kidney+treatments

There are many different types of treatments for kidney failure. Here are a few examples:

__Treatment Choice: Hemodialysis__
Purpose Hemodialysis cleans and filters your blood using a machine to temporarily rid your body of harmful wastes, extra salt, and extra water. Hemodialysis helps control blood pressure and helps your body keep the proper balance of important chemicals such as potassium, sodium, calcium, and bicarbonate. How It Works Hemodialysis uses a special filter called a dialyzer that functions as an artificial kidney to clean your blood. During treatment, your blood travels through tubes into the dialyzer, which filters out wastes and extra water. Then the cleaned blood flows through another set of tubes back into your body. The dialyzer is connected to a machine that monitors blood flow and removes wastes from the blood.

Hemodialysis. Hemodialysis is usually needed three times a week. Each treatment lasts from 3 to 5 or more hours. During treatment, you can read, write, sleep, talk, or watch TV. Getting Ready If you choose hemodialysis, several months before your first treatment, an access to your bloodstream will need to be created. You may need to stay overnight in the hospital, but many patients have their access placed on an outpatient basis. This access provides an efficient way for blood to be carried from your body to the dialyzer and back without causing discomfort. The two main types of access are a fistula and a graft. A surgeon makes a fistula by using your own blood vessels; an artery is connected directly to a vein, usually in your forearm. The increased blood flow makes the vein grow larger and stronger so that it can be used for repeated needle insertions. This kind of access is the preferred type. It may take several weeks to be ready for use. A graft connects an artery to a vein by using a synthetic tube. It doesn’t need to develop as a fistula does, so it can be used sooner after placement. But a graft is more likely to have problems with infection and clotting. Arteriovenous fistula. Before dialysis, needles are placed into the access to draw out the blood. You’ll be given a local anesthetic to minimize any pain. Graft. If your kidney disease has progressed quickly, you may not have time to get a permanent vascular access before you start hemodialysis treatments. You may need to use a catheter—a tube inserted into a vein in your neck, chest, or leg near the groin—as a temporary access. Some people use a catheter for long-term access as well. Catheters that will be needed for more than about 3 weeks are designed to be placed under the skin to increase comfort and reduce complications. Catheter for temporary access. For more information about vascular access, see the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) fact sheet [|Vascular Access for Hemodialysis]. Who Performs It Hemodialysis is usually done in a dialysis center by nurses and trained technicians. In some parts of the country, certain centers are available to offer the training and support for home hemodialysis, which requires the help of a partner, usually a family member or friend, and sufficient space and water supply in the home. If you decide to do home dialysis, you and your partner will receive special training. As home hemodialysis machines become more convenient and the support more available, home hemodialysis may be an option across the country. Possible Complications Vascular access problems are the most common reason for hospitalization among people on hemodialysis. Common problems include infection, blockage from clotting, and poor blood flow. These problems can keep your treatments from working. You may need to undergo repeated surgeries in order to get a properly functioning access. Other problems can be caused by rapid changes in your body’s water and chemical balance during treatment. Muscle cramps and hypotension—a sudden drop in blood pressure—are two common side effects. Hypotension can make you feel weak, dizzy, or sick to your stomach. You’ll probably need a few months to adjust to hemodialysis. Side effects can often be treated quickly and easily, so you should always report them to your doctor and dialysis staff. You can avoid many side effects if you follow a proper diet, limit your liquid intake, and take your medicines as directed.

__**Treatment Choice: Peritoneal Dialysis**__ Purpose Peritoneal dialysis is another procedure that removes extra water, wastes, and chemicals from your body. This type of dialysis uses the lining of your abdomen, or belly, to filter your blood. This lining is called the peritoneal membrane and acts as the artificial kidney. How It Works A mixture of minerals and sugar dissolved in water, called dialysis solution, travels through a soft tube into your belly. The sugar—called dextrose—draws wastes, chemicals, and extra water from the tiny blood vessels in your peritoneal membrane into the dialysis solution. After several hours, the used solution is drained from your abdomen through the tube, taking the wastes from your blood with it. Then you fill your abdomen with fresh dialysis solution, and the cycle is repeated. The process of draining and refilling is called an exchange. Peritoneal dialysis. Getting Ready Before your first treatment, a surgeon places a small, soft tube called a catheter into your abdomen. The catheter tends to work better if there is adequate time—usually from 10 days to 2 or 3 weeks—for the insertion site to heal. Planning your dialysis access can improve treatment success. This catheter stays there permanently to help transport the dialysis solution to and from your abdomen. Types of Peritoneal Dialysis Three types of peritoneal dialysis are available. > CAPD requires no machine and can be done in any clean, well-lit place. With CAPD, your blood is always being cleaned. The dialysis solution passes from a plastic bag through the catheter and into your abdomen, where it stays for several hours with the catheter sealed. The time period that dialysis solution is in your abdomen is called the dwell time. Next, you drain the dialysis solution into an empty bag for disposal. You then refill your abdomen with fresh dialysis solution so the cleaning process can begin again. With CAPD, the dialysis solution stays in your abdomen for a dwell time of 4 to 6 hours, or more. The process of draining the used dialysis solution and replacing it with fresh solution takes about 30 to 40 minutes. Most people change the dialysis solution at least four times a day and sleep with solution in their abdomens at night. With CAPD, it’s not necessary to wake up and perform dialysis tasks during the night. > CCPD uses a machine called a cycler to fill and empty your abdomen three to five times during the night while you sleep. In the morning, you begin one exchange with a dwell time that lasts the entire day. You may do an additional exchange in the middle of the afternoon without the cycler to increase the amount of waste removed and to reduce the amount of fluid left behind in your body. > If you weigh more than 175 pounds or if your peritoneum filters wastes slowly, you may need a combination of CAPD and CCPD to get the right dialysis dose. For example, some people use a cycler at night but also perform one exchange during the day. Others do four exchanges during the day and use a minicycler to perform one or more exchanges during the night. You’ll work with your health care team to determine the best schedule for you. Who Performs It Both types of peritoneal dialysis are usually performed by the patient without help from a partner. CAPD is a form of self-treatment that needs no machine. However, with CCPD, you need a machine to drain and refill your abdomen. Possible Complications The most common problem with peritoneal dialysis is peritonitis, a serious abdominal infection. This infection can occur if the opening where the catheter enters your body becomes infected or if contamination occurs as the catheter is connected or disconnected from the bags. Peritonitis requires antibiotic treatment by your doctor. To avoid peritonitis, you must be careful to follow procedures exactly and learn to recognize the early signs of peritonitis, which include fever, unusual color or cloudiness of the used fluid, and redness or pain around the catheter. Report these signs to your doctor immediately so that peritonitis can be treated quickly to avoid serious problems.
 * Continuous Ambulatory Peritoneal Dialysis (CAPD)**
 * Continuous Ambulatory Peritoneal Dialysis (CAPD)**
 * Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)**
 * Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)**
 * Combination of CAPD and CCPD**
 * Combination of CAPD and CCPD**

__Treatment Choice: Kidney Transplantation__
Purpose Kidney transplantation surgically places a healthy kidney from another person into your body. The donated kidney does the work that your two failed kidneys used to do. How It Works A surgeon places the new kidney inside your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Your blood flows through the donated kidney, which makes urine, just like your own kidneys did when they were healthy. The new kidney may start working right away or may take up to a few weeks to make urine. Unless your own kidneys are causing infection or high blood pressure, they are left in place. Kidney transplantation. Getting Ready The transplantation process has many steps. First, talk with your doctor, because transplantation isn’t for everyone. Your doctor may tell you that you have a condition that would make transplantation dangerous or unlikely to succeed. You may receive a kidney from a deceased donor—a person who has recently died—or from a living donor. A living donor may be related or unrelated—usually a spouse or a friend. If you don’t have a living donor, you’re placed on a waiting list for a deceased donor kidney. The wait for a deceased donor kidney can be several years. The transplant team considers three factors in matching kidneys with potential recipients. These factors help predict whether your body’s immune system will accept the new kidney or reject it. The Time It Takes How long you’ll have to wait for a kidney varies. Because there aren’t enough deceased donors for every person who needs a transplant, you must be placed on a waiting list. However, if a voluntary donor gives you a kidney, the transplant can be scheduled as soon as you’re both ready. Avoiding the long wait is a major advantage of living donation. The surgery takes 3 to 4 hours. The usual hospital stay is about a week. After you leave the hospital, you’ll have regular follow-up visits. If someone has given you a kidney, the donor will probably stay in the hospital about the same amount of time. However, a new technique for removing a kidney for donation uses a smaller incision and may make it possible for the donor to leave the hospital in 2 to 3 days. Between 85 and 90 percent of transplants from deceased donors are working 1 year after surgery. Transplants from living relatives often work better than transplants from deceased donors because they’re usually a closer match. Possible Complications Transplantation is the closest thing to a cure. But no matter how good the match, your body may reject your new kidney. A common cause of rejection is not taking medication as prescribed. Your doctor will give you drugs called immunosuppressants to help prevent your body’s immune system from attacking the kidney, a process called rejection. You’ll need to take immunosuppressants every day for as long as the transplanted kidney is functioning. Sometimes, however, even these drugs can’t stop your body from rejecting the new kidney. If this happens, you’ll go back to some form of dialysis and possibly wait for another transplant. Immunosuppressants can weaken your immune system, which can lead to infections. Some drugs may also change your appearance. Your face may get fuller; you may gain weight or develop acne or facial hair. Not all patients have these problems, though, and diet and makeup can help. Immunosuppressants work by diminishing the ability of immune cells to function. In some patients, over long periods of time, this diminished immunity can increase the risk of developing cancer. Some immunosuppressants can cause cataracts, diabetes, extra stomach acid, high blood pressure, and bone disease. When used over time, these drugs may also cause liver or kidney damage in a few patients.
 * Blood type.** Your blood type (A, B, AB, or O) must be compatible with the donor’s. Blood type is the most important matching factor.
 * Human leukocyte antigens (HLAs).** Your cells carry six important HLAs, three inherited from each parent. Family members are most likely to have a complete match. You may still receive a kidney if the HLAs aren’t a complete match as long as your blood type matches the organ donor’s and other tests are negative.
 * Cross-matching antigens.** The last test before implanting an organ is the cross-match. A small sample of your blood will be mixed with a sample of the organ donor’s blood in a tube to see if there’s a reaction. If no reaction occurs, the result is called a negative cross-match, and the transplant operation can proceed.
 * Human leukocyte antigens (HLAs).** Your cells carry six important HLAs, three inherited from each parent. Family members are most likely to have a complete match. You may still receive a kidney if the HLAs aren’t a complete match as long as your blood type matches the organ donor’s and other tests are negative.
 * Cross-matching antigens.** The last test before implanting an organ is the cross-match. A small sample of your blood will be mixed with a sample of the organ donor’s blood in a tube to see if there’s a reaction. If no reaction occurs, the result is called a negative cross-match, and the transplant operation can proceed.
 * Cross-matching antigens.** The last test before implanting an organ is the cross-match. A small sample of your blood will be mixed with a sample of the organ donor’s blood in a tube to see if there’s a reaction. If no reaction occurs, the result is called a negative cross-match, and the transplant operation can proceed.


 * all information from http://kidney.niddk.nih.gov/kudiseases/pubs/choosingtreatment/#hemodialysis **