Dialysis is a form of renal replacement therapy, typically started when approximately 90% of the kidney function is lost. The decision of when to start dialysis depends on the discussion between the nephrologist, patient and the patient’s family. The Nephrologist decides the need for starting dialysis based on kidney function tests, overall health, nutritional status, symptoms, quality of life, and personal preferences. Dialysis should begin well before kidney disease has advanced to the point where life-threatening complications can occur.
There are two modalities of dialysis- hemodialysis and peritoneal dialysis. The choice between both of them is influenced by availability, convenience, underlying medical problems, home situation, and age. This choice is best made by discussing the risks and benefits of each type of dialysis with the treating nephrologist.
In this type of dialysis, the lining of the abdominal cavity (peritoneal membrane) is used for dialysis. A soft catheter is placed into the abdominal cavity which is used to instil the fresh dialysate fluid and remove the effluent after dialysis is done.
Dialysis solution containing dextrose and other electrolytes flows from a bag through the catheter into the abdominal cavity. When the bag is empty, the patient or attendant disconnects it. Then the patient can move around and can do his normal activities. The dialysis solution absorbs wastes and extra fluid from the body.
There are two types of peritoneal dialysis
Continuous Ambulatory Peritoneal Dialysis: CAPD is done manually by the patient or his family members or a nursing staff. It usually includes 2 morning dwells of 6hrs each and a night dwell of 12hrs.
Automated Peritoneal Dialysis: It is carried out by an automated cycler and is mainly done by connecting the patient to the cycler at night during sleep. APD cycle lasts 10- 12hrs.
Hemodialysis is a procedure where a dialysis machine and a special filter called dialyzer, are used to clean the patient’s blood. Hemodialysis needs a vascular access which is the lifeline for dialysis patients. This access is a way for the dialyser to access the blood and filter it and return filtered blood to the body. It is usually done on an outpatient basis where the patient walks into the hospital, completes his/her session and goes home. Each session lasts about four hours and is usually done 2-3 times a week.