In this episode of the Let's Talk About Kidneys podcast, Dr. Richey talks about the different types of dialysis and provides an overview to help patients and caregivers to understand what is involved and how to decide which modality is right for each patient.

When is dialysis necessary?

Dialysis is recommended when a patient's kidneys can no longer safely support them. This is determined based on several factors:

Creatinine levels
Potassium levels
Fluid overload

Dr. Richey also mentions that doctors consider how the patient feels in addition to the items above. Can they do things they could normally do in the past?

What are the types of dialysis?

There are three main options for dialysis:

In-center hemodialysis
Home hemodialysis
Peritoneal dialysis (performed at home)

How does dialysis work?

With hemodialysis a patient's blood is run through a machine. The machine cleans the blood, removes extra fluid, and then the cleaned blood is returned back to the patient. Both in-center hemodialysis and home hemodialysis follow the same basic process.

Peritoneal dialysis is very different. With peritoneal dialysis, the patient's own body is used to do the filtering. A catheter goes into the patient's abdomen and through the peritoneum. A special fluid goes into the catheter and through the peritoneum there is an exchange of toxins and fluid removal. Then you empty that fluid out from the abdomen.

What are the different types of access points for dialysis?

Access to the patient's blood is required for dialysis. The most common access for both in-center and home hemodialysis is an arteriovenous (AV) fistula or arteriovenous (AV) graft. Through a surgical procedure, an artery and vein are sealed together to allow for blood flow directly through the artery and into the vein. This allows for a higher rate of blood flow.

For peritoneal dialysis, a special catheter is inserted into the abdomen. It sits low in the pelvis area and a small length of tubing comes from under the skin for access.

What would qualify a patient to do home hemodialysis?

Most patients can do home hemodialysis. However, there are a few things that make in-center dialysis a better option including:

If the patient is unable to participate in the training which can take 4-6 weeks for hemodialysis.
If the patient doesn't have good vision.
If they don't have good family support.
If they don't have the appropriate space in their home for the supplies and equipment.

What is the typical hemodialysis schedule?

In-center treatment will take place three days a week and, on average, patients will be at the center for four hours per treatment.

Peritoneal dialysis is a seven day a week treatment. Some patients are able to do this while they sleep, but others will do it during the day.

What medications are used in combination with dialysis?

The most common medication used with dialysis is anti-hypertensive medications to lower blood pressure. We also use phosphorus binders to avoid long term complications with their bones and blood vessels. Other considerations can include vitamin D or medications for anemia or low blood count.