Kidneys balance the fluids, chemistry, and blood pressure in the body. They orchestrate with other organs to keep the delicate equilibrium in the human body to filtrate waste products created by our body’s metabolism. When the kidneys do not function, the body has difficulty keeping balance. The body might retain fluids, waste products, potassium or sodium levels might become abnormal, and the blood pressure might rise, making humans feel rotten and raising the risk for serious illness. All these issues raise a need for a new way to filter and balance the body fluids and electrolytes.
Now, when should we use dialysis, and when should we consider the alternatives? This is where decisions about kidney transplants and dialysis come in. It takes quite a while to decide on a transplant or dialysis. Usually, the doctor starts planning for this when the glomerular filtration rate (GFR) test results are around 20, meaning about 20% kidney function. However, this does not mean the dialysis should be started. Most people start dialysis when the GFR gets below 12. Aside from the GFR numbers, dialysis generally is decided when the patient develops symptoms of kidney failure such as severe fatigue, nausea, decreased appetite, and shortness of breath. The nephrology group checks whether these symptoms are related to the kidney or not and whether they could improve with dialysis; hence these symptoms could be caused by other illnesses as well.
How long does dialysis need to happen?
It generally takes 3-6 months to make dialysis happen.
What are Dialysis kinds and their alternatives?
- Conservative care
- Transplant
- Dialysis
Conservative care is a method where the focus is on dieting properly to preserve kidney function as long as possible. This method will not stop the slow decline of kidney function, ultimately leading to kidney death. It is often chosen by people with other medical conditions who are not candidates for transplant and feel the burden or discomfort caused by dialysis outweighs the potential benefits.
The other two and mainly used options are transplant and dialysis.
Should I do a transplant or dialysis?
Transplant is the method where a kidney is donated from a living donor or a deceased donor. The living donor usually is someone from the family or friend. Not everyone is a candidate for a kidney transplant, so it is essential to determine if the treatment is an option. Deceased donor organs are unavailable immediately, and patients usually must wait 5-10 years. Transplantation is the better option for most people since they will live longer and better than dialysis. In transplant, it is essential to focus on getting a kidney from a living donor, usually a family member or friend. Kidneys from a living donor tend to last longer than a deceased donor, and the transplant can happen earlier.
Types of dialysis and the way they work
Dialysis is a method where the function of the kidney is replaced by special equipment to clean the blood.
There are two basic kinds of dialysis:
- Hemodialysis (Outside the body)
The blood is passed through an artificial kidney, a dialyzer. It is usually done in 4 hours, three times a week. Hemodialysis requires access to the blood either through an intravenous line inserted in the neck or a fistula created surgically by connecting an artery and a vein in the arm. The process takes around three months to get the patient ready. Hemodialysis can also be done at home while sleeping, saving the patient’s time and diet.
- Peritoneal Dialysis (Inside the body)
The blood is cleaned through a lining inside the patient’s abdomen called the peritoneum. A tube is put close to the belly button into the peritoneum, poured with a unique solution called the dialysate, and left there for a few hours. In this method, the solution diffuses the waste products out of the blood and fills the drain that is exchanged regularly. The exchange period varies from 20-30 minutes four times a day or 7-10 hours during sleeping.