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Dialysis, Kidney


Overview :

There are two types of dialysis treatment: hemodialysis and peritoneal dialysis:

Hemodialysis

Hemodialysis is the most frequently prescribed type of dialysis treatment in the United States. The treatment involves circulating the patient's blood outside of the body through an extracorporeal circuit (ECC), or dialysis circuit. Two needles are inserted into the patient's vein, or access site, and are attached to the ECC, which consists of plastic blood tubing, a filter known as a dialyzer (artificial kidney), and a dialysis machine that monitors and maintains blood flow and administers dialysate. Dialysate is a chemical bath that is used to draw waste products out of the blood.

Since the 1980s, the majority of hemodialysis treatments in the United States have been performed with hollow fiber dialyzers. A hollow fiber dialyzer is composed of thousands of tube-like hollow fiber strands encased in a clear plastic cylinder several inches in diameter. There are two compartments within the dialyzer (the blood compartment and the dialysate compartment). The membrane that separates these two compartments is semipermeable. This means that it allows the passage of certain sized molecules across it, but prevents the passage of other, larger molecules. As blood is pushed through the blood compartment in one direction, suction or vacuum pressure pulls the dialysate through the dialysate compartment in a countercurrent, or opposite direction. These opposing pressures work to drain excess fluids out of the bloodstream and into the dialysate, a process called ultrafiltration.

A second process called diffusion moves waste products in the blood across the membrane into the dialysate compartment, where they are carried out of the body. At the same time, electrolytes and other chemicals in the dialysate solution cross the membrane into the blood compartment. The purified, chemically balanced blood is then returned to the body.

Most hemodialysis patients require treatment three times a week, for an average of three-four hours per dialysis "run." Specific treatment schedules depend on the type of dialyzer used and the patient's current physical condition. While the treatment prescription and regimen is usually overseen by a nephrologist (a doctor that specializes in the kidney), dialysis treatments are typically administered by a nurse or patient care technician in outpatient clinics known as dialysis centers, or in hospital-based dialysis units. In-home hemodialysis treatment is also an option for some patients, although access to this type of treatment may be limited by financial and lifestyle factors. An investment in equipment is required and another person in the household should be available for support and assistance with treatments.

Peritoneal dialysis

In peritoneal dialysis, the patient's peritoneum, or lining of the abdomen, acts as a blood filter. A catheter is surgically inserted into the patient's abdomen. During treatment, the catheter is used to fill the abdominal cavity with dialysate. Waste products and excess fluids move from the patient's bloodstream into the dialysate solution. After a waiting period of six to 24 hours, depending on the treatment method used, the waste-filled dialysate is drained from the abdomen, and replaced with clean dialysate.

There are three types of peritoneal dialysis:

  • Continuous ambulatory peritoneal dialysis (CAPD). A continuous treatment that is self-administered and requires no machine. The patient inserts fresh dialysate solution into the abdominal cavity, waits four to six hours, and removes the used solution. The solution is immediately replaced with fresh dialysate. A bag attached to the catheter is worn under clothing.
  • Continuous cyclic peritoneal dialysis (CCPD). An overnight treatment that uses a machine to drain and refill the abdominal cavity, CCPD takes 10-12 hours per session.
  • Intermittent peritoneal dialysis (IPD). This hospital-based treatment is performed several times a week. A machine administers and drains the dialysate solution, and sessions can take up to 24 hours.

Peritoneal dialysis is often the treatment option of choice in infants and children, whose small size can make vascular (through a vein) access difficult to maintain. Peritoneal dialysis can also be done outside of a clinical setting, which is more conducive to regular school attendance.




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