Approaching dialysis is a frightening transition for anyone. In addition to worrying about whether they will be able to continue to support their families, patients often worry about being a burden. Physical symptoms of renal failure can be overwhelming at this time. While there are no alternatives to dialysis except transplant, there are alternative forms of dialysis. The smart patient will consider these seriously and weigh the impact of each type of treatment on his lifestyle. While the choices made can usually be changed in the future, it's best to go into this having researched the options thoroughly.
Hemodialysis
Hemodialysis (HD) is what most people think of when they think about dialysis. Patients go to a dialysis center several times a week. At every visit, the patient is hooked up to a machine called a dialyzer. The patient's blood flows into the dialyzer, which filters the blood before returning it to the patient. Generally, patients dialyze for three to four hours every visit.
Ideally, the patient prepares for dialysis several months in advance by having a surgeon create a venous access so that the patient's circulatory system can be coupled to the dialyzer. The two most common types of vascular access are a fistula or a graft.
The National Kidney Foundation strongly supports fistulas as the best form of venous access. According to the National Institute of Diabetes, Digestive and Kidney Disease (NIDDK), a fistula is created "by connecting an artery directly to a vein, frequently in the forearm. Connecting the artery to the vein causes more blood to flow into the vein. As a result, the vein grows larger and stronger, making repeated needle insertions for hemodialysis treatments easier." It takes several months for the vein to grow larger.
The second type of venous access is a graft. A graft is a catheter that is inserted into an artery for the purposes of dialysis. This is not a long-term solution because the catheters tend to clog and get infected. They are useful, however, in emergency situations or when the patient has not taken the steps to get a fistula.
HD is an enormous time commitment. It can also limit the patient's ability to travel.
Peritoneal Dialysis
Peritoneal dialysis (PD) is an alternative to HD. Instead of using an artificial filter to clean the blood, PD uses a membrane in the abdomen called the peritoneum. The peritoneum lines the walls of the abdominal cavity. A catheter is surgically implanted into the patient's belly. This catheter is used to introduce a special dialysis solution that pulls impurities through the membrane. After a variable period of time called the "indwelling period" the solution is removed. The process of adding and removing the solution is called an exchange.
The two most common ways of performing an exchange are continuous ambulatory peritoneal dialysis (CAPD) and continuous cycler-assisted peritoneal dialysis (CCPD). If the patient elects CAPD, he will perform manual exchanges throughout the day. These exchanges can be done anywhere that is reasonably clean. If the patient elects CCPD, he will perform the exchanges at night using a machine called a cycler.
Many patients prefer PD because they are not tied to a dialysis center. But infections are a common problem because patients perform the dialysis themselves.
Home Hemodialysis
A new variation on dialysis called home hemodialysis (home hemo) has gained popularity in recent years. Patients who elect to do home hemo are equipped with a dialyzer and are trained how to use it. The hardest part of the training for patients is learning how to do needle sticks. Many home hemo patients dialyze every night. This takes longer, but is often gentler on the patient's body because the filtration rate is slower. The lab values of many of these patients often completely normalize.
