Types of Dialysis

There are two types of dialysis we may use: peritoneal and hemodialysis.

Peritoneal Dialysis

To perform peritoneal dialysis, we will:

1. Surgically place a soft, hollow tube into the lower abdomen near the navel.
2. Instill a special solution called dialysate into the peritoneal cavity. The peritoneal cavity is the space in the abdomen that houses the organs and is lined by two special membrane layers called the peritoneum.
3. Leave the dialysate in the abdomen for a certain period of time, which we will determine on an individual basis. The dialysate fluid absorbs the waste products and toxins through the peritoneum.
4. Drain the fluid from the abdomen, measure it and then discard it.

Types of Peritoneal Dialysis

There are three different types of peritoneal dialysis:

• Continuous ambulatory peritoneal dialysis (CAPD): Does not require a machine. Exchanges, often referred to as "passes," can be done three to five times a day, during waking hours.
• Continuous cyclic peritoneal dialysis (CCPD): Requires the use of a special dialysis machine that can be used in the home. This type of dialysis is done automatically, even while you are asleep.
• Intermittent peritoneal dialysis (IPD): Uses the same type of machine as CCPD, but treatments take longer. IPD can be done at home, but it is usually in the hospital.

Peritoneal Dialysis: Possible Complications

Possible complications of peritoneal dialysis include an infection of the peritoneum, or peritonitis, where the catheter enters the body. Peritonitis causes fever and stomach pain. A dietitian will help plan your diet during peritoneal dialysis, so we can ensure you are choosing appropriate meals. During dialysis:

• You may have different protein, salt and fluid needs.
• You may have different potassium restrictions.
• You may need to reduce your calorie intake, since the sugar in the dialysate may cause weight gain.

Hemodialysis

Hemodialysis is can be performed at home or in a dialysis center or hospital by trained healthcare professionals. During the procedure, we will:

1. Surgically place a special type of access, called an arteriovenous (AV) fistula, usually in your arm. We will need to join an artery and a vein together. (We may also insert an external, central intravenous (IV) catheter, but is less common for long-term dialysis.)
2. Connect you to a large hemodialysis machine.
3. The machine drains the blood, bathes it in a special dialysate solution to remove waste substances and fluid and then returns it to your bloodstream.

Tips for Undergoing Hemodialysis

• Hemodialysis is usually performed several times a week and lasts for four to five hours. Because of the length of time hemodialysis takes, it may be helpful to bring reading material, in order to pass the time during this procedure.
• During treatment you can read, write, sleep, talk or watch TV.
• At home, hemodialysis is done with the help of a partner, often a family member or friend. If you choose to do home hemodialysis, you and your partner will receive special training.

Hemodialysis: Dialysis Access Management

Interventional radiologists work closely with you, your nephrologist and your vascular surgeon to help maintain functional hemodialysis access.

• Treating stenoses and clots: If you have arteriovenous fistulas or grafts, hemodialysis may fail if narrowings, called stenoses, develop in your blood vessels. Those narrowing cause poor flow, which affects the ability to efficiently dialyze the blood. The narrowings may cause additional symptoms, such as swelling of the head and arms. Without treatment, poor flow can result in clot formation, which prevents the ability to dialyze. It can even lead to permanent fistula or graft failure.

Interventional radiologists are skilled at treating clots with special devices and by administering clot-dissolving drugs directly into the clot. They are also skilled at treating sites of narrowing with angioplasty and, if appropriate, stent placement.

• Tunneled hemodialysis catheters: Interventional radiologists can also place tunneled hemodialysis catheters. Patients with long-standing use of tunneled hemodialysis catheters may develop blockages in the commonly used veins of the neck and chest. Those blockages may make it challenging to place a new catheter.

Interventional radiologists can often open a channel through the blockage to allow placement of a new catheter. If that is not possible, we can use alternative sites (through the veins draining the legs, through the liver, or through the back) for placing the catheter.

Hemodialysis: Possible Complications

Possible complications of hemodialysis include muscle cramps and hypotension (sudden drop in blood pressure). Hypotension may cause you to feel dizzy, weak or sick to your stomach. You can usually avoid side effects by following the proper diet and taking your medications.

A dietitian will work with you to plan your meals according to your physician's orders. Generally:

• You may eat foods high in protein such as meat and chicken (animal proteins).
• You may have different potassium restrictions.
• You may need to limit the amount you drink.
• You may need to avoid salt.
• You may need to limit foods containing mineral phosphorus (such as milk, cheese, nuts, dried beans, and soft drinks).