Krt Treatmentoptions Series

8/12/2019 Krt Treatmentoptions Series

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www.KidneyFund.org | 866.300.2900 January 2013

Treatment Options forKidney FailureIf your kidneys stop working, you will need treatment to help

manage the symptoms of kidney failure. Treatments that clean

waste and luid from your blood can help you live longer. This

fact sheet will explain the basics about four types of treatment for

kidney failure, including:

Kidney transplant

Peritoneal dialysis

What is a kidney transplant?A kidney transplant is when a healthy kidney from another person

is put into your body. The kidney can come from a living donor or

someone who has just died. The new kidney will do the work that

your old kidneys used to do.

Things to think about: A kidney transplant can help you have a more normal

lifestyle than other treatment options.

You will need to have many tests and may have to wait a

long time before you can get a kidney transplant. You may

need to do dialysis while you wait.

If you get a kidney transplant, you will need to take anti-rejection

medicines for as long as you have the new kidney.

Kidney transplants dont last forever. If your new kidney

stops working, you may need to do dialysis while you wait

for another transplant.

What is peritoneal dialysis?

Peritoneal dialysis (also called PD) uses the lining in your abdomen

(called your peritoneum) and a special solution (called dialysate) to

remove waste and extra luid from your blood.

IMAGE

TREATMENT OPTIONS

Hemodialysis

Medical management

There are many thing

to think about whe

deciding on a treatment

Work with your healthcar

team to find the treatmen

that is best for you


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American Kidney Fund11921 Rockville Pike, Suite 300 | Rockville, MD 20852

www.KidneyFund.org | 866.300.2900

2013 American Kidney Fun

Things to think about:

PD is a treatment that you do for yourself every day (or night) at home.

To do PD, you will need to have a lexible tube (called a catheter) in your abdomen. This requires

minor surgery, and the catheter will stay in your abdomen for as long as you need PD treatment.

If you do PD, you will need enough storage space in your home for all of your PD supplies.

What is hemodialysis?

Hemodialysis (also called hemo) is a treatment that cycles your blood through a special ilter on a dialysi

machine. The ilter cleans waste and extra luid from your blood. This is the most common type of

treatment for kidney failure.

Things to think about:

Hemodialysis is usually done at a dialysis center, but it can be done at home if

you are able and have a partner to help.

Most people do hemodialysis three times each week.

Each hemodialysis session usually lasts for three to ive hours.

In order to have hemodialysis, you must have a vascular access. This is where your blood

will exit and re-enter your body during treatments.

Getting a vascular access requires surgery. The best time to get a vascular access

is several weeks or months before you begin treatment.

What is medical management?

You may choose not to have a kidney transplant or do dialysis treatments. If you decide not to have any of

these treatments, you may not live for very long. Still, you can work with your healthcare team to slow dow

your kidney disease and prolong your life as much as possible. Your healthcare team can also prescribe

medicines to help you manage symptoms and stay comfortable. This is called medical management.

How do I choose a treatment option?

Start by talking to your doctor to learn more about your treatment options. You might also:

Think about your lifestyle and goals. Which treatment is the best match?

Talk with other patients, either online or through a local support group. Hearing aboutothers experiences can be helpful.

Try the treatment option you think will be best. Many patients are able to switch from

one type of treatment to another.


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Treatment Option:Kidney TransplantWhat is a kidney transplant?

A kidney transplant is when a healthy kidney from another person

is put into your body. When your kidneys have stopped working,

the new kidney can do the work that your own kidneys used to do.

There are two main types of kidney transplants:

Deceased donor transplant

A deceased donor transplant comes from someone who has just

died. To get a deceased donor transplant, you must be put on a

waiting list.

Living donor transplant

A living donor transplant comes from someone who is still living.

This is possible because each person only needs one normal

kidney to be healthy. A person with two healthy kidneys can

donate one kidney to someone whose kidneys have failed. A

living donor can be a family member, a friend or even a stranger.

How can I get a transplant?Talk to your doctor if you think you might want to get a kidney

transplant. Your doctor can help you decide if a transplant is right for

you. He or she can also refer you to a transplant center, where you

will work with a transplant team. Your transplant team may include:

A surgeon

A kidney doctor

A nurse or transplant coordinator

A dietitian

A social worker

A inancial coordinator

KIDNEY TRANSPLANT

There are many thingto think about whe






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Your transplant team will help you with the many tests you will

need to have before you can get a transplant. These tests help to

make sure that you are healthy enough for the operation and that

your new kidney is a good match. These might include tests to:

Check your heart and lungs Find the closest donor match (deceased or living)

Your doctor may order other tests, such as a colonoscopy, PAP

smear, mammogram, prostate or dental exam, to check for other

problems that might need to be treated irst.

Once your tests are done, your transplant team will look over your

results and decide if you are ready for a transplant. If you are ready to get a transplant, you can be added

to the transplant waiting list to wait for a deceased donor transplant. You can also start looking for a livi

donor.

If the doctors decide that you are not ready for a transplant, it may be because of other health problems

Some health problems may keep you from getting a transplant, and others may just need to be treated

irst. For example, if you are overweight, you may need to lose weight before you can get a transplant.

Your healthcare team can help you with this.

How long do I have to wait to get a transplant?

If you have a living donor, you can get your kidney transplant when you and your donor are both ready. I

usually best to get a living donor transplant either just before or soon after you need to start dialysis. Watimes for a deceased donor transplant vary, depending on:

Time already on the waiting list Location

Blood and tissue type

Whether certain antibodies are in your blood

While youre on the waiting list for a deceased donor transplant, you can also look for a living donor. If yo

are concerned about the wait time or are having trouble inding a living donor, you may want to ask your

transplant team about being put on lists in other areas, too. You might also ask your transplant team if

expanded criteria donation orpaired donationis an option for you.

Expanded Criteria Donation

Expanded criteria donors are deceased donors who are older or have less than normal kidney function

These kidneys may not last as long as other kidneys, but expanded criteria kidneys may be available

sooner than other kidneys and may improve and lengthen your life.

Transplant was the

answer to give me back

the freedom that I would

use, as far as being

outdoors, being active

being able to travel.

MattTransplant Recipient

Treatment Options: Kidney Transplant


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Paired Donation

Well explain paired donation with an example (see chart on the

right column). Alice wants to give a kidney to Andrew, but theyre

not a good match. Bill wants to give a kidney to Betsy, but theyre

also not a good match. But, Alice is a good match for Betsy, and Bill

is a good match for Andrew. So, Alice donates her kidney to Betsy,

and Bill donates his kidney to Andrew. That way, everyone gets a

kidney who needs one.

How should I take care of my new kidney?

One risk of a kidney transplant is that your body will reject (ight)

the new kidney. This can happen because your bodys immune

system knows that the kidney is from someone else. If your body

does reject your new kidney, the kidney may stop working.

To help keep your body from ighting your new kidney, you will needto take anti-rejection medicines (also called immunosuppressants).

You will need to take these medicines for as long as your new

kidney is working.

Be sure to take your anti-rejection medicines the way your doctor tells

you. If you have a problem with side effects, talk to your doctor. Do not

stop taking the anti-rejection medicines without talking to your doctor.

Even if you take your anti-rejection medicines as your doctor tells you to, there is still a chance that yourtransplant might not work. If the transplant fails, you will need to go back on dialysis. You may also want

to ask about having another transplant.

How will I pay for my transplant?

Kidney transplants and anti-rejection medicines can be very expensive. Many government and private

insurance programs will help you pay for the surgery and medicines. Work with your transplant team to

igure out a plan to pay the expenses that insurance might not cover. You can also ask your social worker

about inancial assistance, or contact the American Kidney Fund for more resources.

Additional resources:

National Institute of Diabetes and Digestive and Kidney Diseases: www.kidney.niddk.nih.gov

Transplant Living: www.transplantliving.org

Illustration courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases, www.niddk.nih.gov.

GETTING KIDNEY

GIVING KIDNEY

BillAlice

BetsyAndrew

GETTING KIDNEY

GIVING KIDNEY

BillAlice

BetsyAndrew

PAIRED DONATION


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Treatment Option:Peritoneal Dialysis (PD)What is peritoneal dialysis?

Peritoneal dialysis (also called PD) is a treatment for kidney failure.

It is a way to clean waste and luid from your blood when your

kidneys have stopped working.

How does PD work?

PD uses the lining in your abdomen (called your peritoneum) and a

special solution (called dialysate).

Before you begin PD, a doctor will place a tube (called a catheter)

into your abdomen. Through this tube, you will put new solution

into your abdomen and drain old solution out.

Each time you change the solution is called an exchange. Between

exchanges, the solution will sit inside your abdomen. During this

time, the solution will absorb waste and luid from your blood,

through your peritoneum. After a certain amount of time, you will

replace the old solution with new solution.

There are two types of PD:

Continuous cycler-assisted peritoneal dialysis (CCPD) uses a

machine (called a cycler) to do exchanges.

Continuous ambulatory peritoneal dialysis (CAPD) uses gravity

to help you do manual exchanges.

Many people do some of both CAPD and CCPD to make sure theyre getting enough dialysis. For example, yo

doctor may suggest that you do CCPD at night while you sleep and do a couple of CAPD exchanges during the da

When should I do PD?

PD must be done every day (or night). Your doctor will tell you how many exchanges you need to do each

day and how long you need to let the solution sit in your abdomen between exchanges.

PERITONEAL DIALYSIS


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Where should I do PD?

Most people do their PD exchanges at home, but you can do them

any place that is clean and dry.

What else should I think about?

As you consider PD, think about how it its with your lifestyle.

Diet

Most people on PD follow a kidney-friendly diet that limits

phosphorus, potassium, sodium and protein. But, the diet for

people on PD is usually not as strict as the diet for people on

standard hemodialysis. Ask your dietitian about making a meal

plan that works for you.

Work and school

PD often allows for a more lexible schedule than other types

of treatment. This may make it easier for you to keep regular

schedules for work, school or other activities.

Travel and activities

When traveling, your PD supplies can be shipped to your

destination(s). Also, there are usually very few limits on

activities, but people on PD are usually told to avoid hot tubs,

public pools and lake swimming. Think about the types of

activities you enjoy and whether PD would be a good it for you.

Finances and insuranceMost people on dialysis are eligible for Medicare. For people

doing home dialysis treatments like PD, Medicare may begin as early as the irst month of treatment.

Talk to the social worker at your dialysis center to learn if you can get Medicare and whether you may

need a second type of coverage.

PD may be a good option for people who are just starting dialysis. Ask your doctor whether PD is a

good option for you.



Kidney School: www.kidneyschool.org


PREVENT PERITONITIS!

Peritonitis is an infection of you

peritoneum. This can happen

when germs get into your

abdomen through your cathete

If you choose PD take simple

steps to help prevent peritoniti

Only do exchanges in clean,

dry spaces.

Do not allow pets or plants

in the room.

Wash your hands with

antibacterial soap before

each exchange.

Wear a mask while you

do exchanges.

Tell your doctor right away

if you have pain or your

solution looks cloudy.


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Treatment Option :HemodialysisWhat is hemodialysis?

Hemodialysis (also called hemo) is a treatment for kidney failure.

It is a way to clean waste and luid from your blood when your

kidneys have stopped working.

How does hemodialysis work?

Hemodialysis uses a machine to clean your blood. During

treatment, your blood travels from your body, through the dialysis

machine, and back to your body. While it is in the machine, your

blood goes through a special ilter (called a dialyzer), which

removes waste and luid.

When and where can I do hemodialysis?

In-center hemodialysisis the most common treatment for

kidney failure. This is done at a dialysis center. Most people who

do in-center hemodialysis will have three treatments per week,

with each treatment lasting about three to ive hours. If youchoose to do in-center hemodialysis, you will work with your

dialysis center to schedule appointments.

Home hemodialysisis a treatment you do yourself, with the

help of a partner, at home. Both you and your partner must be

trained to use the machine and insert needles. Home hemodialysis

may let you have a more lexible treatment schedule. For example,

you may be able to do treatments more often but for shorter times.

Still, you will need to work with your doctor to make sure that youre

getting enough dialysis.

HEMODIALYSIS


to think about whe






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How can I get ready for hemodialysis?

In order to have any type of hemodialysis, you will need to have a

vascular access. Your vascular access is the place on your body that

needles are inserted during treatments. This is how your blood will

exit and return to your body. There are three types of vascular access:

Fistula Graft

Catheter

Discuss with your doctor which type of vascular access is right for

you. Also ask your doctor when you should get your vascular access.

This requires surgery and will need time to heal. Your doctor may

recommend getting a vascular access even if you are not planning to

start dialysis right away.

What else should I think about?As you consider hemodialysis, think about how it its with your lifestyle.

Diet

Following a kidney-friendly diet helps to limit the buildup of waste and luid between dialysis treatments

This can help you feel better during treatments and can also help you avoid heart and bone problems.

Work with the renal dietitian at your dialysis center to ind a kidney-friendly meal plan that works for yo

Travel

You can still travel while doing hemodialysis, but you may need to do a bit more planning. To prepare

for a trip, you will need to schedule dialysis appointments with centers at your destination to make sur

youre covered along the way. Talk with the social worker at your dialysis center to learn more about

travel resources for dialysis patients.

Finances and insurance

Medicare, Medicaid and many insurance plans will cover most of the costs of dialysis. Most people

on dialysis are able to get Medicare coverage, no matter their age; however, depending on the type of

treatment you choose, you may have to wait a few months before coverage begins. You may also need to

pay deductibles or co-pays. Check with your insurance provider to learn more about your coverage. The

social worker at your dialysis center can also help answer questions.





I have been going to

the clinic for a little ove

5 years, and Im very

happy there.

I like working with a

team on my treatment

I think theres a lot o

information that I gain

from being in dialysis.

KathyIn-Center, Hemodialysis Patien


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Preparing for HemodialysisVascular AccessWhat is a vascular access?

Hemodialysis uses a machine to clean your blood. During

treatments, your blood travels through a tube into the machine.

There, it goes through a special ilter (called a dialyzer), which

removes waste and luid. The cleaned blood then lows through

another tube back into your body.

Before you can have hemodialysis, you will need to have a

vascular access. This is the place on your body where yourblood goes in and out during treatments. There are different

types of vascular access. Talk to your doctor to decide which

kind of vascular access is best for you.

What are the types of vascular access?

There are two main types of vascular access:

AV fistula

An AV istula is when an artery is directly connected to a vein.

This is done by surgery. It is usually done in your non-dominantarm (the arm that you do not use as much). If youre right-

handed, it would likely be done in your left arm.

A istula is the best type of vascular access. It is the least likely

to have infections and blood low problems. But, a istula does

need time to heal and mature before its ready to use. It is best

to get a istula a few months before you start your treatments.

HEMODIALYSIS

AV FISTULA


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AV graft

An AV graft is when a special tube connects an artery to a vein. This

is also done by surgery and is usually in your non-dominant arm.

Unlike a istula, a graft is often ready for use in just a few weeks.

A graft is more likely to have problems with infection than a

istula. Still, a graft may be a good option if a istula wont healwell or if you have small veins.

Do I have any other options?

A central venous catheter is another type of vascular access. It is a tube

that goes directly into a vein, usually in your neck or chest. Out of all

the types of vascular access, catheters are the most likely to become

infected and have low problems. A catheter does not need time to

heal, so it can be placed right before your irst dialysis treatment.

A catheter is a last resort option. It should only be used in an

emergency and for a short amount of time.

How can I care for my vascular access?

Because your AV istula or graft allows you to get the treatment you

need, you might call it your lifeline. Below are some ways to care

for your vascular access.

For all types of vascular access:

Keep your vascular access clean and dry at all times. Ask your doctor or nurse if you have any questions.

For catheters:

-Avoid showers and swimming.

For AV fistulas and AV grafts:

-Avoid sleeping on your access arm, and keep tight clothing and

jewelry away from your access. As a general rule, anything that

leaves a mark is too tight.-Ask your nurse how to check the pulse in your access. Check it every day, and call your doctor

or dialysis center if you notice any swelling or redness around your access.

-Be careful not to bump or cut your access. Also, dont lift heavy objects that may press directly

on your access.

AV GRAFT

CENTRAL VENOUS

CATHETER

Preparing for Hemodialysis Vascular Access


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Other common questions:

You might feel like youre alone, but many people who are about to

start dialysis have many of the same concerns, like:

Will I have to get needles put in at each treatment?

At each of your dialysis treatments, a nurse or dialysis technician

will put two needles into your vascular access. If needle

placement hurts too much, you can ask your doctor for a numbing

cream. You can also learn how to put in the needles yourself,

which might help.

What will my vascular access look like?

Your vascular access is a bulge under the skin. You will have some scarring from the surgery and needl

placements as well. Talk to your doctor, nurse, social worker or other patients if you are worried.

What should I wear to dialysis treatments?You should wear loose clothing to dialysis treatments. There is also special clothing for people who get

dialysis. This clothing makes it easier for nurses to get to your access site. You can ind access clothing

online, or ask your nurse or dialysis technician about it.

Will I be cold during dialysis?

People do become cold during dialysis, so you may want to bring a blanket, gloves and/or sweater with yo




PROTECT YOUR VEINS

Protect your arm where your

AV fistula or graft may be

placed. Dont let anyone take

blood or check blood pressure

from that arm.


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Treatment Option:Medical ManagementWhat is medical management?

How you treat your kidney failure is your choice. Learning about the

options can help you decide which treatment is best for you. If your

kidneys fail, you may start dialysis or get a kidney transplant. These

types of treatment replace some of the work your kidneys used to do.

You may choose tonotstart dialysis ornotget a kidney transplant.

And in some cases, people who start dialysis decide to stop. Supportive

care and treatment to manage your symptoms, without doing dialysisor getting a kidney transplant, is called medical management.

How long will I live if I choose

medical management?

How long you will live depends on many things. Some people may

live without dialysis or a kidney transplant for a while, but others

may not live as long. Your doctor will help you stay as healthy as

possible without those treatments.

What else should I think about?

Time-limited trial

If you are not sure whether to start dialysis, ask your doctor about trying dialysis for a set amount

of time. You and your doctor will decide on a treatment plan and goals for the trial. At the end of the

trial, you can decide with your doctor if dialysis helped you meet your goals and whether you want to

continue.

Depression

Depression is a common challenge for people with kidney failure, and it can affect your decisions. Whenyou are depressed, you may feel lonely, sad or worthless. You may lose hope. These feelings might be

temporary and can often improve with help. Talk to your doctor or another member of your healthcare

team about how you are feeling before you make the decision to stop or not to start dialysis.

TALK WITH YOUR DOCTOR


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Hospice

Ask your doctor about hospice care. Most people who choose medical management are able to get

hospice care. The goal of hospice care is to keep you comfortable and improve your quality of life while

you are dying. Hospice care can:

-Provide care and help you manage symptoms

-Help you have the best quality of life possible

-Offer support for you and your family

-Take place at your home, nursing home or a hospice center



Kidney End-of-Life Coalition: www.kidneyeol.org

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Krt Treatmentoptions Series