Treatment Options (Modalities) for Kidney Failure

Transplant

Once the eGFR is less than 20 we make referrals to transplant centers to help appropriate patients get on the transplant list. In case you are started on dialysis before we have had the opportunity to make the referral then we will begin the transplant center referral process from the dialysis unit. The longer one is on the transplant list, the more likely one is to receive a transplant. The more centers one is listed at, the more likely one is to get a transplant. We refer to all transplant centers.

Good Transplant Centers

Transplant Centers with Relatively Low Transplantation Percentages

Home Therapies

Home Peritoneal Dialysis (PD, Tummy Dialysis at home)

We call peritoneal dialysis (PD) as tummy dialysis. In peritoneal dialysis, clear fluid is placed in the belly cavity for about 2 hours and toxins diffuse into the fluid. Depending on the amount of remaining kidney function the number of peritoneal dialysis exchanges is then determined to keep your blood clean. The peritoneal dialysis treatment can be done from the comfort of your home. It takes 2 – 3 weeks of training. A care partner can be involved to help patients with treatments if necessary.

Home Hemodialysis (HHD, Machine Dialysis at home)

We call hemodialysis (HD) as machine dialysis. Access (either a catheter, fistula, or graft) is placed by a surgeon or interventional radiologist/nephrologist to allow for blood to leave the body to run through the machine to clean and return the blood back to the body. Ideally, a fistula or graft is placed though this takes some time to mature. In less than ideal situations, a catheter is placed and can be used immediately.

When hemodialysis is done at home it is called home hemodialysis (HHD). Because patients dialyze more frequently (at least 4 or 5 days a week – and sometimes even daily), patients feel better than when they do hemodialysis in the in-center setting (see below). Because of the complexity involved, it takes 5 – 6 weeks of training and a care partner is almost always involved.

In-Center Hemodialysis (ICHD)

We call hemodialysis (HD) as machine dialysis. Access (either a catheter, fistula, or graft) is placed by a surgeon or interventional radiologist/nephrologist to allow for blood to leave the body to run through the machine to clean and return the blood back to the body. Ideally, a fistula or graft is placed though this takes some time to mature. In less than ideal situations, a catheter is placed and can be used immediately.

When hemodialysis is done at a dialysis unit is called in-center hemodialysis (ICHD). Patients typically dialyze 3 days a week on either a Monday/Wednesday/Friday (MWF) or Tuesday/Thursday/Saturday (TTS) schedule. Though less common, some patients are able to dialyze less frequently including twice or even once a week. This is a good modality for patients who are not able to easily take care of themselves or live in a nursing home. Transportation is arranged for patients who can not travel to the dialysis unit on their own.

Conservative Management/Care and Hospice Services

Some patients may choose the option of conservative management to focus on improved quality of life of the limited time left over extending life with aggressive measures such as dialysis which in some cases can reduce the quality of life available. When patients choose this route, we get palliative care services involved and the next step often times includes hospice care and/or comfort measures. Studies have indicated that in appropriate circumstances that there will be improved quality of life and even an increase in survival.