E.S.R.D. (End-Stage Renal Disease)

Some people have kidneys that fail to work. This condition is called
End-Stage Renal Disease (ESRD), more commonly known simply as "kidney failure."

Today, there are new and better treatments for ESRD that replace the work of healthy kidneys . By learning about your treatment choices, you can work with your doctor to pick the one that's best for you. No matter which type of treatment you choose, there will be some changes in your life. But with the help of your health care team, family, and friends, you may be able to lead a full, active life.

This information describes the choices for treatment:  hemodialysis, peritoneal dialysis, and kidney transplantation . You and your doctor will work together to choose a treatment that's best for you. This information can help you make that choice.

When Your Kidneys Fail
Healthy kidneys clean the blood by filtering out extra water and wastes. They also make hormones that keep your bones strong and blood healthy. When both of your kidneys fail, your body holds fluid. Your blood pressure rises. Harmful wastes build up in your body. Your body doesn't make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys.

Hemodialysis

Hemodialysis is a procedure that cleans and filters your blood. It rids your body of harmful wastes and extra salt and fluids. It also controls blood pressure and helps your body keep the proper balance of chemicals such as potassium, sodium, and chloride.

Hemodialysis uses a dialyzer, or special filter, to clean your blood. The dialyzer connects to a machine. During treatment, your blood travels through tubes into the dialyzer. The dialyzer filters out wastes and extra fluids. Then the newly cleaned blood flows through another set of tubes and back into your body.

Before your first treatment, an access to your bloodstream must be made. The access provides a way for blood to be carried from your body to the dialysis machine and then back into your body. The access can be internal (inside the body -- usually under your skin) or external (outside the body).

Hemodialysis can be done at home or at a center. At a center, nurses or trained technicians perform the treatment. At home, you perform hemodialysis with the help of a partner, usually a family member or friend. If you decide to do home dialysis, you and your partner will receive special training.

Hemodialysis usually is done three times a week. Each treatment lasts from 2 to 4 hours. During treatment, you can read, write, sleep, talk, or watch TV.

Hemodialysis and a proper diet help reduce the wastes that build up in your blood. A dietitian can help you plan meals according to your doctor's orders. When choosing foods, you should remember to:

• Eat balanced amounts of foods high in protein such as meat and chicken. Animal protein is better used by your body than the protein found in vegetables and grains.
  
• Watch the amount of potassium you eat. Potassium is a mineral found in salt substitutes, some fruits, vegetables, milk, chocolate, and nuts. Too much or too little potassium can be harmful to your heart.
  
• Limit how much you drink. Fluids build up quickly in your body when your kidneys aren't working. Too much fluid makes your tissues swell. It also can cause high blood pressure and heart trouble.
  
• Avoid salt. Salty foods make you thirsty and cause your body to hold water.

Peritoneal Dialysis

Peritoneal dialysis is another procedure that replaces the work of your kidneys. It removes extra water, wastes, and chemicals from your body. This type of dialysis uses the lining of your abdomen to filter your blood. This lining is called the peritoneal membrane.

A cleansing solution, called dialysate, travels through a special tube into your abdomen. Fluid, wastes, and chemicals pass from tiny blood vessels in the peritoneal membrane into the dialysate. After several hours, the dialysate gets drained from your abdomen, taking the wastes from your blood with it. Then you fill your abdomen with fresh dialysate and the cleaning process begins again.

Before your first treatment, a surgeon places a small, soft tube called a catheter into your abdomen. This catheter always stays there. It helps transport the dialysate to and from your peritoneal membrane. There are three types of peritoneal dialysis.

1. Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD is the most common type of peritoneal dialysis. It needs no machine. It can be done in any clean, well-lit place. With CAPD, your blood is always being cleaned. The dialysate passes from a plastic bag through the catheter and into your abdomen. The dialysate stays in your abdomen with the catheter sealed. After several hours, you drain the solution back into the bag. Then you refill your abdomen with fresh solution through the same catheter. Now the cleaning process begins again. While the solution is in your body, you may fold the empty plastic bag and hide it under your clothes, around your waist, or in a pocket.

2. Continuous Cyclic Peritoneal Dialysis (CCPD)
CCPD is like CAPD except that a machine, which connects to your catheter, automatically fills and drains the dialysate from your abdomen. The machine does this at night while you sleep.

3. Intermittent Peritoneal Dialysis (IPD)
IPD uses the same type of machine as CCPD to add and drain the dialysate. IPD can be done at home, but it's usually done in the hospital. IPD treatments take longer than CCPD.

CAPD is a form of self-treatment. It needs no machine and no partner. However, with IPD and CCPD, you need a machine and the help of a partner (family member, friend, or health professional).

With CAPD, the dialysate stays in your abdomen for about 4 to 6 hours. The process of draining the dialysate and replacing fresh solution takes 30 to 40 minutes. Most people change the solution four times a day.

With CCPD, treatments last from 10 to 12 hours every night.

With IPD, treatments are done several times a week, for a total of 36 to 42 hours per week. Sessions may last up to 24 hours.

Dialysis Is Not a Cure

Hemodialysis and peritoneal dialysis are treatments that try to replace your failed kidneys. These treatments help you feel better and live longer, but they are not cures for ESRD. While patients with ESRD are now living longer than ever, ESRD can cause problems over the years. Some problems are bone disease, high blood pressure, nerve damage, and anemia (having too few red blood cells). Although these problems won't go away with dialysis, doctors now have new and better ways to treat or prevent them. You should discuss these treatments with your doctor.

Conclusion

It's not always easy to decide which type of treatment is best for you. Your decision depends on your medical condition, lifestyle, and personal likes and dislikes. If you start one form of treatment and decide you'd like to try another, talk it over with your doctor. The key is to learn as much as you can about your choices. With that knowledge, you and your doctor will choose a treatment that suits you best.

This information is an excerpt from a non-copyrighted etext from the NIDDK--National Kidney and Urological Diseases Information Clearinghouse. Readers may duplicate and distribute as many copies as needed. Further information and a complete copy of this brochure, "End-Stage Renal Disease: Choosing a Treatment That's Right For You," may be obtained from the National Kidney and Urologic Diseases Information Clearinghouse, 3 Information Way, Bethesda, Maryland 20892-3580.