Types of Dialysis: Exploring Options for Kidney Failure Treatment

What are the 4 Types of Dialysis

When discussing types of dialysis, it is important to recognise that approximately 69% of all kidney-replacement therapy patients globally receive haemodialysis ¹. The four types of dialysis include haemodialysis, peritoneal dialysis, continuous renal replacement therapy, and sustained low-efficiency dialysis (SLED).

The following sections provide a comprehensive overview of the major types of dialysis:

1. Haemodialysis

In haemodialysis, a dialyser removes the waste and excess fluid from your blood and returns blood into your body. Healthcare professionals perform a minor surgery to create a vascular access site, usually in the arm. The site provides access to get the blood from your body, through the dialyser, and back into your body.

The procedure often lasts for about four hours and is done three times per week. However, in some cases, the duration for the treatment may be longer depending on specific requirements.

How it works:

• A surgeon establishes a vascular access site, mostly in the arm, using a fistula, graft, or catheter.
• Blood is taken from the body and filtered through the dialyser and returned into your body.
• The procedure eliminates waste while keeping an electrolyte and fluid balance.

Benefits:

• Highly effective in removing toxins quickly from the body.
• Highly comfortable for patients and healthcare professionals can provide support easily, which makes the entire process streamlined.
• The process offers flexibility to patients looking for home-based haemodialysis treatment.

2. Peritoneal Dialysis

In peritoneal dialysis, your blood is filtered inside your own body instead of using a dialyser machine. In this process, the lining of the abdomen is used as a filter. Doctors conduct a minor surgery to place a catheter in your belly, and the belly is slowly filled with dialysate through the catheter.

With the natural flow of your blood, the excessive waste products move out of the blood vessels into the belly area by the dialysate. Two of the most common types of peritoneal dialysis include;

• Continuous ambulatory peritoneal dialysis (CAPD): Healthcare professionals conduct this procedure multiple times without mechanical support and with manual intervention.
• Automated Peritoneal Dialysis (APD): The process uses a machine and often occurs overnight during the patient’s sleep.

The duration of the process, which is also known as the exchange, and the number of sessions depend on the type of peritoneal dialysis a patient uses and the medical condition.

How it works:

• The first step is to insert a catheter surgically into the abdomen.
• Dialysis fluid is introduced into the peritoneal cavity, which cleanses the waste particles from the body.
• Finally, after several hours, the fluid drains off, keeping a check on electrolytes and fluid balance.

Benefits:

• The procedure offers flexibility to the patients due to its feasibility of being conducted in the home.
• There is no specific requirement for frequent clinical visits.
• The process is safe and gentle on the body against traditional dialysis processes like haemodialysis.

3. Continuous Renal Replacement Therapy (CRRT)

CRRT is a specialised dialysis process for patients suffering from critical conditions and in intensive care units (ICUs). However, CRRT is a slow and continuous procedure that ensures stable removal of excessive fluids and toxins for patients suffering from kidney failure.

How it works:

• Blood from the body continuously flows out and, accordingly, filters and returns into the body at a slow pace.
• There are two major techniques present at the moment, namely, continuous Venovenous haemofiltration (CVVH) and Continuous Venovenous Haemodialysis (CVVHD).

Benefits:

• Easily accessible for patients and offers flexibility.
• The process does not require frequent trips to the clinic and is therefore a feasible option for patients suffering from chronic kidney disease.
• The process is easy for patients and not so stressful, which is a critical factor for haemodialysis.

4. Sustained Low-Efficiency Dialysis (Hybrid Procedure)

Sustained Low-Efficiciency Dialysis (SLED) or hemodiafiltration are forms of hybrid dialysis and are a novel approach in the field of nephrology. The technique is prominent among patients with indications for dialysis and among patients with acute kidney injury (AKI).

How it works:

• Doctors administer SLED through a conventional haemodialysis technology over longer time durations, typically between 8 and 12 hours, allowing for a gradual treatment process.
• Maintains haemodynamic stability among patients who lack tolerance for traditional hemodialysis.
• The process combines diffusion and convection techniques to remove the waste and excess fluid.

Benefits:

• The dialysis process is effective for removing large waste materials such as urea.
• SLED, which is a new-generation hybrid dialysis, is haemodynamically stable than the traditional haemodialysis process.
• One major advantage is having an individualised approach with the SLED technique.

With a better understanding of the types of dialysis, let’s now understand the effectiveness of dialysis for kidney care.

Effectiveness of Dialysis Treatment

Dialysis is an effective treatment strategy to clear waste products and excessive fluids from your blood. The process, however, is not a replacement for kidney functions and therefore not considered a cure for kidney failure or disorders.

Here are some of the steps that can enhance the effectiveness of your dialysis treatment:

• It is important to complete the treatment procedure according to the prescribed schedule.
• One of the critical elements is to follow a customised eating plan that is recommended by your doctor for a prescribed time.
• Engage in physical activities to improve the strength and health of your vital organs.
• It is essential to maintain an open communication with the dialysis team and be open about side effects and concerns that you may have for dialysis.

Potential Side Effects of Dialysis

Here are some of the common side effects of dialysis that you must be aware of:

• Haemodialysis: Blockage within the vascular access site, along with muscle cramps, weakness, are some of the side effects of haemodialysis.
• Peritoneal Dialysis: One major side effect is a hernia, which is accompanied by weakness in your abdominal muscles, often with lumps and swollen areas. Another side effect includes rapid gain of weight gain.

Also read: How to Manage Chronic Kidney Disease: A Guide from Kidney Specialists.