Kidneys are the main organs that filter waste products and excess fluid from the blood and excrete it through urine. They also function to control blood pressure and the level of minerals in the bones and regulate the production of red blood cells.
If kidneys fail, the filtering of the blood should be done artificially and the blood pressure should be controlled through medication. End Stage Kidney Failure is when the kidneys have lost 90% of their function, and it is difficult for a person to survive unless treated with dialysis or kidney transplant. The patient’s diet should also be changed in order to reduce the stress on the kidneys and the fluid intake should be reduced to avoid fluid build-up in the body.
In the early stages of kidney failure, when dialysis is not needed, conservative i.e., medical treatment is enough to help the kidneys function well. But if the kidney functions deteriorate, then renal replacement treatments such as dialysis and kidney transplant are considered. While the renal team will do its best to keep you healthy and help you cope with the condition, as a patient it is important for you to get involved in the treatment procedure and have a positive outlook and show self-discipline.
Treatment Choices for End-Stage Kidney Failure
The treatment options available for patients with end-stage kidney failure are:
- Peritoneal Dialysis: This type of dialysis is usually performed by the patient at home. It allows greater flexibility for the patient. In peritoneal dialysis, the peritoneum, the natural membrane that lines the abdomen acts as a filter, and waste products are filtered across the natural membrane. The membrane is bathed in a solution called the dialysate passed into the abdomen through a catheter placed in the abdomen. After a few hours, the fluid is drained away and replaced by new fluid. Peritoneal dialysis is of two types: APD and CAPD.
- APD stands for Automated Peritoneal Dialysis, it involves the use of a small machine and most of the dialysis takes place over 8-9 hours when the patient is asleep. A small amount of involvement is required on the part of the patient during the day, but it will not interfere with the patient’s routine.
- CAPD stands for Continuous Ambulatory Peritoneal Dialysis. It involves carrying out 4 fluid exchanges per day by the patient. The patient does the treatment by placing a cleansing fluid in the belly and later draining it. The fluid containing waste products is later removed and thrown away.
- Hemodialysis: During hemodialysis, the blood is treated by passing it through a dialyser or artificial kidney. Before dialysis, the patient will have to undergo a minor vascular surgery that creates a fistula in the arm. In hemodialysis, a dialysis machine and a special filter called the dialyzer are used to clean the blood. The dialyzer has two parts, one for the patient’s blood, and one for the washing fluid called the dialysate. A thin membrane separates these two parts. Blood cells, protein and other important substances remain in the blood as they are too big to pass through the membrane, and smaller waste products such as urea, creatinine, potassium and extra fluid pass through the membrane and are then washed away. Hemodialysis is done 3 times a week for 3 to 4 hours. The patient needs to visit a dialysis centre to get the dialysis done.
- A patient on hemodialysis may consider home hemodialysis after some time. Home hemodialysis requires the patient to install a small dialysis machine at home and the patient will need a caregiver, who is a spouse or friend to help with the dialysis. Home hemodialysis confers the patient with much more freedom and independence and he/she can have a longer or more frequent dialysis which helps to keep the patient healthier.
- Kidney Transplant: If a patient seems fit for renal transplant, then a kidney is procured from a dead person or one of the blood relatives of the patient. The transplanted kidney is placed in the groin, beneath the skin and muscle. As with most operations, the patient will feel weak for a few days, but will be up and about in a couple of weeks. To prevent the patient’s body from rejecting the new kidney, he/she will be prescribed special medicines that will have to be taken till the patient has the transplant.