Frequently Asked Questions
When is dialysis needed?
You need dialysis if your kidneys no longer remove enough wastes and fluid from your blood to keep you healthy. This usually happens when you have only 10 to 15 percent of your kidney function left. You may have symptoms such as nausea, vomiting, swelling and fatigue. However, even if you don't have these symptoms yet, you can still have a high level of wastes in your blood that may be toxic to your body. Your doctor is the best person to recommend when you should start dialysis.
What does dialysis do?
Like healthy kidneys, dialysis keeps your body in balance. Dialysis does the following:
- removes waste, salt and extra water to prevent them from building up in the body
- keeps a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate
- helps to control blood pressure
Are there different types of dialysis?
Yes, there are two types of dialysis - hemodialysis and peritoneal dialysis.
How does hemodialysis work?
In hemodialysis, a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood. To get your blood into the dialyzer, the doctor needs to make an access, or entrance, into your blood vessels. This is done with minor surgery, usually to your arm.
Where is hemodialysis done?
Hemodialysis can be done in a hospital, in a dialysis center that is not part of a hospital or at home. You and your doctor will decide which place is best, based on your medical condition, and your wishes.
How long will each hemodialysis treatment last?
Hemodialysis treatments usually last about four hours, and they are done three times a week.
Your doctor will give you a prescription that tells you how much treatment you need. Studies have shown that getting the right amount of dialysis improves your overall health, keeps you out of the hospital and enables you to live longer. Your dialysis care team will monitor your treatment with monthly lab tests to ensure you are getting the right amount of dialysis. One of the measures your dialysis care team may use is called urea reduction ratio (URR). Another measure is called Kt/V (pronounced kay tee over vee). Ask your dialysis care team what measure they use and what your number is to ensure that you are getting enough dialysis:
- your Kt/V should be at least 1.2 or
- your URR should be at least 65 percent
How does the dialyzer clean my blood?
The dialyzer, or filter, has two parts, one for your blood and one for a washing fluid called dialysate. A thin membrane separates these two parts. Blood cells, protein and other important things remain in your blood because they are too big to pass through the membrane. Smaller waste products in the blood, such as urea, creatinine, potassium and extra fluid pass through the membrane and are washed away.
Can I have hemodialysis at home?
Possibly. Many patients have their hemodialysis treatments at home. Discuss this with your Nephrologist.
What is peritoneal dialysis and how does it work?
In this type of dialysis, your blood is cleaned inside your body. The doctor will do surgery to place a plastic tube called a catheter into your abdomen (belly) to make an access. During the treatment, your abdominal area (called the peritoneal cavity) is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate.
What are the different kinds of peritoneal dialysis? How do they work?
There are several kinds of peritoneal dialysis but two major ones are: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD).
Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. You do this yourself, usually four or five times a day at home and/or at work. You put a bag of dialysate (about two quarts) into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange. You use a new bag of dialysate each time you do an exchange. While the dialysate is in your peritoneal cavity, you can go about your usual activities at work, at school or at home.
Continuous Cycling Peritoneal Dialysis (CCPD) usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2 hours and exchanges are done throughout the night while you sleep.
Can dialysis cure my kidney disease?
In some cases of sudden or acute kidney failure, dialysis may only be needed for a short time until the kidneys get better. However, when chronic kidney disease progresses to kidney failure over time, your kidneys do not get better and you will need dialysis for the rest of your life unless you are able to receive a kidney transplant.
Can dialysis patients travel?
Yes, dialysis patients can travel. Some even go on cruises. Before you travel, you will need to make arrangements with the dialysis clinic you are visiting. The staff at your "home" unit can help you make arrangements. Dialysis centers are located in every part of the United States and in many foreign countries. (See National Kidney Foundation brochure Travel Tips: A Guide for Kidney Patients and Their Families.)
Can dialysis patients continue to work?
Yes. Many dialysis patients continue to work or return to work after they have gotten used to dialysis. If your job has a lot of physical labor (heavy lifting, digging, etc.), you may need to change your duties. If you need to learn new skills or change jobs, your state's Rehabilitation Services office may be able to help you.
I have heard I might have to reuse my dialyzer each treatment. Is this safe?
Yes, dialyzer reuse is a safe and accepted medical practice. Before you reuse your dialyzer, your dialysis center cleans it according to careful guidelines. Before each treatment, your dialyzer must be tested to make sure it is still working well. If your dialyzer no longer works well, it is discarded and you are given a new one. Ask your dialysis care team if they have tested your dialyzer and if it still works well. If you do not wish to reuse your dialyzer, your center may be willing to provide you with a new dialyzer for each treatment. Ask about the center's policy on reuse.
Will I be uncomfortable on hemodialysis?
When you begin hemodialysis, the needles put in your fistula or graft may be uncomfortable. Spray medication can be used to reduce discomfort. Most patients get used to this in time. Your dialysis care team will make sure you are as comfortable as possible during your treatment. Symptoms like cramps, headaches, nausea or dizziness are not common, but if you do have any of them, ask your dialysis care team if any of the following steps could help you:
- Slow down your fluid removal, which could increase your dialysis time
- Check your high blood pressure medications
- Adjust your dry weight, or target weight
- Cool the dialysate a little
- Use a special medication to help prevent low blood pressure during dialysis
You can help yourself by following your diet and fluid allowances. The need to remove too much fluid during dialysis is one of the things that may make you feel uncomfortable during your treatment. The higher the intake of fluids, the greater the amount of fluid that needs to be removed.
How will I pay for my dialysis?
Dialysis is expensive. However, the federal government's Medicare program pays 80 percent of all dialysis costs for most patients. Private health insurance or state medical aid may also help with the costs.
Do dialysis patients have to control their diets?
You may be on a special diet. You may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis. We have a licensed Renal Dietician on staff who can help you with any changes in your diet as well as make recommendations for eating out.
How do your success rates compare to others in the area?
We are proud to say that our success rates for "Percentages of Medicare patients who had enough wastes removed from their blood during dialysis in 2009" (most recent information available) was among the highest in the area (Please view graphs below).