Patients who are experiencing Chronic Kidney disease usually have two choices of treatments. They can go on dialysis or have a transplant. These treatments usually commence when less than 10% of kidney function remains.

Dialysis

Dialysis is a treatment process that helps to replace the work of kidneys by cleansing/filtering the blood and removing excess fluids. Dialysis helps a patient feel better and live longer, but it will not cure kidney failure. However, this treatment has been proven to be effective and is currently used by more than 7,000 Australians.

There are two types of dialysis, Haemodialysis and Peritoneal Dialysis. In some cases the renal physician may recommend one over the other due to medical reasons, however, the choice is totally up to the patient.

Other factors that need to be considered when making dialysis choice include:

  • Place of residence and how often the treatment is required;
  • The impact of dialysis on a personal and family level; and
  • How the method fits into work, study, social life, leisure activities, business and holiday travel requirements.

Both forms of dialysis work equally well when carried out as instructed and, when the patient has taken measures to maintain their health as recommended by their physician. Patients are not required to commit permanently to one form of dialysis. In some cases, a patient may need to change over because of medical reasons. Each form of dialysis treatment lasts between 4-6 hours and is performed 3 times per week. In some cases, dialysis may last longer and need to be done more frequently.

Haemodialysis

Haemodialysis is a treatment where the blood is cleansed outside the body using a machine to temporarily rid the body of harmful wastes, extra salt and extra water. This can be performed at home, or in a satellite, self-care or hospital renal unit.

Advantages

  • Can be performed at home to the patients convenience;
  • Involvement by patient, their partner and family;
  • It can be scheduled to fit into lifestyle; and
  • Reduced time spent in transit and in hospital.

Disadvantages

  • Overcoming fear of needles and self-cannulation;
  • Self motivation;
  • Requires stable and supportive family or network of friends; and
  • Need to be medically stable.

Nocturnal haemodialysis: is a form of dialysis that is performed overnight at home. It usually takes up to 8 hours to complete. The advantage of this treatment includes:

  • Improved feelings of well-being;
  • Fewer medication and dietary restrictions; and
  • Reduced intrusion into daily life.

Note: This treatment is not available yet in Queensland hospitals, but it is currently being trialled.

The cost of haemodialysis in public hospitals and satellite units is covered by Medicare. Private treatments are covered by private health insurance. For home treatments, the cost of all necessary equipment is covered by the Government. Patients are responsible for the maintenance and safe storage of equipment. In some cases, the patient may have to pay for extra equipment such as a recliner chair and cost of plumbing.

Dialysis machines can put stress on water and power supply. However many local authorities do provide rebates and concessions for patients.

Peritoneal dialysis

Peritoneal dialysis  is a procedure that removes extra water, wastes and chemicals from the body. This type of dialysis works inside the body and uses the lining of your abdomen to filter your blood.

Advantages

  • Continuous dialysis means that a steady blood chemistry is maintained;
  • Self care dialysis;
  • Simple to learn and perform (1-2 weeks training);
  • Minimal fluid and dietary restrictions;
  • No needle punctures required;
  • Ease of travel as it is compact and portable;
  • Minimal cardiovascular stress; and
  • Overnight Dialysis.

Disadvantages

  • Peritonitis: inflammation of peritoneal membrane due to bacterial infection.
    Can be lowered by disconnecting delivery system and good hygiene.
  • Protein loss: body protein escapes through peritoneal membrane and into peritoneal solution.
    Can be combated by increasing protein intakes through diet.
  • Potential increase in fat and cholesterol: leads to narrowing of blood vessels.
    Can be overcome by doing regular exercise and taking medication.
  • Peritoneal catheter: a permanent access point in the body for dialysis.
  • Daily dialysis schedules.
  • Possible weight gain.
  • Storage space needed for supplies.

Kidney Transplant

Kidney Transplant surgically replaces the failed kidney with a healthy kidney from another person. In order for a transplant to take place, patients must be matched with a suitable kidney. If a family donation is not possible, patients are required to go on the waiting list. An average, successful transplant can grant survival for 15 years. This form of treatment provides a better quality of life and life expectancy than dialysis. However, transplant may not suit those with severe heart and vascular disease.

Possible complications after transplant

  • Rejection: The body resists foreign cells or tissue of donor kidney.
    – Symptoms: fever, decreased urine output, fluid retention and increase in weight, tenderness over the kidney and elevated blood pressure – most can be reversed with drug treatment.
  • Unsuccessful transplant: If the kidney doesn’t function, even after medical treatment, then it will be removed. Patients will resume dialysis and they are usually permitted to go back on the waiting list.

After a successful transplant, patients can return to normal activities within 3-6 months. Patients who wish to have a baby are advised that they should wait until at least 1-2 years of good kidney function as there is an increased risk of pregnancy issues such as premature births and hypertension in transplant patients. It is advised to discuss this with a doctor.