Our kidneys play a critical role in our bodies, performing many functions to keep our blood clean and chemically balanced.
Kidney functions include:
- Filtering blood to rid it of metabolic waste products and foreign particles, which helps to regulate blood pressure
- Balancing body fluid
- Keeping electrolytes (sodium and potassium being the most important) and water content of the body constant
- Activating vitamin D, which is important for maintaining healthy bones
- Producing erythropoietin (EPO), a hormone needed to make red blood cells
“You can’t live without kidney function,” says Sierra Nevada Specialty Care’s Dr. James Sullivan. “In the event your kidneys fail (also known as chronic kidney disease or CKD), those functions must be replaced.”
Fortunately, we live in a world where those functions can be replaced, either through dialysis or a kidney transplant.
“If your kidneys fail and no longer support your body, dialysis is a means to replace that kidney function and maintain your life,” Dr. Sullivan explains. “Dialysis is an artificial means to replace your kidney function. It doesn’t ‘fix’ your kidneys or ‘let them rest,’ it simply replaces their function to keep you alive.”
There are two types of dialysis — hemodialysis and peritoneal dialysis — and either can be utilized by the vast majority of patients. Dr. Sullivan says the decision really comes down to which type fits the patient’s lifestyle and goals the best.
The most common type of dialysis
The most common type of dialysis is hemodialysis, which is when your blood is sent through a filter (hemodialyzer) to remove waste, extra electrolytes, and fluid from your body. This process begins with minor surgery to the arm or leg, as the surgeon will need access to the blood vessels.
“In this process, the patient’s blood is pumped through a filter to clean it and then returned to the body,” Dr. Sullivan explains. With hemodialysis, most people will need to have their blood filtered completely through the machine for three to four hours, three times a week. These treatments are necessary to maintain their lives.
“Patients can come to a dialysis center for their treatments or we can teach them how to do this kind of dialysis at home,” he explains.
Dr. Sullivan explains that with hemodialysis, patients can be left with a washed out feeling after treatment that may take several hours to recover from.
In addition, since it is only done three times a week, a large amount of excess fluid builds up following the last treatment, which needs to be removed. This fluid removal can cause muscle cramps and low blood pressure.
The peritoneal option
“People who want to be more independent, travel, continue working, and don’t want to come to the dialysis center three times a week, tend to choose peritoneal dialysis,” Dr. Sullivan says.
More than 80% of patients will be eligible for peritoneal dialysis, which is a treatment that cleans the blood inside the body by using the lining of the abdomen (called the peritoneum) and a cleaning solution called dialysate.
There are several types of peritoneal dialysis, but two of the most common are:
- Continuous Ambulatory Peritoneal Dialysis (CAPD), which involves the patient putting a bag of dialysate into the peritoneal cavity through a catheter, usually four or five times a day. The patient can go about normal routines while the dialysate is in the peritoneal cavity.
- Automated Peritoneal Dialysis (APD) is typically done at home with a special machine called a cycler, which operates at night while the patient is asleep. Each cycle lasts between 60 and 90 minutes.
With APD, Dr. Sullivan explains, “We need to cycle that fluid in and out of your body for about 8-10 hours every night (7 days a week). This can be done while you are sleeping, in your own home, in your own bed.”
“Peritoneal dialysis offers more independence, but has to be done every night,” Dr. Sullivan adds. “However, since it is done every night, it tends to be gentler and slower and more accurately replicates what the kidneys do for the body. Since it is daily, fluid and nutritional restrictions tend to be less stringent.”
Since peritoneal dialysis is a gentler treatment than hemodialysis, it’s done day daily, and there doesn’t tend to be a lot of cramping or a feeling of being in a fog.
“There is less fluid shift with peritoneal dialysis, so blood pressure is easier to control and there are fewer episodes of low blood pressure,” Dr. Sullivan explains.
However, peritoneal dialysis has its own challenges. In addition to the toxins and fluid being removed, good proteins and electrolytes are also removed. And these proteins and electrolytes will need to be replaced on a daily basis.
“If diet is not supplemented, you can become protein-malnourished, which can make you feel weak,” says Dr. Sullivan. “This can be overcome by good nutrition and an appropriate exercise regimen.”
Though peritoneal dialysis can be easier on the body, Dr. Sullivan says some patients are nervous to try it due to the responsibility and fear of doing something wrong.
“We provide education, reassurance and 24/7 support to help alleviate those fears,” he says.
Patients should discuss questions with their doctor to decide which option makes the most sense for them. Dr. Sullivan says that most patients can change later if they want to try one or the other.
Making the most of dialysis
While dialysis takes over some of the kidneys’ functions, it is still critical for patients to be an active participant in their own health.
“The kidneys do a lot of things for our body and their ability to filter out the toxins is just one of them,” says Dr. Sullivan. “Dialysis just replaces the filtering functions of your kidneys. Appropriate nutrition, exercise, fluid restrictions, and specialized medications are needed to replace the remaining functions of your kidneys and to help you feel better when you are on dialysis.”
Dr. Sullivan adds that following a medically supervised exercise program and appropriate nutritional guidelines can go a long way to help patients improve how they feel when on dialysis.
“For those with kidney disease and not yet on dialysis, it can also help protect kidney function and hopefully prevent the need for dialysis,” he adds.
Related: Preventing Chronic Kidney Disease
The alternative to dialysis
“The only way to get off of dialysis would be to get a kidney transplant,” Dr. Sullivan says. “Instead of using a machine to replace your kidneys, we use someone else’s kidney. We strongly encourage all patients who are interested to explore the possibility of transplantation. It truly is the gift of life.”
If you’re interested in learning more about kidney health, dialysis or transplantation, schedule a consultation with Sierra Nevada Specialty Care at 775.322.4550. Our practice has more than a dozen physicians and 10 nurse practitioners serving patients throughout Reno, Sparks, Carson City, and the rural communities of Northern Nevada.