Kidney Disease Education Part 2 Treatment Options Council of Advanced Practice Providers Treatment for Kidney Failure What is Dialysis Two main types Peritoneal Dialysis Hemodialysis Does ID: 999984
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1. Kidney Disease EducationKidney Disease EducationPart 2: Treatment OptionsCouncil of Advanced Practice Providers
2. Treatment for Kidney Failure
3. What is Dialysis?Two main types: Peritoneal DialysisHemodialysisDoes some of the work of healthy kidneysRemoves waste from your bloodRemoves fluid from your bloodKeeps body’s chemicals balancedDoes Not:Cure kidney disease
4. What Happens in Dialysis?Dialysis can be compared to how a coffee filter works
5. Types of DialysisPeritoneal Dialysis (PD) uses the peritoneal lining to filter the bloodHemodialysis (HD) uses a machine and filters the blood outside the body
6. What is Peritoneal Dialysis (PD)Takes place inside the bodyMust be done every dayDone at home, but is mobileGives more steady dialysisCan use gravity and no machine (about 4x/day)Uses the peritoneal lining as a filter. This lining covers all of your abdominal organsEveryone learns to do PD by gravity (CAPD)OR…Can use a machine (Cycler) for night (8 hours/day
7. How Does PD Work?Exchanges:FillDwellDrainAbout 30 min/fill/drainAverage 4 times/day
8. PD CathetersOutpatient SurgeryCan be done in operating room or radiologyPlaced 2-4 weeks before neededYou will come to the PD center for one-on-one teaching by a trained PD nurse
9. PD Supplies
10. Pros and Cons of PDProsMay live longer & healthierMobility and flexibilityEasier to travelContinuous dialysis can improve well-beingNo machine necessarily requiredMay have fewer fluid and diet restrictionsNo needles requiredSaves some kidney functionConsUsually done more days than 3 days a weekCatheter is always presentSwimming/bathing may be limited (showering okay)Blood sugar fluctuations possible due to glucose (sugar) in dialysis fluidStorage space needed at home for suppliesPotential for infection in the catheter
11. How Does Hemodialysis Work?Blood is filtered outside your bodyYour blood flows through soft tubes to a filter on the dialysis machineBlood is pumped back into your bloodstream after it’s filteredOnly a small amount of blood is outside your body at one timeCan be done at home or in a center
12. Typical Hemodialysis3 times a weekMonday/Wednesday/Friday ORTuesday/Thursday/SaturdayAverage 4 hours/dialysis2-3 different shifts/dayNocturnalHome hemo
13. How Does the Blood Get to the Dialysis Machine?A connection or access is made by joining two blood vessels.A fistula is the best choice of access for most people.
14. FistulaVessel mapping (ultrasound) done first to pick which artery and vein to useJoins an artery and vein in the armArtery and vein will grow so they can be used for dialysisBest if made at least 6 months before hemodialysis begins
15. Graft and CatheterGraftConnects an artery and nearby vein with a piece of man-made material. Used only if surgeon cannot find vessels for fistulaCatheter A plastic tube placed into a vein in your neck or chest. Choice of last resort. Highest infection rate for any type of dialysis. Can be used in emergency situations.
16. PD vs. HemodialysisPDLess diet restrictionsNo needlesMore flexibility and independenceMore privacy and family timeGreater sense of controlNeed space for suppliesHemodialysisMedical staff on site Friendship and socializingLimited privacyMore diet restrictionsLimited schedulingCost of travel to centerWhat they have in Common:Both need outpatient surgery to place accessBoth clean your blood
17. You Can Travel on DialysisCarry your PD or home hemo supplies or have them shippedYou can have treatment in other hemodialysis unitsSpecial cruises and camps are available Medicare will not cover international hemodialysis You Can Work on DialysisMany employers are flexibleConsider alternative work schedulesConsider alternative dialysis options/scheduleAmericans with Disability (ADA) protects you
18. What Is A Kidney Transplant?A healthy kidney is placed in your bodyThe kidney can come from A living donorA deceased donor
19. Who Can Have a Kidney Transplant?Upper age restriction can differ between centersYour eGFR must be 20 or lowerYou must have a full medical evaluationYou do not have to already be on dialysis Each center has different requirements
20. Advantages of Kidney TransplantLonger improved quality of life Easier to work, study, travel, exercise and remain active Fewer restrictions (diet, fluid, etc.) Better energy & fewer hospital admissionsBetter control of chronic kidney diseaseFreedom from dialysis routine
21. Disadvantages of TransplantOut-of-pocket costs can be very highSurgery has risksRejection of the kidney is always a risk. Medicines must be taken for as long as you have the transplant – no days offMedicines have side effectsAnti-rejection medicines increase the risk for diabetes, infections & some cancersYou may need another transplant or dialysis
22. Where Does the Kidney Come From?A healthy person who wishes to donate one kidneyA family member (e.g. sibling, parent, cousin or other blood relative)A friend, spouse or acquaintance (non-related)An anonymous donorA person who has died and becomes an organ donor It is illegal to buy or sell organs
23. Advantages of a Living DonorOutcome could be better because:Medical history is knownSurgery can be planned May have less rejectionKidney may last longerCan be done before having to start dialysis Less wait time than for a deceased donorDo you have a living donor? Have you asked?
24. Disadvantages for the Living DonorKidney is taken from a healthy personNo medical benefit to the person donatingSurgery can have complicationsRisk of death is small but presentLong term risk to donors may exist
25. Facts About The Waiting ListYou can be on more than one list No one can tell you exactly how long you will wait for a kidneyWait time depends on many factorsThe list is not a rank order but a group of eligible candidatesYounger patients are given priority on the list
26. What happens with no dialysis or no transplant?Using medications to control symptoms of kidney failureSome people want dialysis; others may not be so sureYou will lose function over timeWe will keep you comfortable with medication and hospice/palliative careDialysis or transplant is not for everyone
27. Choosing Medical Management for Kidney FailureMedical Management may be the choice for youWith severe medical problems such as a stroke or dementia or a very bad heart, dialysis may be not be the best optionEvery patient is different and every situation is uniqueTell your family your decisionYou can always change your mind
28. Common QuestionsIs deciding not to have dialysis suicide? No, many religions believe in a person’s right to refuse medical treatment like dialysis if they feel it will not help them or be burdensomeHow long will I live? It varies from person to personIs dying from kidney failure painful? Not usually
29. Advance Directive or Living WillTells WHO will make your medical decisions if you’re unable to make them yourselfTells WHAT you want for health and medical careOutlines WHAT type of care you want…from CPR to a feeding tube to intubation to medications to dialysisMakes all decisions easier on your family
30. Advance Directive or Living WillYou can change what you say in your Advance Directive at any time You can get an Advance Directive form that follows your state’s lawContact the National Hospice and Palliative Care Organization (800-658-8898)Go online to www.abanet.org/agingVisit your library
31. Hospice vs. Palliative CareHospice:Support people in all aspects of the dying processProvides family supportProvides pain managementCan be done in:Your home A hospice facilityHospitalPalliative Care:Manages symptoms of chronic diseaseSupports family and patientCan be used at any time (not only at end of life)Shown to extend life spans
32. Questions and DiscussionsThis Photo by Unknown Author is licensed under CC BY-NC