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Kidney Failure Management and Options

The primary function of the kidneys is cleansing blood within the body by excreting waste products (toxins) and extra fluid from the body, passed out through urine. Once complete kidney failure occurs, dialysis or kidney transplantation are the only options available. Dialysis is basically substituting the kidney function with the help of a machine. Kidney failure is deemed when the kidneys are performing less than fifteen percent.

The best way to deal with kidney failure is to anticipate and prepare for it as an eventuality in case other treatments do not yield desired results. There are various treatment options available with their respective positives and negatives. Greater awareness and help from the Nephrologist (Kidney doctor) will help enable a patient to make the right choice. Often, conversing with others who have undergone various kidney treatments will help in better understanding the outcomes of dialysis, transplant or regular management of the disease. Consulting a kidney specialist along with a team of healthcare professionals is mandatory. Preparing oneself mentally, physically and socially to undergo the procedure(s) is the key to tackling such a life changing event.

Treatment options include Hemodialysis, Peritoneal Dialysis, Kidney Transplant and Conservative Management.

Hemodialysis involves using a machine to filter blood through the dialyser (filter) and returning the toxin free blood back into the body circulation. This removes waste and excess fluids, normalises blood pressure and brings balance to various levels of minerals such as sodium, potassium and calcium. Remember that Hemodialysis will not improve the functioning of the kidneys but will most certainly help improve the condition of patient by making one feel much better and prolong his/her life. A lifestyle change will also have to accompany this procedure; food and water intake will have to be regulated while certain medications will be prescribed. In order to perform Hemodialysis, a minor surgery will be needed to create an access (AV Fistula / Catheters) from where blood will be drawn out and returned into the body. Hemodialysis is done 2-3 times per week at a dialysis centre or at home; the latter can be determined after taking into consideration factors such as condition of the patient. While in centre treatment will provide proper facilities and personnel, in house treatment will provide quick and regular dialysis which could enable the patient to lead a life of greater flexibility.

Peritoneal Dialysis is done at home using the lining (peritoneum) of the belly (abdominal cavity) to filter waste and excess fluid. A prerequisite minor surgery is carried out to insert a catheter in the belly (which will remain there indefinitely). A dialysis solution (medicated water) will be inserted through the catheter into the belly. The patient can resume normal activity like moving around once the liquid is completely transferred into the belly. Inside the abdomen, the solution will soak up excess waste and fluids and this impure fluid will then be drained out into a plastic bag which can then be disposed off. This process will continue and is called an “exchange”. There are two forms of Peritoneal Dialysis - continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In CAPD, the “exchange” is done three to four times a day, each lasting approximately forty minutes and the solution is left in the belly overnight. APD uses a machine known as a cycler to perform three to five exchanges per night while the person is asleep. At times a combination of CAPD and APD might be required if the person weighs more than eighty kilograms or if the peritoneum removes fluid and toxins inadequately. The primary benefits of both CAPD and APD are self-reliance, as external help is not required by the patient to carry out the procedure, and convenience of timings, ease of travel and work as only the solution is required.

It is necessary to manage expectations and people must remember that no form of dialysis can improve the health of the kidneys. 

The other option for kidney failure patients is Renal (Kidney) Transplant, which is basically replacing a failed kidney with a healthy donated one. During a kidney transplant, surgeons mostly leave the failing kidney in place and insert the donated one in the lower abdomen attaching it to arteries and veins of the patient. The donor‘s ureter (urine tube from the kidney) is also transplanted in order to facilitate urine flow from the kidney to the bladder. immunosuppressants or anti-rejection medicines will need to be taken in order to prevent the body from attacking the new kidney. The benefits of a kidney transplant are the resumption of normal life, no need for constant dialysis and a greater chance of leading and living a longer life.

In India, one can undergo kidney transplant with a donation from close relatives, friends and deceased (brain dead) donors. Now-a-days we can do transplants even if the blood group does not match (ABO incompatible transplant).

Conservative Management focuses on the control of symptoms and is sought in case a person refuses or is unfit for dialysis or transplant. Consulting a doctor will help in making the choice between dialysis, transplant or conservative management. Other complications in the body must be taken into consideration as well before planning the management. Kidney complications mar normalcy and are burdensome but timely treatment and professional management go a long way in helping patients lead a fairly healthy and fruitful life.

The choice rests solely with the individual.

 

Dr. Vikram Kalra

Sr. Consultant & Additional Director

Nephrology & Renal Transplantation

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