Making the right decision
Perhaps you have already thought about how different parts of your everyday life might change as a result of dialysis treatment.
It is understandable if the idea of changes scares you at first. We have picked out a few aspects of daily life below, such as self-esteem, work, exercising, travel, mental health, and socio-legal aspects.
You may find it reassuring to be well informed in advance; however, we cannot replace talking to your physician. Every decision needs to be made together with your physician. And always remember: Your dialysis team is there for you if you get stuck and need more support.
Tips that may support choosing the right therapy
With these tips we would like to support you on your path to finding the right therapy
Tip 1: Ask questions
Therapy will have a huge impact on your life. Do some research on therapy options, e.g., on this website as well as others and ask physicians, nurses, relatives, ... questions
Tip 2: Involve your loved ones along the way
Your therapy will also affect your loved ones as well. Take them with you to physician's visits or patient meetings. Talk with your loved ones about the challenges of therapy and share your feelings.
Tip 3: Exchange ideas with your physician
Your physician is the first point of contact when choosing your therapy modality. Take advantage of the time you have with your physician and ask questions.
Tip 4: Exchange ideas with your care team
Your dialysis team in the dialysis center has already gained a lot of experience with the therapies. Use this knowledge and exchange ideas. A talk with an experienced nurse may provide you with valuable insights.
Tip 5: Talk to people who are already being treated
People who are already being treated with kidney replacement therapy have already gained experience. They can share lot of information about each therapy. Ask your physician or dialysis team for a contact.
Tip 6: Take notes about what is important to you
Every therapy has advantages and disadvantages. Take notes about each therapy option and use them to help you decide. Your notes can be the basis for a discussion with your physician. Then talk to your physician about your therapy options and their advantages and disadvantages in a shared decision-making process.
Comparing different options
| CAPD | APD | Home hemodialysis (HHD) | In-center hemodialysis (HD) |
|---|---|---|---|
| Three to five exchanges (each about 30 minutes) performed during the day by yourself or with the help of a caregiver | Typically performed every night (about eight hours) by yourself or with the help of a caregiver | Longer, shorter and more frequent or overnight treatments are possible in your home. Treatment is done by yourself or with the help of a caregiver | Typically performed three times a week at a dialysis unit for four to five hours each session |
| CAPD | APD | Home hemodialysis (HHD) | In-center hemodialysis (HD) |
|---|---|---|---|
| Less but regular visits | Less but regular visits | Less but regular visits | Regular visits required, usually three times a week |
| CAPD | APD | Home hemodialysis (HHD) | In-center hemodialysis (HD) |
|---|---|---|---|
|
|
|
|
| CAPD | APD | Home hemodialysis (HHD) | In-center hemodialysis (HD) |
|---|---|---|---|
| If the hygienic requirements are met, the bag exchange can also be carried out at the workplace or at a hotel room | May have less impact on your work during the day since treatments are mainly performed at night |
|
|
| CAPD | APD | Home hemodialysis (HHD) | In-center hemodialysis (HD) |
|---|---|---|---|
|
| ||
| CAPD | APD | Home hemodialysis (HHD) | In-center hemodialysis (HD) |
|---|---|---|---|
|
| ||
| CAPD | APD | Home hemodialysis (HHD) | In-center hemodialysis (HD) |
|---|---|---|---|
| Typically not needed, as dialysis takes place via the peritoneal catheter. | Typically, two needle insertions per treatment of access via fistula/ graft or via a catheter. | ||
Kidney replacement therapy decision aid tool for patients
A decision aid tool might support you and your family to compare different treatment options based on your lifestyle needs and have more meaningful discussions with healthcare professionals. While the decision aid tool provides valuable information to patients and their families, it is important to note that it does not replace the advice and support of healthcare professionals.
Staying fit on dialysis
Almost everyone finds it difficult at first to motivate themselves to exercise regularly. There will be also additional limitations due to your chronic kidney disease. However, an appropriate amount of exercise can have a positive effect on body awareness, circulation and sleep rhythm.
As a dialysis patient, there are many ways to get involved in exercising. Perhaps you can find a sports partner with whom you can get and stay fit together? By doing so, you can do something good for your body through exercise and for your soul through conversation.
Be aware: Before you start exercising, it is important that you talk with your physician about the different types of sports you would like to do and whether this would be an appropriate option for you.
Work and dialysis
You may continue to work even as a dialysis patient if your health status allows you to. In any case, follow your physician's recommendations.
Which dialysis treatment is suitable for work?
There are differences regarding your flexibility and different treatment options. This has an impact on the compatibility of your job and your treatment. Please consult your physician on which may be the best option for you.
| Peritoneal dialysis | Home hemodialysis | Hemodialysis |
|---|---|---|
| If hygienic requirements are met, bag exchanges can also be performed at your workplace. APD allows for treatment overnight, enabling you to work during the day. PD procedures offer a comparatively high degree of flexibility. | If you perform hemodialysis independently at home, you can decide for yourself when to perform the dialysis sessions. As a result, you are more flexible in the way you practice your profession, even when doing dialysis. | If your hemodialysis treatment takes place at a centre, you would be expected to attend the appointments there. As a result, you can only do your job before or after your dialysis sessions. |
Appointments at the clinic
It is advisable to talk to your employer about your dialysis schedule in the clinic in advance. Outline how often and how long you have to be there for your treatment. If you inform your employer openly and have a transparent exchange, misunderstandings can be avoided in advance. You can also talk to a member of the human resources department, the disability officer or someone you trust.
Facts about the different treatment options
A successful kidney transplantation is close to natural kidney function and is considered the most effective treatment for ESRD.
Fewer restrictions on your diet.
The waiting time for a kidney transplant typically takes several years.
Continuous intake of anti-rejection medication is necessary.
If the new kidney fails, dialysis can still become necessary.
Kidney function is not replaced and your kidneys will eventually stop working, leading to natural death.
Focus lies on maintaining quality of life (not extending life) and treating symptoms.
The decision to choose conservative care should be made with careful consideration and involve your treating physician and loved ones.
Find some answers to further questions related to your treatment options in the next section.
