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Treatment Options for End Stage Renal Disease

Questions and Answers about
Ways to Treat Kidney Disease

What is End Stage Renal Disease (ESRD)?

Once you have begun dialysis therapy, are waiting for or have received a transplant, you have End Stage Renal Disease, or “ESRD” for short.

Why Do Kidneys Stop Working?

  • Diabetes
  • High blood pressure
  • Chronic kidney infections
  • Severe injury
  • Birth defects
  • Certain drugs
  • Other kidney disease

What Do Normal Kidneys Do?

  • Remove extra water.
  • Remove waste products.
  • Balance chemicals in the body.
  • Help control blood pressure.
  • Help make red blood cells.
  • Help build strong bones.

What Happens When Kidneys Fail?

  • The kidneys are not able to clean waste products from the blood.
  • Waste products build up in the blood causing you to feel bad.
  • This build up of waste products is called uremia.

What are Some Signs of Kidney Failure?

  • Extreme tiredness.
  • Nausea and vomiting.
  • Shortness of breath.
  • Difficulty sleeping.
  • Swelling in the hands, face, and feet.
  • High blood pressure.
  • Itchiness.
  • Loss of appetite.

What Can be Done if my Kidneys Fail?

  • Dialysis and kidney transplantation are procedures to replace lost kidney function.
  • Diet and medication are important treatments for kidney failure.
    • The dietitian will tell you what foods to eat to help you feel better.
    • The doctor will order medicine to help with problems such as blood pressure control and water removal.

What About a Transplant?

  • A kidney transplant places a healthy kidney from another person into your body.
    • Transplants can come from living or non-living (cadaveric) donors.
  • The new kidney is placed in your lower abdomen.
    • Most people need to be hospitalized for 1-2 weeks after their transplant.


  • A successful transplant can help return you to a state of good health.
  • Transplant is a treatment, not a cure.
    • You will need to take medicine and see a doctor regularly.
  • You may need to wait for a kidney to be available.
    • A donor kidney must be a “match” for your body.
    • Your doctor will need to make a complete medical evaluation to determine if you are a transplant candidate.

What are my Dialysis Treatment Options?

  • Dialysis is a procedure used to treat kidney failure.
  • Dialysis does some of the things a normal kidney does, such as:
    • Remove extra water from the body
    • Remove the waste products that have built up in the blood.
  • There are two kinds of dialysis — hemodialysis and peritoneal dialysis.


  • Uses an “artificial kidney”, or dialyzer, and a machine.
    • Blood is pumped through the dialyzer.
    • Extra water and waste products are removed.
    • Then the blood is pumped back into your body.
    • About a cup of blood is outside your body during this procedure.

Hemodialysis Access

  • Blood flow to the machine usually comes from a vein in your arm or leg.
    • A surgical procedure is done to change a vein into a fistula or graft.
    • This fistula or graft is called a blood access.
  • Needles are inserted during the dialysis treatment to take blood to the machine and dialyzer.
  • If you have problems with your fistula or graft, or if you need to start dialysis right away, a temporary tube may be put into a vein near your chest or neck.

How is Hemodialysis Done?

Incenter hemodialysis

  • Is performed 3 times a week for usually 3 to 4 ½hours
  • Incenter nocturnal dialysis is usually 3 times a week for eight hours depending on the physicians prescription
  • Nurses and technicians perform the treatments

Home Hemodialysis Treatments

  • You and a partner learn the procedure to perform the treatments at home
  • The number of treatments and the time on dialysis is similar to incenter hemodialysis and dependent on your physician’s orders
  • After you are trained, you come to the clinic usually once a month for a routine doctors appointment.

Things to Consider About Hemodialysis

  • You will have days off dialysis when you can do other activities.
  • You will be able to see and talk to nurses and doctors often.
  • There are many clinics and hospitals that offer hemodialysis treatment.
  • You will need to follow a strict diet to help you remain healthy.
  • Some people experience headaches, cramps, or nausea during the treatments.
  • You will need to check your blood access every day for signs of infection or clotting.
  • If performing hemodialysis at home
    • No trips to the dialysis center three times a week (once a month unless otherwise stated by your physician)
    • You will dialyze in the comfort of your home
    • You must have a partner to learn the procedure with you
    • You must keep accurate records of your treatments
    • You must be motivated, willing and able to learn the dialysis procedure

Peritoneal Dialysis (PD)

  • Uses your peritoneum as a dialyzer.
    • The peritoneum is a space in your abdomen.
    • A thin lining called the peritoneal membrane covers this space inside your body.
    • The peritoneal membrane acts as a dialyzer for your blood.
  • A special fluid called dialysate is put into the peritoneum.
    • The dialysate stays there for several hours.
    • Waste products and extra water move through the peritoneal membrane into the dialysate.
    • Then the used dialysate is drained away and replaced with fresh dialysate.

Peritoneal Dialysis Access

  • Dialysate goes in and out of your peritoneum through a small tube called a catheter.
    • The catheter is about the size of a straw.
    • It is put into your lower abdomen in aminor surgical procedure.
    • Your clothing covers the catheter when you are not using it.

How is PD Done?

  • Each treatment is called an exchange.
    • Your catheter connects to special tubing and a bag of fresh dialysate fluid.
    • Old dialysate is first drained out of your peritoneum.
    • Then you fill your peritoneum with the new dialysate.
  • CAPD (Continuous Ambulatory Peritoneal Dialysis)
    • Most exchanges are done during the day.
    • Exchanges are usually done when you wake up in the morning, around lunch time, and in the late afternoon.
    • The last exchange is done before bed.
    • Each exchange takes about 30 minutes.
  • CCPD (Continuous Cycling Peritoneal Dialysis)
    • Most exchanges are done at night while you sleep.
    • A machine called a cycler drains and fills your peritoneum for you.
    • Most people stay on the cycler for 9 or 10 hours each night.
  • PD Plus is another way to do PD. Many people do this combination of CAPD and CCPD.
    • They use the cycler at night.
    • They do an exchange during the day using the cycler, or they do a CAPD exchange.

Things to Consider About Peritoneal Dialysis

  • You are free to do all your usual activities while your dialysis is taking place.
  • You are in control of your treatment times.
  • You will still see your doctor and nurse during your clinic visits every 4-6 weeks.
  • The treatment is very gentle. Most people have no discomfort at all.
  • Your treatments are done every day.
  • Your exchange area needs to be kept very clean.
  • You must wash your hands and wear a mask for each exchange.
  • Your catheter and skin should be cleaned daily.

How Will I Learn to do Dialysis at Home?

  • The nurses in your clinic will teach you how to do your treatments.
    • Peritoneal dialysis teaching usually takes 1-2 weeks.
    • Home hemodialysis teaching usually takes 6-8 weeks.
  • If needed, a family member or partner will also learn how to do your dialysis.

Home Dialysis

  • You will need a clean place for supplies.
    • Your clinic will arrange for supplies to be delivered to your house every month.
  • If you go home with a peritoneal dialysis cycler or a hemodialysis machine, you may need to have electrical or plumbing outlets installed.

How Can I take Care of Myself?

  • Follow your diet to keep waste and water levels under control.
  • Take your medicines on time.
  • Learn how to recognize problems and who to call for help.
  • Stay as active as possible (based on your doctor's recommendation).
  • Dialysis should be part of your life, not your whole life.
  • Spend time with family and friends.
  • Family support is important to your health and happiness.

Your Healthcare Team

  • No matter which form of therapy you choose, you will have a team of healthcare professionals to meet your needs.
    • Your doctor
    • Nurses
    • Dietitian
    • Social Worker

The Choice is Yours

  • Be sure to ask your doctor and nurses any questions.
  • We want you to get the best care possible with the treatment you choose.

Potential Benefits of Nocturnal Hemodialysis:

  • Feeling more energetic
  • Sleeping better (despite being hooked up to a machine)
  • Having an increased appetite & regaining lost weight
  • Reduced restrictions on food & drink
  • Better skin color & condition
  • Being able to work

For more information about nocturnal hemodialysis or for a list of facilities offering this form of treatment, please call 920-725-9245.

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