Treating Kidney Disease In The Way That Works For You
-
Kidney Transplantation
The best option available for most patients on dialysis.
Kidney transplantation involves placing a healthy kidney into the body. whic h comes from either a living or deceased donor. However. the waiting list for kidney transplants is increasing and the median wait time is 3.6 years.2 -
Home Hemodialysis
Treatment in the comfort of your home during the day or overnight.
Follows a similar treatment procedure as in-center hemodialysis but is usually done in the comfort of your home, and more frequently, 5 or 6 days a week. More frequent hemodialysis may lead to improved health and quality of life outcomes compared to traditional 3 times per week in-center therapy. -
Peritoneal Dialysis (PD)
Treatment you can do almost anywhere.
With peritoneal dialysis you can perform treatments in the comfort of your own home, this therapy uses the lining of your own belly—the peritoneal membrane that covers your abdomen—to filter your blood of toxins and extra fluids. -
In-center Hemodialysis (ICHD)
The traditional approach.
The most common form of dialysis in the US, this therapy option is typically performed three times a week for approximately four hours per session at a dialysis center.
Kidney Transplantation
The best option available for most patients on dialysis.
Kidney transplantation involves placing a healthy kidney into the body, which comes from either a living or deceased donor. Currently the success rate for a kidney transplant procedure is 89-99% one year after the operation.1 The waiting list for kidney transplants is increasing and the median wait time is 3.6 years.2
Kidney transplants may fail if the body detects the new kidney as something foreign and the immune system works to reject it. Unfortunately, not all kidney transplants are successful and patients will need to go back on or continue dialysis if that happens.
References
- National Kidney Foundation. 2013. Kidney Transplant. Accessed on: November 13, 2015. Retrieved from: https://www.kidney.org/sites/ default/files/docs/11-10-0304_bbd_patbro_kidneytransplant2.pdf
- United States Renal Data System. 2015 Annual Data Report. Accessed on, May 26, 2017. https://www.usrds.org/2015/view/ v2_07.aspx.
Home Hemodialysis
Treatment in the comfort of your home during the day or overnight.
Hemodialysis involves accessing your blood through an access site. Most access sites are located in the lower arm but can also be located in the upper chest or leg. The dialysis procedure involves cleaning your blood through a special filter on a dialysis machine.
HHD follows a similar treatment procedure as in-center hemodialysis but is usually done in the comfort of your home, and more frequently, 5 or 6 days a week. More frequent hemodialysis may lead to improved health and quality of life outcomes compared to traditional 3 times per week in-center therapy. HHD can be performed during the day with or without a care partner or overnight while you and your care partner sleep (nocturnal home hemodialysis). A care partner is not a medical professional and can be a friend, spouse, colleague, or family member.
When treating at home, patients are not constrained by the schedule of a dialysis center, and physicians have more flexibility to tailor dialysis prescriptions to patients' individual clinical and quality of life needs. Most patients who do hemodialysis at home perform their treatment more frequently than in-center patients.
Peritoneal Dialysis (PD)
Treatment you can do almost anywhere.
PD therapy cleans your blood while it’s within your body. PD uses a membrane inside your abdomen as a filter to remove toxins and extra fluid from your blood. Typically, PD patients can perform therapy on their own-at home or almost anywhere. PD treatments are done daily, so waste and toxins in your blood don’t have a chance to build up as much between treatments. PD may lead to enhanced health and quality of life outcomes vs 3 times weekly ICHD.
There are two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD).
Continuous Ambulatory Peritoneal Dialysis (CAPD): This type uses a disposable bag system. The patient performs manual exchanges which take around 20-30 minutes to complete, and are usually done 4-5 times per day. After a CAPD exchange is started, most people read, watch TV, or use their computer for 20-25 minutes during drain and fill. Between exchanges, normal activities can resume while the fluid dwells.
Automated Peritoneal Dialysis (APD): APD includes several modality types, but the most commonly performed is called Continuous Cycling Peritoneal Dialysis (CCPD): This therapy uses a machine called a cycler to automatically perform exchanges, typically while the patient is sleeping. The cycler is set up before bedtime and monitors the treatment. In the morning, the patient disconnects and normal activities are resumed.
In-center Hemodialysis (ICHD)
The traditional approach.
The most common form of dialysis, is known as in-center or intermittent hemodialysis, this therapy option is performed three times a week, for approximately four hours per session, at either a dialysis center or hospital.
Hemodialysis involves accessing your blood through an access site. Most access sites are located in the lower arm but can also be located in the upper chest or leg. The dialysis procedure involves cleaning your blood through a special filter on a dialysis machine. Your blood is removed through your access site, cleaned, and then returned to your body.
Talk to a Patient Consultant
The reported benefits of peritoneal dialysis may not be experienced by all patients.
Peritoneal dialysis does involve some risks that may be related to the patient, center, or equipment These include, but are not limited to, infectious complications. Examples of infectious complications include peritonitis, and exit-site and tunnel infections. Non-infectious complications include catheter complication such as migration and obstruction, peritoneal leaks, constipation, hemoperitoneum, hydrothorax, increased intraperitoneal volume, respiratory, and gastric issues. It is important for healthcare providers to monitor patient prescriptions and achievement of adequacy and fluid management goals.
Patients should consult their doctor to understand the risks and responsibilities of performing peritoneal dialysis
The reported benefits of home hemodialysis may not be experienced by all patients.
Despite the health benefits that home and more frequent hemodialysis may provide to those with chronic kidney disease, these forms of therapy are not for everyone. Please review this information carefully and discuss it with your doctor as you evaluate your therapy options.
Personal and Partner Responsibility
Home hemodialysis with the NxStage System during the day may not require a care partner, provided a physician and a qualified patient agree that solo home hemodialysis is appropriate. Patients performing nocturnal treatments are required to have a care partner. Care partners are trained on and follow guidelines for proper operation. If you choose to do more frequent home hemodialysis, you will be responsible for complying with your dialysis prescription, which may require treatments up to six days per week.
If you choose to do home hemodialysis alone during the day, you will need to take on the responsibility for tasks that would normally be taken care of by staff when incenter. You will need to perform all aspects of dialysis treatment from start to finish, including equipment setup, needle insertions, responding to and resolving system alarms, and system tear-down after treatment. In addition, you must monitor your blood pressure, ensure proper aseptic technique is followed, and follow all the training material and instructions given to you by your training nurses. You will also be trained on and need to know how to respond to health emergencies that might happen during treatment at home, including dizziness, nausea, low blood pressure, and fluid or blood leaks.
Treatment Environment
You must ensure that you have a clean and safe environment for your treatments. You also need to set aside space in your home for the needed supplies.
Risks Associated with All Forms of Hemodialysis
All forms of hemodialysis involve some risks. These may include high blood pressure, fluid overload, low blood pressure, heart-related issues, vascular access complications, cramps, backache, headache, dizziness, nausea, an “off” taste in the mouth, fatigue, fever, chills, joint pain, itching, seizures or sinusitis. All hemodialysis therapies also involve the use of medical devices that introduce the potential for additional risks including air entering the bloodstream, damage of red blood cells, inflammatory reactions, blood chemistry imbalances, blood loss due to clotting of the blood tubing set or accidental blood line disconnection or other leak, allergic reactions, and excess warming or cooling of the dialysate. In addition, dialysis patients may have other underlying diseases that may, in some cases, make it more difficult for them to manage their hemodialysis treatments.
Risks associated with More Frequent Home Hemodialysis
Studies suggest that patients performing more frequent home hemodialysis may experience slightly fewer complications associated with their treatments and may experience improved clinical outcomes. However, there are certain risks unique to treatment in the home environment. Treatments at home are done without the presence of medical personnel and on-site technical support. Patients (and their care partners, if required), must both be trained on what to do and how to get medical or technical help if needed. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks.
Risks Associated with Solo Home Hemodialysis Therapy
A qualified patient may dialyze alone, without a care partner present (solo home hemodialysis), provided the patient and physician agree that solo home hemodialysis is appropriate. Certain risks associated with hemodialysis treatment are increased when performing solo home hemodialysis because no one is present to help the patient respond to health emergencies. If patients experience needles coming out, blood loss, or very low blood pressure during solo home hemodialysis, they may lose consciousness or become physically unable to correct the health emergency. Losing consciousness or otherwise becoming impaired during any health emergency while alone could result in significant injury or death. Additional ancillary devices and training are required when performing solo home hemodialysis.
Increased Risks Associated with Home Nocturnal Hemodialysis Therapy
The NxStage System may be used at night while the patient and care partner are sleeping. Certain risks associated with hemodialysis treatment are increased when performing nocturnal therapy due to the length of treatment time and because therapy is performed while the patient and care partner are sleeping. These risks include, but are not limited to, blood access disconnects and blood loss during sleep, blood clotting due to slower blood flow or increased treatment time or both, and delayed response to alarms when waking from sleep. Treatment with nocturnal therapy may require adjustments to medications, including but not limited to iron, Erythropoiesis- Stimulating Agents (ESA), insulin/oral hypoglycemics, anticoagulants, and phosphate binders.
References
- Daugirdas, John T.; Blake, Peter G.; and Ing, Todd S., "Handbook of Dialysis (5th ed.)" (2015)
- United States Renal Data System. 2015 Annual Data Report. Accessed on, May 26, 2017. https://www.usrds.org/2015/view/v2_07.aspx.
