Dr. MJ Bazos MD, Patient Handout Kidney Failure- Treatment of The kidneys are the master chemists of the body. Normally you have two kidneys, one on either side of your spine under your lower ribs. They are reddish brown in colour and shaped like kidney beans. Each kidney is about the size of a clenched fist. Kidneys are as important to your health as your heart, liver or lungs. Kidneys remove wastes from the blood via the urine. They regulate the levels of water and different minerals needed by the body for good health. They also produce hormones that control other body functions such as blood pressure. Many other organs depend on the kidneys in order to work properly. When kidney function is no longer adequate, dialysis treatment or a kidney transplant is needed to keep on living. Acute kidney failure occurs when your kidneys fail suddenly. In this situation, kidney function usually returns to normal, but dialysis may be needed until the kidneys begin to work again. There are a number of reasons why acute kidney failure happens. Slow and progressive deterioration of kidney function is called chronic kidney failure or chronic renal insufficiency (CRI). It is usually irreversible. Chronic kidney failure occurs when the tiny filters in the kidney (nephrons) that remove wastes stop working. Damage to the nephrons can be caused by conditions such as diabetes and high blood pressure. In some cases, good control of these conditions may slow or even prevent the development of complete kidney failure. There is no cure for chronic renal insufficiency. In the early stages, proper food choices, medications and good blood pressure control may be all that is required to slow the damage to the kidneys. However, once the kidneys are functioning at less than 10-20% of their normal rate, either dialysis or transplantation is needed to keep on living. This period is called end-stage renal disease or ESRD. Your doctor will tell you when you need to start treatment based on your medical condition and blood tests. Dialysis is a way to clean the blood by removing wastes and excess water. There are two types: hemodialysis and peritoneal dialysis. During hemodialysis, the blood is passed through an artificial kidney. The artificial kidney cleans the blood in almost the same way that healthy kidneys do. The treatment is performed usually three times a week. It can take between three and five hours each time and is called a run. Hemodialysis can be done in a hospital dialysis unit, in a self-care centre (with some assistance from the staff), or at home with the aid of a partner. Special training is required for self-care or home dialysis. Peritoneal dialysis works on the same principle as hemodialysis, but the blood is cleaned inside the body rather than through an artificial kidney. Your abdomen or "belly" has a peritoneal cavity lined by a thin membrane called the peritoneum that surrounds the intestines and other internal organs. In peritoneal dialysis, your peritoneal cavity is filled with a special dialysis fluid. Excess water and wastes pass through the peritoneum into the dialysis fluid. This fluid is then drained from the body and discarded. The process is repeated between four to five times a day (continuous ambulatory peritoneal dialysis, CAPD), or a machine called an automatic cycler can perform exchanges while you sleep. In most cases, this treatment can be performed without assistance, at home or at work. Peritoneal dialysis is sometimes done in a hospital, but more often, you are trained to do this independently at home. A kidney transplant is another treatment option for people with ESRD. It is now widely considered to be the best way of treating kidney failure; however, it is not suitable for everyone. Speak to your doctor to see if a kidney transplant is right for you. A kidney transplant is an operation where a healthy donated kidney is transplanted into your body. The new kidney is able to do the work of two healthy ones. The donated kidney may come from a living person (living donor) or from a person who has died suddenly (cadaveric or non-living donor). The transplant operation takes two to four hours. After the surgery, people need to take anti-rejection medication every day. Regular blood tests are also needed in order to watch for any signs of rejection. It is hard to say how long a kidney transplant will last, although some kidneys have lasted longer than 25 years. People have the right to decide not to start treatment if they feel that the burden of treatment would outweigh the benefit. Before considering this option for yourself, it is important to discuss your feelings fully and openly with your doctor and family. You may also wish to speak with your religious adviser or a mental health professional about your decision. Without treatment, people with ESRD may live anywhere from one week to several months. The length of time depends on the amount of kidney function left, as well as the overall medical condition. Death from kidney failure is usually painless. Toxic wastes and fluid build up in the body, making a person feel more and more tired. The fluid build-up may make it more difficult to breathe. However, doctors and nurses remain available to care for the person and family if the decision is not to start treatment. Choosing a treatment depends on what is most appropriate for your particular needs and circumstances. Each treatment has requirements, advantages and considerations. Your healthcare team can provide information and support to help you make a decision concerning the best treatment option for you. It is important to discuss all options and ask any questions that you or your family may have.