Definition

End-stage renal disease (ESRD) is that stage of kidney impairment which is irreversible, cannot be controlled by conservative management alone, and requires dialysis or kidney transplantation to maintain life.

Description

There are two types of kidney failure: acute and chronic.

Acute kidney failure is a temporary decline in kidney function that can most often be corrected.

Chronic kidney failure, on the other hand, is a permanent condition, meaning that once it occurs, the kidneys cannot be made to function again.

Chronic kidney failure may be the result of heredity, as with polycystic kidney disease, or may be caused by prolonged medical conditions, such as high blood pressure or diabetes. Persons with chronic renal failure are referred to as having end-stage renal disease. The term indicates that the patient must rely on some type of medical treatment to help replace the loss of kidney function.

Treatment

The treatment alternatives for ESRD include hemodialysis, peritoneal dialysis, and kidney transplantation. These are all viable treatment alternatives.

Hemodialysis

This is a procedure that cleans and filters the blood. It rids the body of harmful wastes and extra salt and fluids. It also controls blood pressure and helps the body keep the proper balance of potassium, sodium, and chloride.

Hemodialysis uses a dialyzer, or special filter, to clean the blood. The dialyzer connects to a machine. During treatment, the blood travels through tubes into the dialyzer. The dialyzer filters out wastes and extra fluids. Then, the newly cleaned blood flows through another set of tubes and back into the body.

Before the first treatment, an access to the bloodstream must be made. The access provides a way for blood to be carried from the body to the dialysis machine and then back into the body. The access can be internal (inside the body, usually under the skin), or external (outside the body).

Hemodialysis can be done at home or at a center. Hemodialysis is usually done three times a week. Each treatment lasts from 2 to 4 hours.

Peritoneal Dialysis

This is another procedure that replaces the work of the kidneys. It removes wastes and chemicals form the body. This type of dialysis uses the lining of the abdomen to filter the blood. This lining is called the peritoneal membrane.

A cleansing solution, called dialysate, travels through a special tube into the abdomen. Fluid, wastes, and chemicals pass from tiny blood vessels in the peritoneal membrane into the dialysate. After several hours, the dialysate gets drained from the abdomen, taking the wastes from the blood with it. Then the abdomen is filled with fresh dialysate and the cleaning process begins again.

There are at least three types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD); continuous cyclic peritoneal dialysis (CCPD); and intermittent peritoneal dialysis (IPD).

CAPD is the most common type of peritoneal dialysis. It needs no machine and can be done in any clean, well-lit place. The dialysate passes from a plastic bag through a catheter and into the abdomen. The dialysate stays in the abdomen with the catheter sealed. After several hours, the solution is drained back into the bag.

CCPD is like CAPD except that a machine which connects to the catheter automatically fills and drains the dialysate from the abdomen. The machine does this at night when the patient is asleep.

IPD uses the same type of machine as CCPD to add and drain the dialysate. IPD can be done at home but is usually done in the hospital. IPD treatments take longer than CCPD.

There are pros and cons to each type of peritoneal dialysis which should be discussed with your doctor. Hemodialysis and peritoneal dialysis are treatments that try to replace the failed kidneys. These treatments help the patient feel better and live longer, but they are not cures for end-stage renal disease.

Kidney Transplantation

This is a procedure that places a healthy kidney from another person into the recipient's body. The one new kidney does all the work that the two failed kidneys cannot do.

A surgeon places the new kidney inside the body between the upper thigh and abdomen. The surgeon connects the artery and vein of the new kidney to the recipient's artery and kidney. The blood flows through the new kidney and makes urine. The new kidney may start working right away or may take a few weeks. The failed kidneys are left where they are, unless they are causing infection or high blood pressure.

After kidney transplantation, the patient must begin taking immunosuppressive medications in order to prevent the donor kidney from being rejected by the patient's body.

You may receive a kidney from a member of your family. This kind of donor is called a living-related donor. You may receive a kidney from a person who has recently died. This type of donor is called a cadaveric donor. Sometimes a spouse or very close friend may donate a kidney. This kind of donor is called a living-unrelated donor.

It is very important that the donor's blood and tissue match the recipient's. This match will help prevent the body's immune system from rejecting the new kidney.

Questions to Ask Your Doctor

• What treatment choices are there?
• What are the pros and cons of hemodialysis and peritoneal dialysis?
• What are the advantages and disadvantages of the several types of peritoneal dialysis?
• Which do you recommend?
• Is this procedure preformed at home?
• Is a transplant needed?
• Are there donor organizations that can help in this case?