The kidneys remove waste, toxins and excess fluid from the blood. They also regulate body water and release important hormones in your blood to control blood pressure, make red blood cells and promote strong bones. If a person’s kidneys fail, he or she will become quite ill because toxins accumulate in the blood. If there is no medical intervention, the patient may die.
End-stage kidney disease (ESKD), or kidney failure, is a chronic, irreversible condition that may ultimately lead to death without one of two interventions: dialysis or transplant. Because transplant is a limited option due to a shortage of donor organs, dialysis is by far the most common treatment. It is estimated that nearly 2 million people worldwide will use dialysis in lieu of properly functioning kidneys to cleanse their blood by 2010.
Peritoneal Dialysis
In PD, dialysis solution is administered into the peritoneal (abdominal) cavity through a catheter in the patient’s abdomen. The peritoneal cavity is surrounded by a thin membrane (called the peritoneum), which serves as a filter through which waste and excess water are drawn into the solution. The used solution is then drained from the abdomen and discarded. There are two types of PD treatment: continuous ambulatory peritoneal dialysis (CAPD), in which patients manually infuse their PD solution and perform solution exchanges several times a day; and automated peritoneal dialysis (APD), in which solution is infused and drained automatically by a device.
Hemodialysis
In HD, blood is withdrawn from the body, usually from a site in the arm and pumped through an external filter, or dialyzer. The cleansed blood is then returned to the patient. Patients are connected to a machine throughout the process, which takes several hours and generally takes place three to four times a week in a dialysis clinic or hospital.
Home Hemodialysis (HHD)
Recently, growing clinical evidence suggests that more frequent HD may improve patient outcomes, prompting an interest in the development of home HD systems to make more frequent dialysis more convenient for the patients. HHD is a form of HD using a device modified for the home. It can be done at night while the patient is asleep, or during the day. It typically is done three to six times a week. The length of the dialysis sessions varies. If done during the night while the patient sleeps (nocturnal HD), it usually lasts anywhere from six to eight hours. If done during the day (short daily HD), the treatments are usually from two to four hours.
Continuous Renal Replacement Therapy (CRRT)
Acute kidney injury (AKI) is a rapid decline in the kidneys’ ability to clear the blood of toxic substances, as opposed to chronic kidney disease, which occurs slowly over time. Acute renal failure can result from any condition that decreases the supply of blood to the kidneys, obstructs the flow of urine once it has left the kidneys, or causes injury to the kidneys. This can lead to an accumulation of metabolic waste in the blood requiring immediate attention in an acute care setting. CRRT is typically performed 24 hours a day in the intensive care unit to address AKI.