Other Treatments for End-stage Renal Disease (ESRD)

Hemodialysis is done with a machine. Blood leaves the body through tubes placed into a vein. The machine filters the blood with a special solution. Clean blood is sent back to the body.

Vascular access allows blood to move between the body and the machine. Minor surgery is needed to make the connection. There are 3 types:

• Arteriovenous (AV) fistula—An artery and vein are connected together. The vein gets stronger and wider. This allows blood to move faster between the body and the machine. An AV fistula needs to be placed at least 6 months before hemodialysis starts.
• AV graft—A tube is used to connect an artery and vein. The healing time is not as long. An AV graft can be placed 3 to 6 weeks before hemodialysis starts.
• Catheter for temporary access—A tube can be placed in a neck, chest, or leg vein. This method is only used if hemodialysis needs to be done quickly or for a short time.

Hemodialysis is done at a special center or at home. The number of days a week and hours needed is different for each person. Hemodialysis at home must be done more often and for more hours.

Some problems are:

• Infection
• Lightheadedness
• Headache
• Feeling tired and weak
• Muscle cramps
• Dry skin
• Heart rhythm problems
• Bleeding

This method uses the lining of the belly to filter blood. A special solution is placed through a tube that goes into the belly. Fluids, wastes, and chemicals pass out of the lining and into the solution. The solution is then drained from the belly. Surgery may be needed to place a port for long-term peritoneal dialysis.

There are 3 main types:

• Continuous ambulatory peritoneal dialysis (CAPD)—This is the most common type. No machine is needed. A special fresh solution fills the belly through a tube. The blood is filtered on a steady basis so it is always clean. Waste is drained into another bag. This needs to be done a few times a day.
• Continuous cyclical peritoneal dialysis (CCPD)—Fluid exchanges are done by machine at night while you are asleep. Wastes drain through a tube into a container or the toilet.
• Intermittent peritoneal dialysis (IPD)—This method uses the same type of machine as CCPD. But, it is usually done at a special center a few times a week. This type is not done as often.

Some problems are:

• Serious infection
• Constipation
• High blood glucose levels
• Weight gain
• Bleeding in the belly
• Fluid leaks from the belly