What is Dialysis and Which Modality is Best for Me?

What Are the Different Types of Diabetes Modalities?

There are two main types of dialysis: hemodialysis (HD) and peritoneal dialysis (PD). Whichever type of dialysis you perform, you will need a dialysis access. For hemodialysis, the AV fistula is the access of choice, there is also an AV graft. A catheter can be used and is usually considered a temporary access. Your doctor will talk to you about the different hemodialysis access options and which one is best for you. For PD, you will need a catheter placed in your abdomen to perform peritoneal dialysis.

Hemodialysis Options

Hemodialysis works by having your blood circulate through a man-made filter (or dialyzer), which cleans it. Blood circulates through the dialyzer for several hours during a treatment, with a machine controlling the speed and several safety factors.

Today, there are hemodialysis options that can help you better fit hemodialysis into your lifestyle. Traditional hemodialysis is done at a dialysis center three times per week. Each treatment lasts about three to four hours. In-center self care hemodialysis also lasts about three to four hours, three times per week; however, patients perform some of their treatment giving them a better sense of control. In-center nocturnal hemodialysis is performed at a dialysis center three times a week but happens overnight while the patient sleeps, usually for about eight hours each treatment. Home hemodialysis provides the most control for patients as they can choose when to perform dialysis and will perform the treatment, usually with the help of a care partner at home.

Peritoneal Dialysis Options

Peritoneal dialysis differs from hemodialysis in that your blood is cleaned inside your body. Your abdomen is lined with a semipermeable membrane (peritoneal membrane) that separates your blood and the dialysate. The abdominal cavity is filled with a dialysis fluid, or dialysate, via a catheter. The dialysate is left in the abdomen for several hours, where it absorbs excess fluid and waste products. Then it is drained and replaced with fresh dialysate — this process is called an exchange.

Usually PD is administered using a cycler. This automated machine works to flush fluid in and out of the abdomen while an individual sleeps. For people who perform automated peritoneal dialysis (APD) they may also need to perform a manual exchange sometime during the day. There is also the option of continuous ambulatory peritoneal dialysis (CAPD) which is performed manually by the dialysis patient at home, work or wherever they may be.

Can Dialysis Cure Chronic Kidney Disease?

Dialysis does some of the work that healthy kidneys normally do, but if you have chronic kidney disease, it will not change the fact that your kidneys no longer function as well as they once did. You will always need to get dialysis treatments, unless you have a kidney transplant.

For those diagnosed with acute kidney failure, some function may return. In acute kidney failure, kidneys stop working suddenly. This can happen for a number of reasons, including:

  • blood pressure drops severely
  • blood supply to the kidneys is restricted
  • urine flow is obstructed, due to conditions such as kidney stones, bladder tumors or an enlarged prostate
  • kidneys are damaged from a reaction to allergens, medications or toxic substances

Dialysis cannot cure chronic kidney disease, but it can help an individual live a longer and more satisfying life. Talk to your doctor about the dialysis options and your lifestyle, so that you can both determine the best dialysis modality for you.

Reprinted with permission by DaVita Inc. For more on dialysis treatment options, go to DaVita.com.

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Last Modified Date: February 16, 2013

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by Brenda Bell
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...
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