While humans start life with excess kidney function, disease often robs some patients of this capability. As kidney function dwindles to a point where it is no longer possible to sustain life, doctors often speak to patients about possible treatment options. Failing kidneys can be replaced through transplantation with one new organ, or the blood can be filtered through some sort of dialysis.
Transplant
It is important to note that transplant is a treatment for kidney disease, not a cure. Life will not return to the way it was before the patient was diagnosed. Nevertheless, transplant is the preferred option for most patients.
The transplanted organ may come from a live donor or a cadaver. Generally, organs from live donors are preferred because the patient will not have to be on a waiting list and the life expectancy of the recipient is better if the donation is made by a live donor.
Potential donor candidates undergo a physical to determine whether they are in good health and whether their kidney will be a match for the recipient. Donors often are eliminated from consideration because of hypertension, obesity or other problems. Paired donations allow a patient to receive an organ even if the donor's kidney is not a match. The donor will be paired with a matching patient who also had a potential donor lined up.
If the patient does not have a potential donor, he will be put on a waiting list. While wait times vary in different parts of the country, overall waits have been increasing as demand for kidneys grows. The University of Florida School of Medicine Insider Newsletter reports that in 2009 "on average, wait time nationally for a deceased-donor kidney is four to five years, but in some states it is more than seven."
After transplant, patients will take immunosuppressant drugs for the rest of their lives. These drugs prevent rejection of the new kidney.
Hemodialysis
Hemodialysis (HD) is what most people envision when they think of dialysis. Patients go to a dialysis center where they are hooked up to a machine that filters their blood for them. Most patients dialyze for several hours three to four times a week. This process can be very difficult on patients, as they often feel washed out after their dialysis days.
In home hemodialysis, or home hemo, patients are given a dialyzer and taught how to use it. The tricky part for many patients is learning how to access their own veins. The procedure can be performed at night. The National Kidney Foundation reports people who do home hemo often feel better because they dialyze more than they would in a dialysis center.
Peritoneal Dialysis
Peritoneal dialysis (PD) is another option for the patient in renal failure. It requires that a catheter be implanted into the abdomen. The dialysis solution is inserted into the abdomen through the catheter, and the solution absorbs wastes and is drained out. The National Institute for Diabetes, Digestive and Kidney Diseases explains that "the walls of your abdominal cavity are lined with a membrane called the peritoneum, which allows waste products and extra fluid to pass from your blood into the dialysis solution." Exchanges--the processes introducing dialysis fluid and draining it out--can be performed manually or with the help of a machine called a cycler when sleeping.
Many patients prefer PD because it is less disruptive to their personal lives. This is a trade-off because infections can be introduced if the patient does not observe sterile technique when performing exchanges.
References
- MedlinePlus: Kidney Transplant
- "Kidney International"; Cadaver versus living donor kidneys: Impact of donor factors on antigen induction before transplantation; Dicken D H Koo, et al; 1999
- National Institute of Diabetes and Digestive and Kidney Diseases: Home Hemodialysis
- National Institute of Diabetes and Digestive and Kidney Diseases: Peritoneal Dialysis
- U. Florida College of Medicine Insider: Shorter wait means longer life for kidney transplant candidates
