that there are many emotional and physical side effects that a dialysis patient goes through. Some of the common side effects are anemia, infections, nausea, headaches, cramps, low blood pressure, loss of appetite and depression. These side effects are real and lasting and the dialysis patient may have to live with some or all of these for the rest of their lives unless they are successful in obtaining a donor kidney. Even with this knowledge it is important for those on dialysis to maintain a positive attitude and have faith in order to lead a fulfilling life, regardless of statistics about their life expectancy. Know that you can do this! Think of CKD as a challenge to be met head on. 

Dialysis is not a death sentence. You can live a rich and full life in spite of your physical or emotional barriers if you cultivate an appreciation of life. Stay positive. Your life expectancy and quality of life depends on the right support, perspective and attitude. Do not forget to do the things you love that make you happy such as visiting with friends, going out to dinner, and taking vacations. You can be one of many to prove that the statistics do not always apply. -kidneybuzz..com

Haemodialysis

HAEMODIALYSIS

The Problem

Kidneys play a major role in intoxicating the body. Damage of the kidneys is irreversible and has no known cure thus can only be treated to sustain life. If you develop kidney failure, there is an interruption in the excretion and osmoregulation process which results your body in experiencing a build up of harmful wastes, rise in blood pressure and retaining of excess fluids. [7] Your kidneys also produce hormones and balance chemicals in your system thus; failure may cause you problems with anaemia and conditions that affect your bones, nerves, and skin. Common sign and symptoms of renal failure include fatigue, bone problems, joint problems, itching, and restless legs. [11]

Haemodialysis; a Treatment Option

Dialysis treatments help you feel better and live longer, but does not cure kidney failure. Treating renal failure is not secluded to one type of treatment which is not often known by the general public, previously including myself. It is crucial in selecting the correct treatment as the choice made will highly affect ones day-to-day lifestyle with each treatment having their pros and cons. However, treatments are interchangeable if a patient feels uncomfortable or experiences difficulties in what they currently undergo.

Haemodialysis is a primarily diffusion-based therapy in which solute from the patient's blood crosses a semipermeable membrane (the dialyzer) into the dialysate at a location outside the body. [5] Its extracorporeal location [6] distinguishes haemodialysis from other treatments such as peritoneal dialysis. Removal of excess fluid is attained by ultrafiltration, in which hydrostatic pressure causes the bulk flow of plasma water through the membrane. With advances in vascular access, anticoagulation, and the production of reliable and efficient dialyzers, haemodialysis has become the predominant method of treatment for acute and chronic renal failure.

How it Works

Blood and dialysate are flowed on opposite sides of the semipermeable membrane in a counter current direction for maximal efficiency of solute removal. [3] Dialysate composition, the characteristics and size of the membrane in the dialyzer, and blood and solute flow rates all affect solute removal. The electrolyte composition of the dialysate is chosen meticulously [3] because ion fluxes (particularly potassium) can induce arrhythmias. The standard glucose concentration of dialysate is 200mg/dl. [6]

Arm with an arteriovenous fistula.Vascular Access

Before starting haemodialysis, an important step is preparing a vascular access i.e. a site on your body from which your blood is removed and returned. [13] It needs to be prepared either weeks or months before the actual procedure starts [13] and must be able to deliver blood flow rates as high as 400 to 500ml/min through the dialyzer. [6] There are two general types available; catheters placed in a central vein which is often used by patients with acute renal failure and more permanent arteriovenous shunts placed peripherally [6], usually in the forearm or upper arm and occasionally in the leg or on the chest.

The standard duration for each haemodialysis treatment is three dialyses per week for 3 to 5 hours per treatment depending on patient size, residual renal function, and access blood flow. It is done on alternate days as a routine with either a choice of Monday, Wednesday, Friday or Tuesday, Thursday, Saturday commonly referred as 1,3,5 and 2,4,6 respectively. [7] The large-bore needles required for haemodialysis are inserted into the A-V fistula or graft under local anaesthesia. There is no pain with initiation of dialysis if catheter access is used. The procedure itself is very safe, having been administered in many centres over a million times each without any serious complications.

Anticoagulation

During haemodialysis, blood clotting can happen due to initiation of the cascade of events in the intrinsic clotting pathway resulting from exposure of fresh blood to an artificial surface. [6] If unchecked, this would normally lead to clotting in the dialyzer and tubing within only a few minutes after starting the blood pump. For every extracorporeal device, a method for inhibiting this clotting process is essential. Most centres inhibit blood clotting both in the patient and in the dialyzer temporarily by injecting heparin intravenously in small to moderate doses during dialysis. [4] In some centres, a low dose of heparin is also infused continuously directly into the dialyzer to enhance the effect locally. [6]

Factors Influencing the Prognosis of Kidney Patients on Haemodialysis

Haemodialysis is a life saving treatment modality. However, the prognosis for renal patients may differ according to the following factors.

Good prognosis means higher chance of cure for the patients but in this case of no cure, it refers to higher chances of survival.

Survival of Haemodialysis Patients

Widespread data of dialysis patient survival is found in annual reports of the European Dialysis and Transplant Association. [2] For the entire series based on 650 patients treated over 3 months at Necker Hospital and associated centres, the overall cumulative actuarial survival rate reaches 92.7% at 1 year, 84.3% at 3 years and 75.7% at 5 years (a mean annual mortality of about 5% after the first year). [2] From the graph, survival of patients under 50 is higher than that of above 50 years of age. Despite that, overall mortality in patients is low showing the reliability of performing haemodialysis. [14]

Complications of Haemodialysis

Hypotension is the most frequent complication faced during haemodialysis. For patients dialyzed following the usual schedule of three treatments per week, hypotension must be anticipated with a treatment plan in advance. Prevention can be achieved by monitoring dry weight, precise ultrafiltration, stabilizing body temperature, careful choice of dialysate sodium and calcium concentrations, and reduction of medications for hypertension immediately before dialysis. [5]

Muscle Cramps happen as a result of plasma volume contraction and rapid sodium fluxes usually during ultrafiltration. Restriction in fluid intake to ensure weight gain of not more than 2kg between treatments, stretching exercises, and hypertonic saline injections are among the preventive measures that are taken. [5]

Hypoxemia is a deficiency in oxygen which is important to take note during dialysis in patients with compromised cardiopulmonary function. Predisposed patients need to be given supplemental oxygen and dialyzed with synthetic copolymer membranes using bicarbonate dialysate. [5]

Arrhythmias in predisposed patients are contributed by hypoxemia, hypotension, removal of arrhythmic agents during dialysis and rapid changes in serum bicarbonate, calcium, magnesium and potassium. It is a disturbance in the normal rhythm of the heart making it necessary for continuous electrocardiogram monitoring in high-risk patients. [5]

Acquired Renal Cystic Disease. Up to 80% of dialysis patients treated over 3 years develop multiple renal cysts. It is recommended that screening of haemodialysis patients by ultrasonography or computed tomography be carried out after 3 years of dialysis treatment to detect any malignant changes. [5]

Bleeding. Despite uremia causing platelet dysfunction which can be assessed by measuring bleeding time, anticoagulants must still be given to the patient to prevent clotting of the extracorporeal circuit. The dose of heparin as a drug of choice can be adjusted according to the clotting time. [4] Nevertheless, in suitable cases dialysis without heparin may be conducted. [4]

Through personal observations of haemodialysis patients, I found that there are patients who are incompatible with certain types of treatment modalities. This may be attributed to fine and narrow veins or other diseases experienced by the patient.

Alternative Treatments

Peritoneal dialysis differs from haemodialysis as cleansing happens inside the body. It uses the lining of your abdomen called the peritoneal membrane to filter blood. The dialysis solution is inserted through a catheter initially placed surgically into your abdomen 2 or 3 weeks beforehand. [9] Waste, chemicals and extra water diffuses into the dialysis solution which is drawn out of the body after several hours. [9] The cycle is repeated by refilling the abdomen with fresh dialysis solution.

Illustration of a patient receiving peritoneal dialysis.

Illustration of a kidney transplantation.Kidney transplant is surgically placing a normal functioning kidney belonging to another person into your body. The new kidney is positioned inside your lower abdomen and its artery and vein is connected to your own. [10] Notice that the diseased kidneys do not have to be removed. The new kidney can be used soon after surgery or may take up a few weeks to function like your own kidneys when undamaged.

The above is quoted from a published book so the information should be factual unless it has become out of date since being published. Newer discoveries would not be available.

Transplantation is closest to cure but despite the best match available there is still a tendency of rejection by the body. In my opinion, the elderly should not opt for this treatment.

Social, Psychological and Economic Implications

Patients can live normally for a long time despite renal failure but gradually activities will start to get limited due to increasing weakness and anaemia. Strict diets must be followed and frustration often develops especially in young children and adolescents. Feelings of weakness, discouragement and even anxiety greatly affect the patients and a few suicides have been reported to support this. [1]

The cognitive capability of the patient is also gradually lowered, more so to the elderly. Having to deal with these patients prove to be quite challenging. To give more comfort to elderly patients, I personally feel that instead of undergoing peritoneal dialysis every day, haemodialysis is a better option. After going through dialysis, the patient feels exhausted and this can prolong the whole day. As haemodialysis is done on alternate days, the patient is able to rest a day without the treatment giving more quality of life. This can also help reduce depression experienced by the patient.

A recent study finds that the more pills taken by kidney dialysis patients, the more side effects they suffer. [12]

MedlinePlus works to update people with current health information. It is a service provided by the U.S NATIONAL LIBRARY OF MEDICINE and the NATIONAL INSTITUTES OF HEALTH which are well established sources making it reliable. Moreover, the study is referred to the Clinical Journal of the American Society of Nephrology ensuring its validity. A limitation would be lack in variation as sources focus on the US instead of the whole world. I feel that the issue above should be looked upon seriously as researchers say that increase in prescribed pills do not improve phosphorus levels instead jeopardizes their quality of life.

Different statistical studies indicate that a minimum of 40-50 patients per million citizens annually enter the fatal phase of kidney failure requiring haemodialysis. [1] These studies have been confirmed by data from countries that have successfully succeeded in treating all their chronic uremic patients such as Sweden and Australia, making it very reliable. [1] Haemodialysis creates a financial problem for the national budget due to its high cost. The high cost treatment for a small number of patients strikes an imbalance in the general budget for the entire population. To reduce the financial burden, home dialysis and renal transplantation is promoted.

Future Development

Haemodialysis therapy has been in clinical practice for over 60 years. A review of treatment options to intensify haemodialysis is being continuously carried out to improve the efficacy and safety of the procedure. Although it is not without risk, by far I feel that it has proven to be life sustaining for majority of patients with end-stage renal disease.

Bibliography

[1] Hamburger, Crosnier, Grunfield (1979) Treatment of Terminal Renal Failure: General Concepts of Supportive Therapy, Nephrology, USA: Wiley Medical Publication

[2] Hamburger, Crosnier, Grunfield (1979) Results and Limitations of Long-term Dialysis Treatment, Nephrology, USA: Wiley Medical Publication

[3] Paul Glynne, Andrew Allen, Charles Pusey (2002) Basic Principles of Haemodialysis, Acute Renal Failure In Practice, London: Imperial College Press

[4] Allen R. Nissenson, Richard N. Fine (2008) Methods of Haemodialysis Anticoagulation, Handbook of Dialysis Therapy 4th Edition, USA: Saunders Elsevier

[5] Christopher S. Wilcox, C. Craig Tisher (2005) Hemodialysis and Continuous Therapies, Handbook of Nephrology & Hypertension 5th Edition, USA: LIPPINCOTT WILLIAM & WILKINS

[6] Francesco P. Schena, Alexander M. Davidson, Hein A. Koomans, Jean-Pierre Grunfeld, Fernando Valderrabano, Fokko J. Van der Woude (2001) Hemodialysis, Clinical Medicine Series, Nephrology, England: Mc Graw - Hill

[7] Treatment Methods for Kidney Failure: Hemodialysis-http://kidney.niddk.nih.gov/kudiseases /pubs/hemodialysis/index.htm: retrieved on December 21, 2008

[8] Hemodialysis-en.svg-http://en.wikipedia.org/wiki/File:Hemodialysis-en.svg : retrieved on June 20, 2009

[9] How PD Works- http://www.kidney.niddk.nih.gov/kudiseases/pubs/peritoneal/: retrieved on December 25, 2008

[10] Treatment Choice: Kidney Transplantation-http://www.kidney.niddk.nih.gov/kudiseases/ pubs/choosingtreatment/index.htm: retrieved on December 25, 2008

[11] Conditions Related to Kidney Failure and Their Treatments-http://www.kidney.niddk.nih.gov /kudiseases/pubs/peritoneal/: retrieved on December 25, 2008

[12] For Dialysis Patients, More Pills = Lower Quality of Life-http://www.nlm.nih.gov/medlineplus /news/fullstory_84219.html: retrieved on June 3, 2009

[13] Vascular Access for Haemodialysis-http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysi s/index.htm: retrieved on December 21, 2008

[14] Domenico Santoro, Giampiero Mazzaglia, Vincenzo Savica, Maurizio Li Vecchi, Guido Bellinghieri (2009) Hepatitis Status and Mortality in Haemodialysis Population, Informa Healthcare, Renal Failure 31:6-12

Dialysis: All You Need to Know

People with failed or damaged kidneys may have difficulty eliminating waste and unwanted water from the blood. Dialysis is an artificial way of carrying out this process.

Dialysis substitutes the natural work of the kidneys, so it is also known as renal replacement therapy (RRT).

Healthy kidneys regulate the body's levels of water and minerals and remove waste. The kidneys also secrete certain products that are important in metabolism, but dialysis cannot do this.

Contents of this article:

1. What is dialysis?
2. Symptoms of kidney failure
3. Adverse effects of dialysis

What is dialysis?

The kidneys filter and eliminate waste.

A healthy person's kidneys filter around 1,500 liters of blood each day. If the kidneys are not working correctly, waste builds up in the blood. Eventually, this can lead to coma and death.

The cause might be a chronic, or long-term condition, or an acute problem, such as an injury or a short-term illness that affects the kidneys.

Dialysis prevents the waste products in the blood from reaching hazardous levels. It can also remove toxins or drugs from the blood in an emergency setting.

There are different types of dialysis.

The three main approaches are:

• Intermittent hemodialysis (IHD)
• Peritoneal dialysis (PD)
• Continuous renal replacement therapies (CRRT)

The choice will depend on factors such as the patient's situation, availability, and cost.

Intermittent hemodialysis

In hemodialysis, the blood circulates outside the body of the patient. It goes through a machine with special filters.

The blood comes out of the patient through a flexible tube known as a catheter. The tube is inserted into the vein.

Like the kidneys, the filters remove the waste products from the blood. The filtered blood then returns to the patient through another catheter. The system works like an artificial kidney.

Patients who are going to have hemodialysis need surgery to enlarge a blood vessel, usually in the arm. Enlarging the vein makes it possible to insert the catheters.

Dialysis takes over part of the kidney function when the kidneys no longer work properly.

Hemodialysis is usually done three times a week, for 3-4 hours a day, depending on how well the patient's kidneys work, and how much fluid weight they have gained between treatments.

Hemodialysis can be done in a special dialysis center in a hospital or at home.

Patients who have dialysis at home, or their caregiver, must know exactly what to do. If a person does not feel confident doing dialysis at home, they should attend sessions at the hospital.

Home hemodialysis is suitable for people who:

• Have been in a stable condition while on dialysis
• Do not have other diseases that would make home hemodialysis unsafe
• Have suitable blood vessels for inserting the catheters
• Have a caregiver who is willing to help with hemodialysis

The home environment must also be suitable for taking hemodialysis equipment.

Peritoneal dialysis

While hemodialysis removes impurities by filtering the blood, peritoneal dialysis works through diffusion.

Fast facts about kidney disease

• Chronic kidney disease affects 14 percent of the population in the U.S.
• Over 661,000 Americans have kidney failure
• 468,000 of these are undergoing dialysis.
• Around 193,000 have had a kidney transplant

Find out more about kidney disease

In peritoneal dialysis, a sterile dialysate solution, rich in minerals and glucose, is run through a tube into the peritoneal cavity, the abdominal body cavity that surrounds the intestine. It has a semi-permeable membrane, the peritoneal membrane.

Peritoneal dialysis uses the natural filtering ability of the peritoneum, the internal lining of the abdomen, to filter waste products from the blood.

The dialysate is left in the peritoneal cavity for some time, so that it can absorb waste products. Then it is drained out through a tube and discarded.

This exchange, or cycle, is normally repeated several times during the day, and it can be done overnight with an automated system.

The elimination of unwanted water, or ultrafiltration, occurs through osmosis. The dialysis solution has a high concentration of glucose, and this causes osmotic pressure. The pressure causes the fluid to move from the blood into the dialysate. As a result, more fluid is drained than is introduced.

Peritoneal dialysis is less efficient than hemodialysis. It takes longer periods, and it removes around the same amount of total waste product, salt, and water as hemodialysis.

However, peritoneal dialysis gives patients more freedom and independence, because it can be done at home instead of going to the clinic several times each week. It can also be done while traveling with a minimum of specialized equipment.

Before starting peritoneal dialysis, the patient needs a small surgical procedure to insert a catheter into the abdomen. This is kept closed off, except when being used for dialysis.

There are two main types of peritoneal dialysis:

Continuous ambulatory peritoneal dialysis (CAPD) requires no machinery and it can be done by the patient or a caregiver.

The dialysate is left in the abdomen for up to 8 hours and then replaced with a fresh solution straight away. This happens every day, four or five times per day.

Continuous cyclic peritoneal dialysis (CCPD) uses a machine to exchange the fluids. It is generally done every night, while the patient sleeps.

Each session lasts from 10 to 12 hours. After spending the night attached to the machine, most people keep the fluid inside their abdomen during the day. Some patients may need another exchange during the day.

Peritoneal dialysis is a suitable option for patients who find hemodialysis too exhausting, such as elderly people, infants, and children. It can be done while traveling, so it is more convenient for those who work or attend school.

Continuous renal replacement therapy

Dialysis can be intermittent or continuous. While a session of intermittent dialysis lasts for up to 6 hours, continuous renal replacement therapies (CRRT) are designed for 24-hour use in an intensive care unit (ICU).

There are different types of CRRT. It can involve either filtration or diffusion. It is better tolerated than intermittent dialysis, because the solute or fluid removal is slower. This leads to fewer complications.

Temporary dialysis

Sometimes dialysis is given for a limited period of time.

People who may benefit from temporary dialysis include those who:

• Have a sudden, or acute, kidney condition
• Have consumed toxic substances or taken a drug overdose
• Have had a traumatic injury to the kidney
• Have chronic heart disease

In some cases, the kidneys recover and do not need further treatment.

Does dialysis replace the kidneys?

Dialysis helps patients whose kidneys have failed, but it is not as efficient as a normal kidney. Patients who receive dialysis need to be careful about what and how much they drink and eat, and they need to take medication.

Many people who have dialysis can work, lead normal lives, and travel, as long as dialysis treatment is possible at the destination.

Women who have dialysis normally have difficulty becoming pregnant. There will be a higher level of waste products in the body than there are with normal kidneys. This interferes with fertility.

Women who do become pregnant while on dialysis will probably need increased dialysis during the pregnancy. If a woman has a successful kidney transplant, her fertility should return to normal.

Dialysis has some effect on male fertility, but less than on female fertility.

Symptoms of kidney failure

Chronic kidney failure happens gradually. Even if just one kidney works, or both work partially, normal kidney function is still possible. It can be a long time before the symptoms of a kidney condition appear.

Blood or protein in the urine can be a sign of kidney failure.

When symptoms do occur, they often vary between individuals, making it harder to diagnose kidney failure quickly.

Symptoms of kidney failure may include:

• Fatigue, or tiredness
• Increasingly frequent need to urinate, especially at night
• Itchy skin
• Erectile dysfunction, when a man has difficulty sustaining an erection
• Nausea
• Shortness of breath
• Water retention, leading to swollen feet, hands, and ankles
• Blood in urine
• Protein in urine

A sudden injury can cause kidney failure. When it does, symptoms tend to appear faster and progress more rapidly.

Anemia is common in people with chronic kidney disease. It can happen when levels of erythropoietin (EPO) are low. EPO is a produced by the kidneys, and it helps the body produce red blood cells. When the red blood cell count is low, it is called anemia. -medicalnewstoday.com