When you develop kidney disease, your kidneys are damaged and cannot filter blood the way they should. As your kidney disease gets worse, your provider or nephrologist may talk to you about preparing for kidney failure. When your kidney function drops below 15 percent of normal, you are said to have worsening kidney failure, and you may reach a point when the kidney function has to be replaced with dialysis. You will then need to be referred to a vascular specialist to create your access.
At South Charlotte General and Vascular Surgery, our dialysis access specialists are very experienced in the creation and maintenance of all types of dialysis access.
How is dialysis done?
There are two main types of dialysis: hemodialysis and peritoneal dialysis.
Hemodialysis (HD): uses an external machine and a special type of filter to remove excess waste products and water from the blood. It requires that a permanent access is created in the patient’s arm to allow access with two needles, one to pull the blood out and the other to return the cleansed blood to the patient. The vascular access can be provided through one of three methods:
1. Dialysis catheter: a specialized catheter with two large ports is inserted in your neck under ultrasound guidance and will provide a temporary method for patients who need urgent dialysis.
2. Arteriovenous fistula: our vascular surgeon will create a connection in one of your arms between a vein and an artery. The procedure is commonly done in a hospital setting as an outpatient. The connection will cause the vein to enlarge and thicken over a period of time to allow the safe access to the blood vessel during dialysis. After 4-6 weeks, our surgeons will evaluate the fistula and determine if it is appropriate for use. If your fistula does not mature on its own, it may require further intervention in our office with balloon angioplasty to help it mature and become ready for dialysis.
3. Arteriovenous Graft: prior to creating your access, our surgeons will thoroughly evaluate your veins with a preoperative venous mapping to gage if your vein and artery is suitable for a fistula. Alternatively, if your veins or arteries are deemed too small, a vascular tube (graft) is inserted under the skin and connected to the vein on one side and to the artery on the other. The graft itself is accessed with two needles during the treatment after a short period of healing, normally two weeks.
Peritoneal dialysis (PD): uses a fluid that is placed into the patient's abdominal cavity through a special tube (peritoneal dialysis catheter which would be inserted surgically as an outpatient procedure) to remove excess waste products and fluid from the body. Peritoneal dialysis uses the patient’s own peritoneal membrane inside of the belly (abdominal cavity) to act as the filter. A special fluid called dialysate is then placed and allowed to dwell into the abdominal cavity and wash around the intestines. The peritoneal membrane acts as a filter and is able to draw the waste products and excess water from the body. After a period of time, the dialysate is allowed to drain.
Where will my dialysis take place?
Hemodialysis will typically require that you to go to the dialysis center nearest to you three times a week for a few hours. However, more and more patients are now able to do their own hemodialysis at home.
Peritoneal dialysis is done in the comfort of your own home. Initially, the treatments are repeated a few times a day, but after the initial period of adjustment, most patients are able to receive while they are sleeping (night time dialysis). One additional treatment during the day will then suffice to cleanse their body adequately.
Which method is better for me?
Truthfully, no dialysis method is perfect. Each modality has its advantages and potential problems. Our vascular surgeons will discuss with you at length each modality, and present you with the rationale for choosing one method over the other after they consult with your kidney specialist. You will then be able to decide which modality suits your lifestyle better.
Our vascular surgeons are well experienced in the creation, monitoring and maintenance of all forms of dialysis access. Our accredited vascular laboratory and angiography suite allow us to care for your dialysis right in our office, right here in South Charlotte, and save many hospital admissions.