This Health Facts for You tells you about the types of treatment to replace kidney function in patients with kidney failure. Our Kidney Treatment Team is here to support you and answer questions you may have.
Kidneys remove waste and extra fluid from your body. When your kidneys stop working, waste and excess fluids build up and can cause symptoms. You may have noticed some of the symptoms listed below.
Symptoms of Kidney Failure
Shortness of breath
Swelling around your eyes and lower legs, ankles, or feet
Poor sleep or feeling tired
Muscle cramps or weakness
Making less urine
Replacing Kidney Function
When your kidneys are not working, you will need a different way to remove waste and fluid from your body. There are a few different treatment methods. Some treatments are done at home. Others must be performed in a dialysis center. You can always change your type of treatment. You can choose which option would best fit your lifestyle and meet your needs.
We will review the treatment options with you and work with you to help you make your decision. Review the options and think about which choice best suits your needs. We will support your choice.
Peritoneal dialysis (PD) is a treatment that you do at home. Your blood is cleaned using the lining in your abdomen (peritoneum). Dialysate fluid is placed in your belly through a tube called a catheter. The fluid helps to draw waste products and excess fluid from your blood. This fluid drains out with the waste. This process is called an “exchange.” The catheter is disconnected from the tubing and capped tightly when not in use.
Continuous Cycling Peritoneal Dialysis
Some patients choose to hook up to a machine called a “cycler.” This machine allows patients to do several exchanges at night while they sleep. This method is called continuous cycling peritoneal dialysis (CCPD).
Continuous Ambulatory Peritoneal Dialysis
Others do these exchanges manually without connecting to a machine. Performing dialysis without a cycler is called continuous ambulatory peritoneal dialysis (CAPD). They do it a couple of times during the day, and a long exchange overnight.
Peritoneal Dialysis Catheter
A peritoneal dialysis catheter is placed with a simple procedure and heals in about 14 days. This type of catheter may be used right away after placement. Early use before healing requires you to lie flat while doing the exchanges for the first two weeks. After healing, you can perform the exchanges in any position.
Prolongs the kidney function you may still have
Fewer limits on what you eat or fluid you drink
Requires less time in the clinic, supplies are sent to your home
Easier to travel and maintain work/school schedule
Does not require needles for treatment
Slower, gentler treatment with fewer side effects
Better blood pressure control
Does not require a partner to help
Supplies are delivered monthly and take up a lot of space (about the space of a walk-in closet)
Treatment is done daily, and needs to be scheduled into your routine
The sugar in the dialysate fluids may cause weight gain or increased need for insulin in diabetics
Requires training in a clinic for 1-2 weeks for 4-6 hours daily
Requires careful cleaning to avoid infection
Hemodialysis is a treatment given in a dialysis center. This process cleans the blood by running blood through a filter to remove waste and excess fluid. The cleaned blood is then returned to you. In-Center treatment is done three times per week for 3-5 hours each session.
Types of Hemodialysis Access
Hemodialysis requires a way to access your blood to provide the treatment. There are three types of access that are used for hemodialysis. These options include:
Fistula that needs time to heal and will not be ready for about six weeks.
Graft that is ready for use in two weeks.
Catheter that is placed if you need to start dialysis right away.
Hemodialysis at Home
Most patients start this treatment in the dialysis center and then transition to home dialysis later, if desired. Most centers have a waiting list of people who want to do hemodialysis at home.
Requires less time than peritoneal dialysis
Less risk of infection (if using fistula or graft)
Trained staff will perform the treatment
Allows you to be social and meet other dialysis patients
Schedule times are limited. Your time slot might not work well with your schedule
You will be at the clinic for several hours, 3 times per week
You must follow strict diet and fluid restrictions
Visiting is limited during the treatment
Eating and drinking in dialysis units is often not allowed
A transplant is a surgery that places a donor’s healthy kidney into your body. Some patients have family or friends who are willing to donate a kidney. Other patients go on a transplant waiting list for a deceased donor kidney. Often, patients need dialysis while waiting for a transplant. Sometimes, patients receive a transplant before they need dialysis.
After a Transplant
After the transplant, you will need to be in the hospital for about a week. Transplant is not a cure. It is a replacement treatment for your failed kidneys. You will still need treatment to prevent your body from rejecting the donor kidney for as long as you have the transplant.
If you want to get a transplant, ask your nephrologist for a referral to a transplant center. You can also contact transplant centers directly as well. Organ Procurement and Transplantation Network provide patients with transplant contact numbers. Medicare will help with costs at the time of the transplant and for up to 3 years after the transplant.
No fluid or diet restrictions
Patients feel much healthier
More control over your schedule
Lower risk of death
You will need to take anti-rejection medicines for the rest of your life and some of these have side effects
Your new kidney may not work right away
Requires major surgery
Increases the risk of infection, diabetes, high blood pressure, and cancer
Some people choose not to treat their kidney failure. We encourage patients who have kidney failure but are otherwise healthy to treat their kidney failure. But some patients may have good reasons for choosing not to treat kidney failure. Choosing not to treat kidney failure is terminal and will result in death (in most cases sooner than if kidney failure treatment is started). If you do not wish to not treat your kidney failure, we do suggest that you see a Palliative Care Specialist. They will help to make you comfortable during terminal illness.
Please discuss your wishes with your family and your health care provider. If treatment is unlikely to improve your life expectancy or you do not wish to start treatment, please make your wishes known.
Making Your Choice
Each type of treatment has pros and cons. You will decide which therapy best suits your needs. Some find making this decision with family helpful. As you make your choice, think about:
Prolonging the kidney function you still may have
Fluid and dietary restrictions or changes
Number of treatments
Time spent for treatments and transportation to and from treatments
Costs of Treatment
Kidney treatment centers have social workers who can help patients figure out how to deal with the costs of treatment. Medicare covers most of the costs of treatment if you have kidney failure. They will cover regardless of your age. Contact the Social Security office to enroll. Before you can sign up, you will need a form called CMS 2728 filled out that states your kidneys have failed.
Medicare provides coverage starting at different points depending on your choice of treatment. They will begin to cover:
Your third full month of in-center hemodialysis
When you start training to do your home dialysis (starts with training)
When you are admitted for transplant
You are already on Medicare
Medicare will pay up to 80% of the costs related to kidney failure treatment. Other sources of funding may include:
Private health insurance or Employer-provided health insurance
State kidney programs, such as the Wisconsin Chronic Disease Program
Medigap (Medicare supplemental health insurance)
American Kidney Fund that can help with insurance premiums
Patient Advocate Foundation
Take Time to Review Your Options
There are a lot of things to think about when making your choice. Think about your ability to perform your dialysis or to fit a dialysis schedule into your routine. Your kidney care team can talk with you about your needs or answer any questions you may have.
Who to Call
If you need to speak with any members of the team, ask your nurse to contact the Inpatient Dialysis Team at UW Health. They can connect you with a kidney options nurse.
UW Dialysis Inpatient/Hospital Unit
Monday – Saturday, 7:30 am - 9 pm