When your kidneys are healthy, they clean your blood and make hormones that
keep your bones strong and your blood healthy. When your kidneys fail, you
need treatment to perform the work your kidneys used to do. There are two
treatments for kidney failure: transplant and dialysis. If you do not have
a kidney transplant, kidney dialysis is crucial to maintaining your quality
Dialysis replaces kidney function by using special equipment to clean
wastes from the blood. There are two forms of dialysis:
circulates blood through a machine outside of the body to remove poisonous
wastes and excess fluid, and to correct electrolytes such as potassium,
sodium, phosphate and calcium. The machine then pumps the cleansed blood
back into the body. This type of dialysis usually involves going to a
dialysis center three times each week, but can sometimes be done at home.
uses the lining inside the abdomen as a filter to purify the blood by
flushing the abdominal cavity with a diluted dextrose (sugar) solution. The
solution traps waste and is usually drained from the abdomen through a
surgically placed tube called a catheter. This type of dialysis can be done
during the day, with four fluid exchanges through the catheter, or
overnight using a special cycler machine that flushes your system while you
sleep. It is your personal choice which type of peritoneal dialysis you
decide to do. Peritoneal dialysis is done at home and can even be done at
work. People who have had abdominal surgery are not the best candidates for
peritoneal dialysis because scar tissue may interfere with the
effectiveness of treatment.
What type of dialysis you get depends on what you and your doctors and
nurses feel is the best fit for your lifestyle and your medical condition.
Keep in mind each type of dialysis has pros and cons. By learning as much
as you can about both types, you will be able to make the best decision for
yourself. If your needs change, you may be able switch to another type of
dialysis if your doctors and nurses feel it is medically possible.
Hemodialysis cannot begin until doctors establish a vascular connection
between your bloodstream and the dialysis machine. This process is called
hemodialysis access. Surgeons create vascular access in the arm or leg for
hemodialysis by placing arteriovenous (AV) fistulae, or surgically placed
shunt, and grafts that connect arteries to veins. Sometimes it is necessary
for surgeons to place a catheter in the chest if hemodialysis is needed
urgently, or if arm or leg access is not ready to use at the time
hemodialysis is needed.
Peritoneal dialysis cannot be started until the special peritoneal dialysis
catheter is surgically placed in the abdomen.
A Proactive Approach
It can take up to six months of appointments and treatments to establish
access, depending on what kind of dialysis you need, so it is important to
be proactive with your medical care. Your kidney doctor or nurse will be
following your kidney function closely and will make the referral to the
surgeons for dialysis access at the appropriate time.
Healthcare Professionals You Will See
When we evaluate you for dialysis access surgery, you will meet with a
dialysis access nurse coordinator and a transplant surgeon who does
dialysis access surgery. Both have extensive experience with dialysis
access and will be able to answer any of your questions.
Evaluation is an outpatient process. While many of the tests will be
performed at the Transplant Institute, some can be done at a hospital or
clinic closer to your home.
During the evaluation, you will undergo a number of medical tests such as:
Noninvasive vein mapping with an ultrasound to help surgeons determine
which veins can be used for your hemodialysis access
Blood lab tests
The dialysis access nurse coordinator will give you a physical exam and
review your medical history as well as any experience you may have had with
dialysis access. It is important to let us know if you have had any surgery
or procedures that involved putting lines in your neck or if you have a
pacemaker. This information is important because it could potentially
impact how your surgeons create access for your dialysis treatment.
After the Dialysis Access Evaluation: Scheduling and Preoperative Testing
Once you have decided with your dialysis access team what kind of dialysis
access you will need, you will meet with your dialysis access nurse
coordinator, who will schedule your surgery and the preoperative tests you
will have prior to the surgery.
For preoperative testing you will meet with an anesthesiologist for a
physical and a review of your medical history. You will also have some
blood taken for testing and may get an EKG (a test that electrically checks
your heart rhythm to look for abnormalities or evidence of past damage) or
chest X-ray if needed.