You have kidney disease, so now what? More than 37 million people are living with Chronic Kidney Disease in the United States, but what does that mean? When do you need treatment? What does treatment entail? Michael Kraus, M.D. and Associate Chief Medical Officer at Fresenius Kidney Care, breaks down the basics on kidney disease treatment.
Q: What is kidney disease, and when does someone need kidney care treatment?MK: Chronic kidney disease (CKD) occurs when your kidneys don’t work as well as they should to filter waste, toxins, and excess fluids from your body. Kidney disease progresses in five stages and may lead to end stage renal disease (ESRD) or kidney failure. When you are approaching kidney failure and have not had a preemptive kidney transplant, it is time to look into dialysis options for treating kidney disease. Your doctor will help you navigate this process.
Q: What are options for a patient when they first require kidney care?
MK: First, let me say that for many patients, receiving a working kidney through transplantation is the preferred treatment. The best option, if it is possible in your situation, is to receive a transplant before ever needing dialysis. This is called a preemptive transplant. Discuss with your dialysis team and doctor what steps to take to be eligible for a transplant.
Dialysis essentially takes the place of kidney function, filtering the blood and ridding the body of unwanted toxins, waste products, and excess fluids. Most dialysis centers offer
the option of receiving dialysis treatments either in-center or
in your own home.
Q: What is in-center hemodialysis and how does it work?
MK: Hemodialysis (HD) is a treatment for kidney failure that occurs when a patient reaches ESRD. During the dialysis process of HD, some of your blood exits your body and is filtered through a dialyzer or “artificial kidney” to remove unwanted waste, toxins, and excess fluids. The filtered blood is then returned to your bloodstream. In-center dialysis treatment takes place in a kidney dialysis center, under the close supervision of
a care team.
In-center dialysis is a safe and well-delivered therapy that allows people to receive care on a set schedule. With in-center dialysis, you’ll typically go to a kidney dialysis center three times per week for about 3-5 hours each visit, depending on your prescription. You’ll be connected to the dialysis machine via your hemodialysis access. Members of your care team will supervise your entire treatment and look after you throughout
Q: What is home dialysis?
MK: Home dialysis allows you to perform your dialysis treatments by yourself or with the support of a care partner in the comfort of your own home, rather than at a center. It is an increasingly popular option for many people with kidney failure. It allows for more flexibility and other benefits which can improve quality of life, including treatments at night or more frequent treatments, consistent with your physician’s dialysis prescription. The two options for home dialysis are peritoneal dialysis (PD) and home hemodialysis (HHD), both of which allow you to perform dialysis in your own home.
Q: What is peritoneal dialysis (PD) and what are the benefits?
MK: PD is a treatment for kidney failure that uses blood vessels in the lining of your abdomen—the peritoneum—to naturally filter waste from your blood. During PD, a cleansing solution called dialysate is sent through a catheter to your peritoneal (abdominal) cavity, where it absorbs waste and toxins from blood vessels in the peritoneum
and is then drained back out
PD is typically done at home or in any other clean, enclosed environment. PD treatments are done more frequently, so waste and toxins in your blood don’t have
a chance to build up as much between treatments.
There are two types of peritoneal dialysis—continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD), also known as continuous cycling peritoneal dialysis (CCPD).
CAPD is done manually, which can be a benefit when faced with an emergency like a natural disaster or power outage. APD, or CCPD, uses a machine to perform each exchange.
Q: What is home hemodialysis?
MK: Home hemodialysis (HHD) is the same as in-center hemodialysis, except it is performed in your home by yourself, or with the support of a care partner, and uses simpler devices. Depending on your prescription, you can dialyze approximately 2.5 to 3 hours each day and perform more frequent treatments. You can also do HHD for 6-7 hours while sleeping, referred to as nocturnal hemodialysis.
Q: What are the benefits to home dialysis?
MK: Home dialysis allows for a flexible schedule and gives you the freedom to travel. Many people report feeling better, since when dialysis is done more frequently than three times a week, it more closely mimics the normally continuous function of your kidney. Dialyzing at home can also eliminate the transportation challenges of receiving treatments on a set schedule. You may experience more leniency in your diet since you are removing wastes and toxins from your body more often.
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Michael Kraus, MD, is Associate Chief Medical Officer at Fresenius Kidney Care focusing on home therapies. He held a similar role with NxStage Medical Inc. before Fresenius Medical Care completed the acquisition of the company in 2019. He is the former Service Line Chief for IU Health Physicians Kidney Diseases and Clinical Chief of Nephrology at Indiana University School of Medicine.
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