When your kidneys fail, you need ongoing treatment to replace their function. Unless you have a kidney transplant, you will need a treatment called dialysis.
If the function of a person’s kidneys drops to 15% or less, they are said to have end-stage kidney disease, or kidney failure. At this point, dialysis or kidney transplant is necessary for the patient’s survival.
Most patients experience a gradual loss of kidney function before they reach end-stage disease. If you are approaching kidney failure, you will need to work with your health care team to plan ahead for your care.
Dialysis is an ongoing treatment that replaces the fluid and waste removal functions of the kidneys. Dialysis may be a lifelong option for you, or you may use dialysis until you receive a kidney transplant.
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Hemodialysis is a treatment that removes waste products and excess fluids from the body using a dialyzer. The dialyzer is a machine that acts as an external, artificial kidney.
During a hemodialysis treatment, the patient’s blood is drawn out of the body through a small tube and run through the dialyzer. The blood is then returned back to the bloodstream. Only a small amount of blood is outside the patient’s body at any time. During the treatment, the patient's entire blood volume circulates through the machine every 15 minutes. In general, most patients require three hemodialysis sessions per week for four hours each time.
There are different options for patients to receive ongoing hemodialysis treatments. Providence Health Care’s Renal Program offers the following services:
Patients can visit one of seven Community Dialysis Units across Vancouver and the Coastal regions: Vancouver, East Vancouver, North Shore, Powell River (qathet Community Dialysis Unit), Richmond, Sechelt and Squamish. Community dialysis units are the preferred option for many patients because they help minimize the time and inconvenience of traveling downtown for dialysis. Eligibility for community dialysis depends on factors such as the patient’s health status and stability on dialysis, patient mobility and transportation, and unit capacity.
Patients can visit the main Hemodialysis Unit at St. Paul’s Hospital in downtown Vancouver. This 42-station hemodialysis centre is the largest in British Columbia, with 24-hour service Sunday - Friday (daytime hours only on Saturday). Appointments are available throughout the day, and there is an in-centre nocturnal hemodialysis service for patients to stay overnight while they dialyze.
Home hemodialysis is available as part of the Renal Program’s Independent Dialysis Program. It offers significant benefits to patients, including the option for more frequent and/or longer treatments. Patients receive training on how to manage their own dialysis and their home is modified to accommodate a hemodialysis machine. Equipment and nursing support are available by phone, and dialysis supplies are delivered to the patient’s home.
Preparing for hemodialysis
Before you can start on hemodialysis, you will need to have a vascular access created. A vascular access is a blood vessel that has been modified to efficiently allow blood to be drawn out for dialysis and then returned to the bloodstream. There are two main types of vascular access: a fistula or a graft. Your care team will determine which type is best for you.
Creating a vascular access is a minor surgical procedure that is done weeks or months in advance of the start of hemodialysis. Assessment, surgery and follow-up care for patients is provided by the Renal Program’s Vascular Access Clinic.
Peritoneal dialysis is an independent therapy that patients do at home. The process uses your abdominal lining (peritoneal membrane) to filter out waste products, rather than using an external dialysis machine as in hemodialysis. Dialysis fluid is introduced into the abdominal cavity through a small tube (catheter). The peritoneal membrane draws waste products into the dialysis fluid. The waste products are then removed from the body when the fluid is drained out.
Peritoneal dialysis is the preferred option when patients:
- Wish to dialyze independently at home
- Want the freedom to travel
- Are afraid of needles
- Live in a remote area where there are no hemodialysis services
- Are not suitable for vascular access or have major heart problems
Like independent hemodialysis, peritoneal dialysis offers the option for more frequent and/or longer treatments. The Peritoneal Dialysis Program provides training, support and supplies to these patients.
Preparing for peritoneal dialysis
Before a patient can start on peritoneal dialysis, he or she will need a catheter inserted into the abdomen. The catheter is a thin, soft plastic tube that carries the dialysis solution in and out of the abdomen.
Inserting the catheter is a minor surgical procedure that takes about 45 minutes. The end of the catheter sticks out near the bellybutton. It takes at least two weeks for the catheter site to heal before a patient can begin peritoneal dialysis.
The patient will also require training on how to dialyze independently. The Peritoneal Dialysis Program has a specialized team that provides education and training to patients and their families. The procedure is easy to learn and it usually only takes one to two weeks of one-on-one training with a nurse before a patient or caregiver can perform the treatment independently.
Here are some resources about dialysis that you may find helpful.
Providence Health Care Renal Program
- Home Based Dialysis Options (PDF)
- Home Based Dialysis Questionnaire (PDF)
- PHC/VCH Home Hemodialysis Newsletter (PDF)
BC Renal Agency
Kidney Foundation of Canada