Dialysis

Dialysis is currently practiced in two forms: peritoneal dialysis and hemodialysis. Both types filter the blood to help the body eliminate waste, excess water, and excess salt.

Peritoneal dialysis (PD) uses the lining of the abdomen to filter the blood. This process is conducted through a small tube surgically placed in the lower part of the abdomen. Several times a day, dialysis fluids are introduced into the abdomen and allowed to remain for several hours. While the fluid is in the abdomen, extra water, salt, and waste travel across the abdomen lining into the dialysis fluid. Afterwards, the dialysis fluid is drained, flushing away the body’s chemical waste products.

There are two types of peritoneal dialysis. The first type is continuous ambulatory peritoneal dialysis (CAPD), which doesn’t require a machine. The patient is able to walk around with the dialysis solution in their abdomen. The second form, continuous cycler-assisted peritoneal dialysis (CCPD), requires the use of a machine called a cycler to fill and drain the abdomen, usually while the patient sleeps.

The main advantage of peritoneal dialysis is that it can be performed at the patient’s home. No scheduled hospital or clinic visits are required. It can then be carried out at times convenient to the patient. The patient must work to a high standard of cleanliness and self-discipline while carrying out the procedure, in order to avoid the risk of infection.

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Peritoneal dialysis is a good treatment option for people who have kidney failure. Advantages include:

• Few dietary or fluid restrictions.
• No needle sticks.
• Independence and ability to normalize daily routines.
• Ability to do dialysis at home.
• Reduced dependence on blood pressure medicine.
• Fewer problems with anemia.

Miami Kidney Group has 3 centers in South Miami where the doctors work in close conjunction with peritoneal dialysis nurses, dieticians, and social workers to provide optimal training and close monitoring for peritoneal dialysis.

For further information on PD, visit the following websites:

Fresenius Medical Care peritoneal dialysis treatment options:
http://www.ultracaredialysis.com/Treatment/PeritonealDialysis.aspx

Kidney Patient Guide (animated video on peritoneal dialysis):
http://www.kidneypatientguide.org.uk/pdanim.php

Hemodialysis (HD) filters blood with the help of a dialysis machine. The blood is removed from the body through a needle and passed through the machine, which removes all waste, excess water, and excess salt. The cleansed blood is then returned to the body through a second needle.

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If hemodialysis is going to be done on a regular basis, then a vascular access site, called a fistula or graft, is surgically created in one of the patient’s veins. If hemodialysis is being performed as a temporary measure, then a catheter is likely to be inserted through the neck vein to create an access point through which blood is removed and returned.

A fistula is the best choice for hemodialysis. It is preferred because it usually lasts longer and creates fewer problems, such as clotting or infections. Fistulas may need as long as two to three months to fully heal or “mature” before they can be used on a regular basis. Ideally, a fistula is created electively, many months before starting dialysis, in cases of chronic renal failure where the need for dialysis is felt to be inevitable.

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A graft can be implanted under the skin of the arm for patients that have small veins that won’t develop properly into a fistula. The graft is a synthetic tube that connects an artery to a vein. It becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. A graft doesn’t need to develop as a fistula does, so it can be used sooner after placement, often within two or three weeks. Compared with properly formed fistulas, grafts tend to create more problems with clotting and infection, and they need replacement sooner. However, a well cared-for graft can function for several years.

A venous catheter may be inserted into a patient as temporary access when there is not enough time to create a permanent vascular access. A catheter is a tube inserted into a vein in the neck, chest, or leg (near the groin.) It has two chambers to allow a two-way flow of blood. Once a catheter is placed, needle insertion is not necessary. Catheters are not ideal for permanent access. site directory . They can clog, become infected, and cause narrowing of the veins in which they are placed. But if a patient needs to start hemodialysis immediately, a catheter will work for several weeks or months while the permanent access develops.

The physicians in Miami Kidney Group work closely with vascular surgeons to determine what type of access is ideal for each individual patient based on the size and the quality of the patient’s veins.

There are also different types of hemodialysis:

• In-center hemodialysis requires the patient to go to a hospital or a dialysis center for treatment. Hemodialysis is usually performed 3 days a week and takes 3 to 5 hours a day.

• Home hemodialysis allows a patient to perform dialysis treatments at home, after some training. Hemodialysis is usually performed 3 days a week (or every other day.) The length of each session varies as recommended by the nephrologist.

• Daily home hemodialysis also allows a patient to perform dialysis treatments at home, after some training. Hemodialysis is performed 5 to 7 days a week. Each session takes about 3 hours.

• Nocturnal home hemodialysis allows a patient to perform dialysis treatments at home overnight, after some training. Hemodialysis is performed 3 to 7 nights a week. Each session is done overnight (about 6 to 8 hours.)

Miami Kidney Group, in conjunction with Fresenius Medical Care, has the ability to accommodate dialysis patients in 13 different dialysis units in the South Florida area. We operate these dialysis units at different times during the day and night to accommodate each patient’s schedule.

For further information on HD, visit the following websites:

US Department of Health and Human Services:
http://kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/

In-Center Hemodialysis (video including tour of dialysis facility):
http://www.youtube.com/watch?v=saJoipF4noY&feature=plcp

Dialysis Access (video describing access options):
http://www.youtube.com/watch?v=8LFer0mwOf8&feature=channel&list=UL

Kidney Patient Guide (animated video on hemodialysis):
http://www.kidneypatientguide.org.uk/HDanim.php

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