Dialysis is a process that uses a machine (an artificial kidney) to remove the waste products that have accumulated in the blood. There must be a connection to a blood vessel (vascular access), usually in your forearm, permitting blood to flow to and from the artificial kidney. Typically, hemodialysis is performed three times a week for 4-6 hours each time.
Another form of dialysis, called peritoneal dialysis, removes wastes from the blood in small blood vessels in the membrane lining your abdominal cavity. After the physician creates a “permanent” access to this area, dialysate can be put into and drained from the abdomen at regular intervals. Continuous ambulatory peritoneal dialysis (CAPD) is the most common of this type of dialysis. During CAPD, approximately 2 liters of dialysate are infused and drained every 4-6 hours by the patient. You do not have to go to the hospital or clinic for this.
For the large majority of people with diabetes – more than 80% – who develop ESRD in the U.S., hemodialysis is the therapy. Approximately 12% of the others will be treated with peritoneal dialysis, and the remaining 8% will receive a kidney transplant. People who are motivated and well-trained are quite successful with peritoneal dialysis. The advantages of CAPD are freedom from a machine, rapid training, minimal cardiovascular stress, and avoidance of the need (as with hemodialysis) for an anti-clotting drug called heparin.
Although some physicians call CAPD a first choice treatment for ESRD patients with diabetes, you and your physician should weigh the pros and cons of each before deciding what is best for you. The disadvantages of CAPD are the need to pay constant attention to fluid exchange, being at constant risk of peritonitis (infection of the lining of the abdomen) that requires hospitalization, and running out of abdominal area to use.
The results of daily hemodialysis are being studied. Reports indicate that patients’ blood pressure is lower, there is less anemia, and they have a greater sense of well-being.
Dialysis is not likely to give you the same long-term results as a kidney transplant. Current statistics show that about half of the people with diabetes who start on hemodialysis die within 4 years. This is often from a heart attack because many of these patients also have hypertension and cardiovascular problems. But success rates are improving each year.