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Information > Kidney Disease > Treatment

There are two treatment options for patients diagnosed with ESKD.
  • Dialysis of which there are two types of treatment.

Haemodialysis with three versions of treatment (option 1) Haemodialysis Haemodiafiltration Haemofiltration Peritoneal Dialysis of which there are also two versions of treatment (option 2) Continuous Ambulatory Peritoneal Dialysis (CAPD) Automated Peritoneal Dialysis (APD)  
  • Kidney Transplantation (option 3)
  • Conservative Management (option 4)

Option 1: Haemodialysis

A dialysis machine sometimes called a kidney machine pumps blood out of your body to an artificial filter on the machine. The machine also pumps a dialysate solution to the filter. The blood is on one side of the filter separated by a membrane and the dialysate is on the other side. Waste substances and excess water only pass from your blood through the membrane and into the dialysate. This cleaning process continues for normally 4 hours.

The typical haemodialysis patient will have to attend a treatment centre 156 days a year and have 624 hours of dialysis treatment per year. The 312 journeys annually to and from the dialysis unit typically involve sharing transport with others.

Time spent travelling and waiting for fellow patients, delays and breakdown of equipment, waiting for Doctors and drug prescriptions, x-rays and blood tests, easily add two hours a time to the 4 hours on dialysis. Eighteen hours or half the working week is assigned to life preserving treatment. This time commitment by the patients is 2nd to none in the health system. The typical patient has a fluid restriction of one litre a day because they don’t pass urine and have to adhere to a bland dietary regime, multiple drugs have to be consumed because dialysis does not replace all the functions of the kidney. Dialysis treatment only gives 5% kidney function back to the patient. This is why it has to be done so often. The patient must have an operation to join a vein to the artery to increase and strengthen the flow of blood to the haemodialysis machine. With good management this access point - (which if is often called) should last 5 years. When it fails the operation has to be repeated - if possible.

Option 2: Peritonealdialysis

The peritoneum is a thin lining or membrane surrounding many of the bodys internal organs. Peritoneal dialysis uses this membrane as a natural filter to separate waste products from the blood. A tube is permanently inserted into the abdominal cavity (via a minor operation) and a specially prepared fluid called dialysate is put into this cavity (1-2.5 litres). Waste substances slowly pass from your blood across the peritoneal membrane and into the dialysate fluid. The dialysate fluid with the waste substances must be removed after a period of time and fresh dialysate fluid is inserted immediately to continue the process. This removal and replacement of dialysate is called "the exchange". The CAPD patient will do these exchanges themselves every 4 hours, 4 times a day, every day.

The typical peritoneal dialysis patient manages himself his own care and will have to spend 1-2 hours a day draining dialysis fluid in and out of the tummy. The dialysis happens inside the body in the rest of the time. Regular medical checks apply. A special commitment of the patient is needed. The long-time implanted catheter may cause problems (infection, drainage). Some important aspects of life may be limited, others are easier to achieve as dependency from medical staff and flexibility in the treatment are greater.

Option 3: Kidney Transplantation

A surgeon will place the donor kidney above the left or right side of the groin. The blood vessels of the new kidney are joined to the large artery and venin that carry blood to your legs. Normally the failed kidneys are not removed.

The typical kidney transplanted patient is on a daily immunosuppressive therapy (anti rejection drugs) to stop their body from rejecting the transplanted organ and often on other necessary drugs (high blood pressure, cholesterol). Regular medical checks apply. A rejection of the transplant can happen especially in the first months after the transplant or when long time transplanted. The quality of life has increased.

Option 4: Conservative Management

Some patients may already be coping with other chronic or serious diseases and have a very poor quality of life already. Dialysis may just prolong suffering rather than offer relief. Patients themselves sometimes choose to stop having dialysis treatment. For obvious reasons the survey has none of these patients included and the amount of patients who chose the option is unknown to us.

CEAPIR acknowledges
the financial contribution
of Roche for maintenance
of this website.
  Copyright © 2008, European Kidney Patients' Federation (CEAPIR): All rights reserved.