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The lowdown on dialysis

In this country, one out of every nine adults suffers from chronic kidney disease, roughly 20 million in all. While early detection can help prevent the progression of the disease, it is not something to be taken lightly.

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse.

When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant.

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes.

High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure. Other conditions that affect the kidneys include glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney's filtering units. These disorders are the third most common type of kidney disease.

Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue, can also be a contributing factor, as are malformations that occur as a baby develops in its mother's womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.

Kidney function can also be affected by lupus and other diseases that affect the body's immune system. Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men, as well as repeated urinary infections, can be factors as well.

When kidneys are unable to function properly, medical science has to step in, in the form of dialysis, in which technology helps filter the blood when the kidneys no longer can. Dialysis is needed in the end stages of kidney failure, when roughly 85 to 90 percent of kidney function has already been lost.

Like healthy kidneys, dialysis keeps your body in balance by removing waste, salt and extra water to prevent them from building up in the body. Dialysis also keeps a safe level of certain chemicals in your blood, including potassium, sodium and bicarbonate. It also helps control blood pressure.

Is kidney failure permanent?

Some kinds of acute kidney failure get better after treatment. In some cases of acute kidney failure, dialysis may only be needed for a short time until the kidneys get better. In chronic or end-stage kidney failure, your kidneys do not get better, and you will need dialysis for the rest of your life. If your doctor says you are a candidate, you may choose to be placed on a waiting list for a new kidney.

Different types of dialysis

There are two types of dialysis - hemodialysis and peritoneal.

In hemodialysis, an artificial kidney is used to remove waste and extra chemicals and fluid from your blood. To get your blood into the artificial kidney, the doctor needs to make an entrance into your blood vessels by minor surgery to your arm or leg. Sometimes, an access is made by joining an artery to a vein under your skin to make a bigger blood vessel called a fistula. If your blood vessels are not adequate for a fistula, the doctor may use a soft plastic tube to join an artery and a vein under your skin. Occasionally, an access is made by means of a narrow plastic tube, called a catheter, which is inserted into a large vein in your neck. This type of access may be temporary, but is sometimes used for long-term treatment. Usually, each hemodialysis treatment lasts about four hours and is done three times per week. A type of hemodialysis called high-flux dialysis may take less time. You can speak to your doctor to see if this is an appropriate treatment for you.

The time needed for your dialysis depends on how well your kidneys work, how much fluid weight you gain between treatments, how much waste you have in your body, how big you are and the type of artificial kidney used.

In peritoneal dialysis, your blood is cleaned inside your body. The doctor will do surgery to place a catheter into your abdomen to make access. During the treatment, your abdominal area is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your abdomen, but extra fluid and waste products are drawn out of your blood and into the dialysate.

There are several kinds of peritoneal dialysis, but two major ones are: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD).

Continuous Ambulatory Peritoneal Dialysis is the only type of peritoneal dialysis that is done without machines. You do this yourself, usually four or five times a day at home and/or at work. You put a bag of dialysate (about two quarts) into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange. You use a new bag of dialysate each time you do an exchange. While the dialysate is in your peritoneal cavity, you can go about your usual activities at work, at school or at home.

Continuous Cycling Peritoneal Dialysis usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles occur. Each cycle usually lasts one-and-a-half hours and exchanges are done throughout the night while you sleep.

Dialysis does some of the work of healthy kidneys, but it does not cure your kidney disease. You will need to have dialysis treatments for your whole life unless you are able to get a kidney transplant.

The facts

You may have some discomfort when the needles are put into your fistula or graft, but most patients have no other problems. The dialysis treatment itself is painless. However, some patients may have a drop in their blood pressure. If this happens, you may feel sick to your stomach, vomit, have a headache or cramps. With frequent treatments, those problems usually go away. It is not yet know how long patients on dialysis will live, although it is believed that some dialysis patients may live as long as people without kidney failure.

Many patients live normal lives except for the time needed for treatments. Dialysis usually makes you feel better because it helps many of the problems caused by kidney failure. Dialysis centers are located in every part of the United States and in many foreign countries, allowing patients to travel as desired. You must make an appointment for dialysis treatments at another center before you go. The staff at your center may help you make the appointment.

Many dialysis patients can go back to work after they have gotten used to dialysis. If your job has a lot of physical labor, you may need to get a different job.

Information provided by the National Kidney Foundation