End Stage Renal Disease (Dialysis)

End Stage Renal Disease (Dialysis)

End Stage Renal Disease (ESRD) is when the kidneys are are functioning below the point where they can effectively do their job which causes symptoms.  This typically occurs when the kidneys are functioning below 10 to 15% of normal function.  ESRD occurs due to worsening of an underlying chronic kidney disease process or due to a severe acute kidney injury that does not recover over time.

Typical symptoms or findings of ESRD include:

1. Decreased urination that can lead to increased swelling and new uncontrolled high blood pressure
2. Nausea and vomiting.
3. Loss of appetite or metallic taste in the mouth.
4. Increased itchiness of the skin
5. Increased fatigue or weakness
6. Trouble concentrating or increased confusion
7. Increased risk of bleeding and severe anemia

Once the kidneys reach ESRD, without treatment an individual can become very sick and have a high risk of death.  The options for treatment of ESRD include kidney transplant and dialysis.  Kidney transplant however cannot be done rapidly and a patient has to be screened to be eligible to receive a kidney; either by being put on a wait list or if they have an acceptable living donor.  If a patient develops ESRD and is either ineligible to receive a kidney transplant or needs to continue to wait to get a kidney transplant then the treatment option is dialysis.

Dialysis: Dialysis is a procedure that can remove extra water, clear waste and toxins, and correct abnormal electrolytes from the bloodstream.  There are 2 main type of kidney dialysis; Peritoneal Dialysis (PD) or Hemodialysis (HD).

1. Peritoneal Dialysis (PD) – The inside lining of the abdomen (or belly) is used to act as a natural bloodstream filter.  Waste is removed by introducing a fluid called dialysate into abdominal cavity.  The dialysate interacts with the peritoneum (lining of the abdomen that contains many microscopic blood vessels) and transfers waste and extra fluid from the bloodstream into the dialysate.  The dialysate is then exchanged with fresh dialysate solution in a number of cycles to cleanse to blood.  The dialysate fluid is inserted into and removed from the abdomen via a soft tube (catheter) that is inserted surgically.  PD is done at home by the individual either by a few manual exchanges throughout the day or by an automated machine that exchanges fluid usually at night while one sleeps.  PD is done daily.
2. Hemodialysis (HD) – In HD a dialysis machine and special filter are used to cleanse the blood.  Blood flows directly out of the bloodstream and passes through the filter on the machine and then back into the bloodstream.  To access blood from the bloodstream ideally those undergoing HD have a minor surgery done to create an arteriovenous fistula or graft either in the arm or leg.  If an individual does not have an AV fistula or graft then a hemodialysis catheter can also be placed to access blood.  Hemodialysis can be done at an outpatient hemodialysis unit or at home.  If an individual elects to have HD at an outpatient dialysis unit they typically have treatments 3 times per week for 4 hours per treatment.  A dialysis nurse and technician attach and disconnect the patient from the machine.  Home hemodialysis is done at home by the individual and typically perform 5-6 treatments per week that last about 2 hours each treatment.