Kidney Treatment Options Pathway

Dialysis is a broad name used for a medical treatment for kidney failure. Dialysis removes waste products and extra fluid from the blood.

What are the different types of dialysis?

There are two different types of dialysis: peritoneal dialysis (also called PD and is done at home), and haemodialysis (also called HD and can be done at home or in the renal unit).

Dialysis has a number of options, which include home dialysis (either peritoneal dialysis or home haemodialysis) and centre-based haemodialysis (in a satellite dialysis unit or a hospital dialysis unit).

Unless your medical condition affects your choice of options, there are usually two types of dialysis we can offer:

Haemodialysis  

This means a type of treatment where some of your blood is pumped through special tubing to a haemodialysis machine.  The machine acts like an artificial kidney, filtering waste products and extra fluid from the blood before returning it back to your body.  During haemodialysis your blood goes through a special filter called a 'dilayzer' before being returned into your body.

Peritoneal Dialysis

This dialysis treatment for kidney failure is where dialysis fluid is moved in and out of the peritoneal cavity in your belly. This is usually done 3 or 4 times during the day to clean the blood. It can also be done at night using a special machine called a Cycler. The membrane in peritoneal dialysis is the natural lining of the abdomen, so dialysis takes place inside the body. PD is generally done at home, by either the patient or a carer.

Is one better than the other?

PD and HD work in similar ways: the blood is filtered through a very thin membrane known as the dialysis membrane. The excess wastes and fluid pass into a special liquid called dialysis fluid or dialysate so that they can easily be removed from the body. They both are effective in removing the excess waste and fluid from your blood.

Your decision about which dialysis treatment to choose is sometimes affected by your other health conditions.  Unless your medical condition means one is not suitable, they are both good long term treatments for kidney failure.

Introduction

Some people with kidney failure will decide not to have dialysis treatment. There may be many reasons for this. Some may feel that the treatment will be hard to manage and impact too much on the remainder of their life, or they may feel that the journey to the dialysis unit three times a week is too much for them.

Having heart disease or other chronic conditions may also make the kidney treatments such as dialysis particularly difficult. For those who are easily confused, for example, people who have dementia, dialysis may seem frightening or upsetting.

Whilst old age itself is not a barrier to commencing dialysis, older people are more likely to have other diseases such as heart or respiratory diseases which may impact on their ability to do well on dialysis. Also, because of these additional health problems they may not be suitable for a transplant.

Some people having reached the stage where they decide not to have dialysis to treat their renal disease may live for one to two years without dialysis, but this varies and is often difficult to predict.  People making the decision not to have dialysis will ultimately die, but often of other causes and many die with some kidney function remaining.

Treatment once someone decides not to have dialysis

If you decide not to have dialysis you will still receive support and medical treatment from your kidney team. Your GP will also be aware of the decision.

Everyone involved in your care will support your decision, as long as they are happy that it is a fully informed choice.  Your kidney team will counsel and support you and your carers through these difficult decisions.

If you have end-stage renal disease (ESRD), kidney transplantation may be the treatment option that allows you to live much as you lived before your kidneys failed. However it is important to remember that it is not a cure, as it can only provide 50% of normal kidney function and requires you to take medicines for the rest of your life.

How transplants work

Kidney transplantation is a procedure that places one healthy kidney from another person into your body to take over the work of your two failed kidneys.  It is inserted into your lower abdomen and connected to an artery and vein in your pelvis. Your blood flows through the new kidney, which makes urine and removes harmful waste products, just like your own kidneys did when they were healthy. Your own kidneys are usually left in place.

The transplant process

Transplant workup. First you'll need an assessment to determine whether your body will accept an available kidney. This may require several visits over 4-6 months. You must be healthy enough for surgery.

If a family member or friend wants to donate a kidney, they'll need to be evaluated separately for compatibility, general health and counselling. Matching the kidney to your immune system is less important for living transplants.

Transplant waiting list.

If you don't have a living donor, you will be registered with the national waiting list to receive a kidney from a deceased donor. The average wait in Australia is three years, but it varies considerably.

Transplant operation.

If you have a living donor, the operation is scheduled in advance at a time that suits you both.

If you're on a waiting list for a deceased donor kidney, as soon as a kidney becomes available you must go to the hospital quickly. There you will have some tests tom ensure the transplant can go ahead. The operation usually takes 3-4 hours.  Often the new kidney will start making urine as soon as your blood starts flowing through it, but you may need dialysis if this is delayed.

To prevent your immune system from seeing your new kidney as foreign and rejecting it, you need to take drugs that suppress your immune response. Be sure that you understand the instructions for taking your medicines before you leave the hospital.

You will have regular appointments with the transplant team once you are discharged from hospital.  It is very important to attend.