By Yaakov Liss, MD | Nephrology
By the time individuals with chronic kidney disease (CKD) need dialysis treatments, they’ve already been through a lot. More than 26 million American adults have kidney disease – meaning the kidneys aren’t fully removing waste from the body – though many don’t know it. Diabetes and high blood pressure are the top two causes of CKD, which can start slowly but ramp up to trigger symptoms such as nausea, fatigue, swelling, and vomiting. When patients begin to experience these symptoms, this usually means they have lost more than 90% of their kidney function, and it is time to begin treatment to replace their lost kidney function.
The most commonly utilized treatments for advanced CKD are a kidney transplant and hemodialysis. Hemodialysis replaces kidney function by removing a patient’s blood and running it through a dialysis machine to remove toxins and excess fluid, returning cleansed blood to the body. Unfortunately, hemodialysis tends to be a burdensome process. Most patients who receive hemodialysis do so in a dialysis center, which they must visit at least 3 times a week and sit in a chair for 3 to 4 hours at a time while the machine does its work. While dialysis itself is generally painless, patients on dialysis are prone to sudden drops in blood pressure, which can cause nausea, vomiting, headaches, or cramps.
In addition to being time-consuming, center-based dialysis treatments are both tiring and tiresome – the latter because patients’ lives tend to center around the treatments. Their ability to work a normal schedule, travel freely, or otherwise enjoy flexibility is threatened by the treadmill-like existence they face having to visit a dialysis center so often.
This is why I’m pleased that another dialysis option has been growing in popularity and availability: at-home dialysis treatments that patients can perform while they sleep.
The Alternative to in-center Hemodialysis: Automated Peritoneal Dialysis
There’s long been an at-home dialysis option known as peritoneal dialysis (PD), a bloodless method of dialysis that removes toxins and excess fluid from the body by instilling fluid in the belly and subsequently draining it. Historically, PD was performed by instilling and draining fluid 4 to 6 times a day. This involved transferring a dialysis solution from a bag into the belly through a surgically placed tube known as a PD catheter. This taxing process then required draining the fluid out into a separate bag a few hours later in a process known as an “exchange.”
More recently, a more convenient option has been introduced that’s as effective as in-center hemodialysis in cleaning the blood but offers the convenience of being at home. Known as automated peritoneal dialysis (APD), this process removes bodily waste products using a special machine called a cycler. The cycler is programmed to automatically instill fluid into the patients’ belly and then subsequently drain the fluid, and can be set up to perform dialysis in an ongoing fashion throughout the night while patients sleep.
APD works while making just a quiet hum and can even continue working uninterrupted if the patient needs to get up in the middle of the night to use the bathroom. If a patient accidently lies on the catheter attaching them to the machine, an alarm will sound. About 30 minutes are needed to set the APD machine up and connect to the machine before bedtime, and another 20-30 minutes the next day to disconnect from the machine and discard all the supplies used overnight. And once patients disconnect from the machine in the morning, they’re free to move about easily during waking hours.
Many Advantages to Patients
No matter which type of dialysis is used, it can’t cure kidney disease. But home APD offers many distinct advantages, allowing patients to remain more independent, keep their regular jobs, and feel less disabled. In short, it offers a way for dialysis to fit into their lives – and doesn’t force their lives to fit into their dialysis schedule.
If you or a loved one requires dialysis treatments, speak to your doctor to determine the most appropriate type of dialysis for your medical and personal needs.