Dialysis
Patient Treatment
Below is some information on different treatment options that may help with your condition.
Treatment Options:
kidney.niddk.nih.gov/kudiseases/pubs/hemodialysis/index.htm
Renal Disease: A guide for Patients:
www.ika.ie/images/stories/ika_images/jpeg/beaumont%20renal%20book%202.pdf
My doctor says that I will need to have dialysis. What will this involve?
In Ireland, about 170 people each year reach the end-stage of renal failure and are in dire need of treatment to replace their non-functioning kidneys.
All suitable patients are placed on dialysis. If they have a reasonably successful response they may continue on this treatment indefinitely or be placed on a list for a kidney transplant.
Dialysis will involve the removal of waste products from your body by passing your blood through a filtration machine that mimics the function of the kidneys. It is an arduous process that needs to be performed on a regular basis for as long as the kidneys are unable to function.
There are two different types of dialysis, peritoneal dialysis and haemodialysis. Peritoneal dialysis would involve placing a tube through the lining of your abdomen (peritoneum) and into your abdominal cavity. This tube can then be left in place for some time.
Dialysis is performed by running a special fluid into your abdomen via the tube and then draining it out a number of hours later. This fluid collects your body’s toxins that would normally be filtered out by healthy kidneys. Some kidney patients find that this form of dialysis can even be performed at home and many choose to carry out the process at night as they sleep.
Haemodialysis is about one-tenth as efficient as having normal kidney function. This involves running your blood through an 'artificial kidney' machine. The blood passes from an artery via a tube through a membrane in the machine. The machine, generally only available in hospital renal units, cleans the blood of its toxins and returns it through a vein to your body via another tube.
Haemodialysis takes a number of hours to complete and must be repeated every few days. This form of dialysis can be particularly hard on you, as it entails regularly travelling to and from hospital for treatment.
A dietitian will advise you on what to eat when you are on dialysis. You will be encouraged to eat high protein food, including meat and chicken. The amount of potassium in your diet will be strictly monitored as it can be harmful to your heart if your take either too much or too little. Potassium is a mineral found in fruit such as bananas, vegetables, milk, chocolate and nuts. Your fluid intake will be monitored carefully as well. Salt will be restricted as it makes the body retain fluid.
There are currently about 400 people in Ireland successfully receiving dialysis treatment. About 230 of these must attend major city hospitals to receive haemodialysis. The remainder filter their blood at home through the use of peritoneal dialysis.
While haemodialysis involves travelling to hospital for treatment, it can be reassuring to have specially-trained personnel available at all times. If you choose to have peritoneal dialysis, you will certainly find that it is more flexible and can be carried out when it suits your own routine.
What exactly is involved in a kidney transplant?
Kidney transplantation involves removing a kidney from one body and resiting in the body of another person. The donor may be living or recently deceased (cadaver donor).
Live donors include a brother, sister or parent with identical blood and tissue types to those of the recipient and the success rate is higher in these cases. They will usually recover quickly from surgery, with no problems. The removal of the kidney from a living donor and the transplantation in the recipient are usually synchronised in adjacent operating theatres to reduce the risk of damage to the kidney.
For cadaver donors, after death the body is kept on a ventilator and the kidneys are ‘harvested’ in an operating theatre. Once removed the kidneys can be transplanted up to 36 hours later. The donations are usually anonymous.The kidneys are kept cool during transport and are brought to Beaumont Hospital, Dublin, where the transplant operations are performed.
Donors must be free of significant disease, such as cancer or serious high blood pressure. Similarly, recipients must not have any diseases that would make a transplant operation dangerous or cause the transplanted kidney to fail. These include:
HIV or AIDS.
An incurable disease such as TB.
Severe disease affecting other organs, such as severe heart disease, emphysema or cirrhosis of the liver.
Recipients must also be able to understand the transplant operation and the responsibilities that go with it. They must not abuse alcohol or drugs and must be willing to follow medical advice.
When a kidney becomes available the surgeon has a very short time to accept it for transplantation, therefore the potential recipient must be available and contactable at all times. This may mean wearing a pager or mobile phone constantly.
A transplanted kidney takes over the functions of the damaged kidneys. The ureter (long, thin tube that transports urine from the kidney to the bladder) of the transplanted kidney is imbedded in the wall of the recipient’s bladder and the kidney is attached to the renal artery and vein to ensure a good blood supply.
The recipient must have regular blood tests and check-ups, and must take imunosuppressant medications for the rest of their lives to ensure that their body does not reject the kidney as a foreign body. A kidney from a cadaver donor usually lasts about 10 years, while those from living donors can last 20 or 30 years. If the kidney fails, it is possible to go back on dialysis and have another transplant.
The Irish success rate is one of the highest in Europe – 90% with kidneys from cadaver donors and over 91% with kidneys from live donors. While the rate of transplantation does not quite keep up with the waiting list, the situation is improving. Patients can expect to wait an average of less than one year for a transplant.
The number of transplants has risen steadily in the last 10 years. In 1990, there were 137 patients transplanted, a rise of 30% on the previous year. In 1995 that figure had risen to 147 and by October 1998 the figure was 133.
Where can I get more information about kidney disease?
You may wish to contact the Irish Kidney Association, which provides support and information to kidney patients, their families and friends. The IKA publishes a magazine and runs educational awareness campaigns about kidney disease. The association offers advice on diet and actively promotes organ donation. The IKA has also opened a state-of-the-art support centre to accommodate families of patients receiving treatment at the National Kidney and Transplant Unit in Beaumont Hospital. To find out more, contact the Irish Kidney Association online at www.ika.ie or Tel: LO-CALL 1890 456556.
If you are diagnosed with kidney damage your GP will refer you to a specialist renal unit. There are specialist renal units at the following hospitals in Ireland:
Castlebar General Hospital (094) 21733
Cavan General Hospital (049) 61399
Cork Regional Hospital, Wilton (021) 546400
Beaumont Hospital, Dublin (01) 8377755
Adelaide & Meath Hospital, Tallaght (01) 4142000
St Vincent's Hospital, Dublin (01) 2694533
Mater, Dublin (01) 8032000
Children's Hospital, Temple Street, Dublin (01) 8748763
Children's Hospital, Crumlin, Dublin (01) 4558111
Galway Merlin Park Regional Hospital (091) 757631
Letterkenny General Hospital, Donegal (074) 25888
Limerick Regional Hospital (061) 327455
Sligo General Hospital (071) 71111
Tralee General Hospital, Kerry (066) 26222
Waterford Ardkeen Regional Hospital (051) 73321
The staff at any of these units should be able to answer any questions you may have