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| Introduction |
| Your doctor has explained that your kidneys are not functioning properly and that you need treatment. In this website you will learn about what kidney failure means and how the treatment namely haemodialysis and peritoneal dialysis works. You may not find all the answers to your questions but reading the facts, will allow you to ask the right questions about your particular condition. Use this website to inform your family, friends and employer about kidney failure and dialysis |
| Kidneys: What are they? |
The kidneys are a pair of bean - shaped organs located at the back of the body about the level of the waist. Each kidney measures 10-15 cm in length and weighs approximately 160 grams. There is a constant flow of blood through the kidneys. Inside the kidneys the blood is filtered, through millions of small, thinly walled blood vessels. The fluid filtered out is called urine. The urine is collected in the central part of the kidney and passes through the urinary ducts, or urethras, down to the bladder. Each day the two kidneys excrete about 1-2 liters of urine.
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| Function of the Kidneys |
| The kidneys perform the vital jobs of cleaning the blood of waste products and removing excess fluid. They filter the blood. The other functions of the kidney are to maintain the body's balance of various salts such as sodium, potassium, calcium, phosphate as well as acid. They release hormones, which influence the bone structure (Vit D), the generation of red blood cells (erythropoietin) and the regulation of blood pressure. |
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| Kidney Failure |
Kidney failure occurs when the kidneys stop working or the level of efficiency is less than 10%. When the kidney function deteriorates, the waste products and excess fluid remain in the body. These waste products and fluids are toxic in large quantities and their accumulation will eventually lead to nausea, headaches and dizziness. Your skin may begin to itch and various parts of your body may swell as a result of fluid retention. This retention of fluid called oedema, will lead to an increase in body weight, resulting in high blood pressure and respiratory problems.
Kidney failure can lead to blood deficiency (anaemia) and brittle bones.
Acute renal failure occurs when the kidneys suddenly stop working. This condition is temporary. The cause may be disease, injury, major surgery or toxic agents. Chronic renal failure can occur suddenly, or develop gradually over a period of time. This is not reversible. Kidney function never returns. |
| Causes of Kidney Failure |
| The common causes of kidney failure are hypertension, and diabetes mellitus. Other causes include glomerulonephritis (inflammation of the kidney), blockage, chronic infection, hereditary, accidents and injury caused by medication, drugs, poisons and radiation. Kidney failure is life threatening unless treated by dialysis or transplantation. |
| Symptoms of Kidney Failure |
Uremia is the medical term to describe symptoms when the kidneys no longer work. When waste products build up in the blood stream you may feel sick due to the symptoms of uremia.
Symptoms include the following: Headache, drowsiness, nausea, vomiting, itching, feeling tired, high blood pressure, diarrhea, decrease in urination, swelling, loss of appetite and thirst. |
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| What is Dialysis? |
Dialysis is the major treatment for kidney failure. It is the medical word for filtering waste products and removing fluid from your body that your kidneys are no longer able to remove.
There are two forms of dialysis: Haemodialysis and Peritoneal Dialysis |
| Haemodialysis |
| Haemodialysis is a process by which excess waste products and water are removed from the blood by using a dialyser, also known as an artificial kidney. This form of treatment means the blood is transported outside the body through the dialyser via a specially created vein in the forearm known as arterio-venous fistula. This process requires the use of a machine. |
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In haemodialysis, the blood channels through tubing to the dialyser. The dialyser is a bundle of hollow fibres made up from a semi-permeable membrane. The membrane is thin film with thousands of microscopically small holes. The holes allow water and small dissolved substances to pass through but retain the proteins and blood cells, which are too large.
During the dialysis treatment the blood is allowed to flow on one side of the membrane and dialysate solution on the other, and exchange (diffusion) takes place from the blood to the dialysate solution and visa-versa. The dialysate solution has a salt composition similar to blood but without the waste products. Usually one session takes about 4 hours.
The actual dialysis treatment is controlled and monitored by a dialysis machine. This consists of a blood unit and fluid unit. The pump in the blood unit pumps blood from the patient through the dialyser and back to the patient via the blood tubes. The fluid unit controls the mixture of the dialysate solution.
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| Access |
| In order to have chronic haemodialysis, you need to have surgery to create access, a way to carry the blood to the dialyser. |
| The most common type of chronic access used nowadays is: Arterio-venous (A.V) fistula and the Arterio-venous (AN) graft. |
| The fistula is created internally and is used for a prolonged length of time. |
| Your surgeon makes a fistula under the skin by joining an artery and vein, allowing arterial blood to flow directly into the vein. |
| Due to arterial pressure, the vein will increase in size and thicken; it takes about 4-8 weeks for the fistula to mature. |
| A fistula makes it easy to put a needle into the vein to allow blood flow through the dialyser using the blood pump. |
| The graft is an artificial blood vessel used to join an artery and vein. It is used when patients own blood vessels are too small for fistula construction. |
| The graft may be either straight or looped and is close to the surface of the skin. |
| The graft may be of artificial material or can be obtained from the patients own body e.g. vein in the thigh. |
| Temporary access can be created in cases that need urgent dialysis and cannot wait for a few weeks for the fistula to mature. |
| These include the subclavian catheter, internal jugular catheter and arterio-venous shunt. |
| he subclavian catheter is a set of tubing which is inserted into the subclavian vein near the neck. |
| The internal jugular catheter is placed into the veins at the side of the neck. |
| The sublclavian and internal jugular catheter cannot be used beyond a few weeks as it tends to get blocked or the site of insertion may become infected. |
| The shunt is surgically created with an artificial material, and has a short life span i.e. 6 months. |
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| Care of the Fistula/Graft |
| Keep area clean and dry. |
| Feel for thrill sensation at both ends of fistula/graft at least twice weekly. |
| Inspect fistula for redness, swelling, tenderness, or warmth to touch to detect infection. |
| Avoid constrictive clothing, jewellery etc. that may block the fistula. |
| No blood pressure, blood taking, or intravenous administration should be done on the fistula arm. |
| Avoid excessive pressure on puncture sites after dialysis. |
| Rotate needling sites to prevent aneurysm. |
| If injury occurs at site, apply pressure over bleeding and seek immediate medical help. |
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Advantages and Disadvantages
Advantages |
| Staff performs treatment |
| No equipment at home |
| Treatment 3 times/week |
| No external access |
| Regular contact with staff and other patients |
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| Disadvantages |
| Travel to centre |
| Fixed dialysis times |
| Two needles inserted each treatment |
| Wastes build up between treatments |
| Diet and fluid restrictions |
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| Peritoneal Dialysis |
Peritoneal dialysis is performed by introducing dialysate solution into the peritoneal (abdominal) cavity through a silastic catheter. The natural membrane lining of the peritoneal cavity acts as a filter where waste products and excess fluid from the body pass through the membrane into the dialysate solution. The dialysate solution used is sterile and contains salts and a high content of glucose (sugar). The glucose will cause water from the blood stream to be drawn into the peritoneal cavity.
A peritoneal dialysis procedure is called an exchange because used solution is removed and replaced with fresh solution. You connect long tubing set to the short tubing you are wearing (attached to catheter). The lower bag is for draining used solution from the peritoneal cavity and when empty, you are ready to fill with fresh dialysate solution from the upper bag. The fluid surrounds the internal organs; it does not go into the stomach or other organs. The dialysate solution is left in the peritoneal cavity for several hours to collect waste products and excess fluid from the blood.
The most common forms of peritoneal dialysis used today are C.A.PD. and A.PD.
Continuous ambulatory peritoneal dialysis (C.A.PD.) functions much like the kidneys do. Constantly cleaning the blood as long as there is dialysate solution in the cavity. Typically you do exchanges four times a day i.e. when awaking, lunch time, late afternoon, and bedtime (every 5-6hours).
C.A.PD. gives you constant dialysis, 24 hours a day seven days a week.
Automated Peritoneal Dialysis (A.PD.) is dialysis at home with a cycler machine.
Each night before you go to sleep, you connect your set to a long tubing set, attached to dialysate bags on the cycler. The machine does the exchanges while you sleep. The machine is quiet and does not wake you. The tubing is long enough for you to sleep comfortably and walk several feet.
The peritoneal catheter called a tenckhoff is a small soft tube; it is placed into the peritoneal cavity surgically. You will typically stay overnight in hospital. Just a few inches of the catheter is outside your body. Most is inside you body. The catheter is left in place so dialysis can be done. It provides a small opening in which dialysate solution can be placed.
 
Training for Peritoneal Dialysis is provided on a national basis at all National Renal Care units and is normally done as an out-patient.
Patients on Peritoneal Dialysis lead very normal lives; many patients continue to work, go to school or are active in the community and can even travel.
Disposables are delivered to your home or your travel destination free of charge.
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Advantages and Disadvantages
Advantages |
| Self-care |
| No needles |
| Greater independence |
| Flexible diet |
| Flexible schedule |
| Blood pressure control |
| Blood sugar control |
| Less stress on body |
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| Disadvantages |
| Daily exchanges |
| No off days |
| Permanent catheter |
| Some risk of infection |
| Some possible weight gain |
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| Living with Dialysis |
The dependence on artificial life support devices, adherence to strict medical regimes and increase in financial obligations and a decrease in physical and social functioning, frequently result in feelings of depression, anxiety, worthlessness and hostility. All members of your family unit are affected by your renal disease. Family members may need to assume new roles. For the person who is ill, losing former roles either temporary or permanently, can be frightening and depressing. These include unemployment or being too ill to do family chores, to name a few. There are changes in roles or lifestyles that may occur in your own family.
Family members may need to be responsible for you at first but continuing to treat you as if you are too sick to care for you can place a huge burden on the family. Due to your illness you may need to depend on your family at first, this may be hard to accept, especially if you are a very independent person.
Sex may be a difficult topic to many, but it is important to discuss it in order to understand the physical and emotional changes that occur with renal failure. A chronic illness such as renal failure will change one's desire for sexual intimacy. For men impotence or the inability to maintain an erection may occur and women may experience difficulty with arousal. Men and women may just show a lack of interest, which can strain a sexual relationship. It is important to talk these concerns over with your doctor or nurse. Being a kidney patient doesn't mean you can't have a satisfying relationship.
Kidney failure and the treatment may be difficult to accept at first however with time, support and education you can adjust. You must learn to live with dialysis as part of your life. Learn is the key word for you as a dialysis patient if you are going to make the most of life. You will need to learn to understand and accept your illness and learn what it means to be a kidney patient. You will need to learn to eat and drink the right things, to take medication and exercise appropriately.
Communication is vital, talk about your feelings and experiences with someone you trust. Talking and sharing about what is happening to you will decrease your feelings of loneliness and increase your feelings of being supported and loved. Share your thoughts and feelings with family, friends and your medical treatment team. Talking to other patients is helpful. Once you are feeling better it will be important to return to as many of your past activities as possible. With your doctors permission you may return to work, your hobbies, clubs etc. Getting back into old routines will help you feel that sense of normality again.
In conclusion your overall physical and mental adjustment depends upon you. |
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