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My therapy options

Which therapy option is right for me?

Your physician has discussed with you that your kidney function is severely impaired and that you will need to select a renal replacement therapy (RRT) option that is most suitable for you soon, to preserve both your life and quality of life. As there is more than one option available for therapy for many patients, it is important that you take the opportunity to learn more about your therapy options to make the right choice for you personally.

Choosing the right therapy for kidney failure may be difficult. Become familiar with the therapy options and, together with your physician, choose the therapy that best suits your health status and lifestyle.

Supporting you on your way

We would like to support you on your path to the right therapy and have compiled the most important information about different therapy options.

  • With some tips that support choosing the right therapy, we will provide you some guidance on the way to making a decision
  • We want to introduce to you the most important therapy options: transplantation, peritoneal dialysis, hemodialysishome hemodialysis and conservative therapy
  • The dialysis therapy you chose is not set in stone…
  • Dialysis changes your everyday life. In the section My life with dialysis, we address the most relevant topics for choosing a therapy option: everyday life, exercising, vacation and nutrition

Kidney transplantation

Who can donate a kidney?

  • A living blood relative (e.g. parents or siblings).
  • A living unrelated donor (e.g. a life partner or very close friend)
  • A deceased donor who agreed to donate before their death

Peritoneal dialysis (PD)

The PD catheter

  • A catheter is a soft, flexible plastic tube that is about the thickness of a straw in diameter.
  • In peritoneal dialysis, dialysis fluid flows in or out of the abdomen through the catheter.
  • The catheter is placed into the abdominal cavity through a minor surgical procedure and permanently remains in place. It is usually ready for use two weeks after the surgery.

Facts about PD

  • You perform the treatment independently, seven days a week, at home, as prescribed by your nephrologist.
  • However, you are not alone: a physician will check on you regularly and a PD nurse is available for you on-call by phone.
  • With PD, you are relatively flexible. That allows you to plan your daily life. This can be important for you if you work, go to school or travel.
  • In addition, PD is possible almost anywhere, so you can dialyze at work, for example. However, talk to your physician about this beforehand!
  • By not having to travel to a dialysis center, you have more time for yourself and only need to schedule check-ups with your physician.
  • PD can help maintain residual kidney function.
  • No needles (punctures) are needed to perform PD and the treatment is usually painless.

What you need to do to succeed at PD:
 

  • You will receive detailed training at your dialysis center to ensure that you feel comfortable doing PD on your own. You will also learn proper catheter care.
  • Be aware that it may take some time to get used to the fluid in your stomach. It is usually not a problem for an adult to have two to three liters of fluid in the abdominal cavity.
  • Following certain precautions will help you avoid the risk of an infection called peritonitis. Hygiene control is one of the most critical aspects of PD therapy. Your nurse will give you instructions on how to avoid infection.
  • You will need ample storage space for your supplies at home.
  • If you have diabetes, be aware that your physician may need to adjust your dose of insulin. This is because the sugar in the dialysis may raise your blood sugar levels.
  • You will perform your treatment every day, seven days a week, as prescribed by your nephrologist.
  • You will visit your dialysis center once or twice a month for check-ins with your physician and your care team.

Continuous ambulatory peritoneal dialysis (CAPD)

How to perform a bag exchange step-by-step

Automated peritoneal dialysis (APD)

Learn about peritoneal dialysis in the following video:

Hemodialysis

During a hemodialysis treatment, your blood is filtered outside of your body through a dialyzer, also called a filter or artificial kidney, to remove unwanted waste, toxins, and excess body fluids. For the treatment, a specific access to the blood stream (vascular access) needs to be created that is used to access your blood vessels during treatment. There are three main vascular access types: a fistula, graft, or catheter. A surgeon will create this access, usually in the arm or sometimes in the leg, if it is a fistula or a graft. Catheters are generally inserted into the vessels in your neck. The preferred access for HD is a fistula, which is an access in the arm made by joining your vein and artery in a small surgical procedure and has been shown to have better outcomes compared to a graft or a catheter.

Hemodialysis uses a solution called dialysate to remove unwanted substances from your blood. Different from peritoneal dialysis, there is a special man-made membrane in the dialyzer that allows the cleaning of the blood. This restores your body and provides chemically balanced blood which is then returned to your body.

A typical hemodialysis treatment takes four to five hours and is repeated three times a week. However, the timing, duration and frequency of hemodialysis depend on your medical conditions and lifestyle as well as your insurance coverage.

If you choose in-center dialysis, you usually have three fixed appointments per week. With this treatment option, the dialysis team will prepare, carry out and monitor the dialysis for you.

Facts about hemodialysis

  • The treatment is carried out by trained nurses and physicians.
  • Your dialysis is in one place. You do not have to store dialysis machines or materials at home.
  • During dialysis, you can read, relax, work on the computer, watch TV, listen to music or do anything else you enjoy.
  • You may also want to talk to other dialysis patients. After all, it is good to know that you are not alone in this situation. For many patients, the dialysis treatment is a place to socialise and sometimes strong friendships develop between fellow patients.

Keep in mind:

  • Stick closely to your dialysis schedule: usually three appointments per week, four to five hours a day, plus arrival and departure.
  • Complete the entire session. Even stopping five minutes early can make dialysis less effective and harm your health.
  • In the first few months of therapy, you may still be exhausted and wobbly on your feet after dialysis. If this is the case, ask a family member or friend to bring you to and pick you up from the sessions. Some dialysis centers may also be able to offer support.

Home hemodialysis

Facts about home hemodialysis

  • You are more flexible in terms of work, school or other social activities, as you can choose your dialysis times yourself as recommended by your dialysis team, as compared to In-center HD.
  • You stay in the familiar environment of your own home during dialysis, and have the possibility to always reach your dialysis team by phone.
  • Typically, you can choose your diet more freely if your physician prescribes more frequent dialysis sessions.
  • You do not have to leave the house for dialysis, which saves travel time and transportation costs and you do not need to worry about arrival and departure times.
  • You may be able to do the HHD completely on your own. You or your care partner insert the needles yourself, which is preferred by some patients.

Keep in mind:

  • Generally, in the first weeks, you go through a training phase, together with a partner or a friend whom you trust, if necessary.
  • If you have a family member or friend to help you with dialysis, this person must be reliable. The person must agree to assist with your HHD or stay with you to monitor the treatment.
  • You or your loved one must be ready to prepare for dialysis and clean the equipment afterwards.
  • It must be checked whether your water and electricity supplies need to be renovated or converted. Make sure there is someone who can organize this.
  • You also need to create some space at home to store materials and equipment.
  • If you are frightened of needles, this is one point to consider when making your decision. Talk to your physician about it!

Dialysis in a center

Learn about hemodialysis in the following video:

Conservative treatment

Make a choice

Related Content

1 Mucsi I, Hercz G, Uldall R, Ouwendyk M, Francoeur R, Pierratos A. Control of serum phosphate without any phosphate binders in patients treated with nocturnal hemodialysis. Kidney Int. 1998;53(5):1399-1404. doi:10.1046/j.1523-1755.1998.00875.x
2 Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA. 2007;298(11):1291-1299. doi:10.1001/jama.298.11.1291
3 Chan CT, Shen SX, Picton P, Floras J. Nocturnal home hemodialysis improved baroreflex effectiveness index of end-stagerenal disease patients. J Hypertens. 2008; 26(9):1795-1800. doi: 10.1097/HJH.0b013e328308b7c8
4 Marshall MR, Polkinghorne KR, Kerr PG, Hawley CM, Agar JW, McDonald SP. Intensive Hemodialysis and Mortality Risk in Australian and New Zealand Populations. Am J Kidney Dis. 2016;67(4):617-628. doi:10.1053/j.ajkd.2015.09.025
5 Rydell H, Ivarsson K, Almquist M, Segelmark M, Clyne N. Improved long-term survival with home hemodialysis compared with institutional hemodialysis and peritoneal dialysis: a matched cohort study. BMC Nephrol. 2019;20(1):52. Published 2019 Feb 13. doi:10.1186/s12882-019-1245-x
6 Marshall MR, Walker RC, Polkinghorne KR, Lynn KL. Survival on home dialysis in New Zealand. PLoS One. 2014;9(5):e96847. Published 2014 May 7. doi:10.1371/ journal.pone.0096847

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