Dialysis and Hemodialysis
Treatment Options for Kidney Failure (ESRD)
Once kidney function diminishes to less than 10 to 15% and end-stage renal disease (ESRD) occurs, dialysis or transplant are the only treatment options.
There are two types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis is the more prevalent treatment in the U.S.
In hemodialysis, a device called a dialyzer (or artificial kidney) is used to remove excess fluid and waste products from the bloodstream. During the treatment, blood travels out of the patient, through blood tubing, a dialysis machine, and a dialyzer (known collectively as the dialysis circuit), and back into the patient again.
To provide easy access to a patients vascular system, a surgically implanted access site called a fistula or graft is created, usually on the arm. This is where blood exits and re-enters the dialysis patients body through attached catheters. Sometimes a catheter is inserted into a vein for temporary vascular access while a patient awaits a permanent access site.
When the patients blood passes through the dialyzer, an artificial membrane within it acts as a filter. Dialysate, a liquid solution, is cycled through one side of the membrane while blood is pumped through the other. Toxins and excess fluids are filtered from the bloodstream and into the dialysate fluid, and electrolytes pass from the dialysate across the dialyzer membrane and into the bloodstream. The clean and chemically balanced blood is shuttled back into the body via the vascular access.
Hemodialysis treatment is typically administered three times a week, and takes three to four hours (depending on the patient's clinical needs and the type of dialyzer used). It is usually performed in a dialysis unita dedicated dialysis clinic that is located in a freestanding outpatient center or within a hospital setting. Home hemodialysis is also a treatment option, but because it requires a significant investment in both training and equipment, the majority of U.S. ESRD patients undergo dialysis in a center.
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