Treatment Options

A comprehensive transplant information source can be found at: www.transweb.org. 

Transplantation

Transplantation places one healthy kidney into your abdomen. This one kidney is sufficient to replace the work of your two failed kidneys.

A kidney transplant can be the first form of treatment you receive or it can be selected later after receiving dialysis treatments for some time. Transplantation is the preferred treatment for certain people.

You may receive a transplant from a living related donor, a donor who is not related but willing to donate a kidney, or you may receive a kidney from someone who has recently died (deceased donor).

There is a regional matching service that is funded by the federal government. It updates the list of those waiting for a kidney, does the blood typing and tissue matching for the possible deceased donor transplant.

If a living donor is willing to give you a healthy kidney, this donor must be evaluated for medical fitness and compatible blood type. Depending on the type of donor, waiting time for a kidney will vary. The wait for a deceased donor kidney will be longer than that for a living donor due to the shortage of deceased donor kidneys. The surgery will take from 2 to 4 hours and your stay in the hospital will be 5-7 days.

Your doctor will prescribe several new medications to prevent rejection by your body of your new kidney. You will have to take these medications as long as the transplanted kidney works. Transplantation can offer you the greatest potential to return to a healthy and productive life.

Learn more about kidney transplantation from the UNOS website. The information is also available in español (Outside links open in new window).

Transplant Resources

• UNOS

• The National Kidney Foundation

Home Dialysis

Home dialysis is an option for many CKD Stage 5 patients who require dialysis.  It offers flexibility of time and convenience of remaining in your home for treatment.  There are multiple options for home dialysis:

• CAPD

• CCPD

• Conventional Hemodialysis

• Daily Hemodialysis

• Nocturnal Hemodialysis

How Peritoneal Dialysis Works

Continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) replaces some of your kidney function by using the lining of your abdomen, called your peritoneum, to filter wastes and fluid out of your blood.

To do PD, you'll need to have a soft plastic tube (called a catheter) surgically placed in your abdomen. You'll be trained to use the catheter to fill your peritoneum with 2 liters or so of a special fluid called dialysate. Wastes and extra fluid in the blood flow through the tiny blood vessels in your peritoneum into the dialysate.

After a few hours of "dwell" time wastes and fluid will flow into the dialysate. With CAPD, you drain out the fluid and replace with clean dialysate.  With CCPD, the cycler automatically drains and refills the dialysate while you sleep.  This process is called an exchange.  Peritoneal dialysis is done every day and may allow for a more liberal diet and fluid restriction.  A partner is not required for peritoneal dialysis.  You should discuss with your nephrologist the advantages and disadvantages of peritoneal dialysis.

How Home Hemodialysis Works

Hemodialysis (HD) replaces your kidney function by using a dialyzer—a plastic tube filled with hollow fibers—to filter your blood and remove wastes and excess fluid. One needle carries your blood through tubing to the dialyzer, and another needle returns your cleaned blood to your body. The dialysis machine pushes your blood through the system and monitors time, temperature, and pressure.

Home hemodialysis can be conducted in several manners. Conventional home hemodialysis is done three times a week for 3-4 hours based on your physician’s order. Daily home hemodialysis is done at least 5-7 times per week for a time determined by your physician. Nocturnal home hemodialysis is done 3-7 times per week for longer periods of time while you are sleeping. Each type of home hemodialysis allows you the flexibility to determine when during the day you and your partner are available for treatment.  You must have a partner for home hemodialysis and train at a home training dialysis center prior to beginning treatments at home. A vascular access is required for hemodialysis. A fistula is considered the optimal form of vascular access for hemodialysis and can be placed in your arm in preparation for the initiation of dialysis. You will then avoid the placement of an emergency catheter.  A graft is another form of vascular access that involves the placement of a small plastic tube connecting the vein and the artery. This type of access is preferable to a catheter, however, it is not considered the optimal type of vascular access.  Patients should discuss what form of vascular access will be best for them with their nephrologist and vascular surgeon.

Hemodialysis

Hemodialysis is a treatment that cleans and filters your blood by removing the waste products and extra fluid that your kidneys can no longer eliminate. Hemodialysis requires a machine and an artificial kidney that is called a dialyzer. During the hemodialysis treatment your blood is pumped by the machine through tubing to the dialyzer. In the dialyzer, your blood is filtered, waste products and extra fluid are removed. The filtered or 'cleaned' blood is then returned to your body.

In order to remove and return blood to your body, an access to your blood vessels must be made. This access is made during a surgical procedure in which a fistula is created or a graft is inserted under your skin. The fistula or graft is put in the lower or upper arm if possible; other places can be used if the arm is not suitable. Your surgeon will determine which access is best for you.

If treatments must be started before a fistula is created or a graft is inserted, a temporary catheter may be placed externally (outside your body) to allow for immediate access to your blood vessels.

Once your access has healed (matured) it can be used for treatment. Two needles are placed in the access at the start of each treatment and taken out at the end of each treatment. One needle is used to remove your blood for cleansing (filtering) and the other is used to return the filtered blood to your body.

Hemodialysis treatments are usually performed three times each week. The length of your treatment is decided by your doctor but usually lasts from 3 to 5 hours. The time depends on your body size, any remaining kidney function and activity level. During your treatment you can read, watch TV or socialize with others close to you in the facility.

Hemodialysis treatments are available in a dialysis facility (in-center) which may or may not be part of a hospital. Many units are in buildings that are not part of a hospital setting. Trained staff performs in-center dialysis treatments.

Nocturnal Hemodialysis

Nocturnal hemodialysis is a form of hemodialysis that is done either at home or in-center when the patient is sleeping at night. Most home patients dialyze three or four nights per week, anywhere from six to 12 hours, on average for eight hours. The home patient, in consultation with his/her nephrologist, may choose to dialyze more frequently. The in-center nocturnal hemodialysis patient will typically continue to dialyze three times per week for a longer period of time than is usually done during the day. This will allow the patient to attain better lab values and ultimately feel better. The night time treatments can help preserve a patient’s normal schedule of work, school or family responsibilities. 
 
Some of the advantages of nocturnal hemodialysis include: feeling better, more alert and more energetic; having more time for daytime activities; saving money due to fewer hospital visits and fewer medications such as phosphate binders; more liberal diet; decreased prevalence of sleep apnea; lower blood pressure; improved cardiac function and possible improved sexual performance. 
 
Some of the concerns regarding dialyzing when you are sleeping include the noise of the machine and the possibility of needles disconnecting. The machine noise has not been shown to be a problem for patients currently on nocturnal dialysis. They are able to block it out and sleep soundly. The needles need to be properly taped and anchored to ensure they will not be dislodged. Patients may consider creating a buttonhole for their fistula if they are concerned about cannulating at home as this needle “channel” can make cannulation easier. If interested, patients should speak with their nephrologists and home dialysis programs about this technique.
 
Nocturnal dialysis is an option that has the potential to benefit many patients.  Patients who choose home nocturnal hemodialysis will need to arrange for training with a partner during business hours at a home training center. But, this option is not widely available so interested patients will need to discuss this with their nephrologist in the hopes of locating a home program in their area.  

The dialysis companies need to hear from patients who are interested so they can make decisions about opening more out-patient nocturnal programs. If patients can’t locate a nocturnal dialysis program near their home, advocating for this option is the best way for patients to have an impact on their treatment options.  The more patients who contact the dialysis companies asking for nocturnal dialysis, the more likely this modality will become available to greater numbers of patients.  
 
So, let your voice be heard.  If you are interested in nocturnal dialysis speak with your provider and let them know.  You have the power to make change if nocturnal dialysis is not currently available in your area.