Kidney Failure and Dialysis

If a person's kidneys fail to function properly, the only way to prevent toxic buildup in the body is to undergo dialysis.
There are two types of dialysis: hemodialysis and peritoneal dialysis. The most commonly recognized form of dialysis is hemodialysis. About 90 percent of dialysis patients receive hemodialysis. In this procedure, the blood is circulated from the body into a machine before being returned to the patient.
In order for hemodialysis to be performed, a doctor must make an access into the patient's blood vessels. This is done by minor surgery in the leg, arm or sometimes neck. The best access for most patients is called a fistula, wherein minor surgery is performed to join an artery to a vein under the skin to make a larger vessel.
If no vessels are suitable for a fistula, the doctor uses a soft plastic tube called a vascular graft to join the artery and vein.
Once the access is made and healed, two needles are inserted in the fistula or graft, one on the artery side and one on the vein side.
For temporary dialysis in the hospital, a patient might require a catheter implanted into a large vein in the neck.
A dialysis machine is composed of two parts: one side for blood and one for a fluid called dialysate. A thin, semipermeable membrane separates the two sides. Particles of waste from the blood pass through microscopic holes in the membrane and are washed away in the dialysate. Blood cells are too large to go through the membrane and are returned to the body.
The benefits of hemodialysis are that the patient requires no special training, and he or she is monitored regularly by someone trained in providing dialysis.
The other type of treatment, Continuous Ambulatory Peritoneal Dialysis (CAPD) uses the patient's own peritoneal membrane as a filter. This membrane, like the membrane in the dialysis machine, is semipermeable. Waste particles can pass through it, but larger blood cells cannot.
The patient has a peritoneal catheter surgically implanted into the belly. He or she slowly empties about two quarts of dialysate fluid through the catheter into the abdomen. As the patient's blood is exposed to the dialysate through the peritoneal membrane, impurities are drawn through the membrane walls into the dialysate. The patient drains out the dialysate after three or four hours and pours in fresh fluid. The draining takes about half an hour and must be repeated about five times a day.
The main benefit of CAPD is freedom. The patient doesn't have to be at a dialysis clinic for several hours a day, three times a week. The dialysate can be exchanged in any well-lit, clean place, and the process is not painful. The drawback to this treatment is that there is a risk of infection of the peritoneal lining, and the process may not work well on very large people.
Pediatric patients often do a similar type of dialysis called Continuous Cycling Peritoneal Dialysis (CCPD). Their treatments can be done at night while they sleep. A machine warms and meters dialysate in and out of their abdomens for 10 hours continuously. In this way, they are free from treatments during the day.
This information was gathered from http://www.fda.gov/fdac/features/1998/198_dial.html

The toll on a person who must endure dialysis can be quite high both physically and mentally. Persons with kidney failure often feel ill and tired in spite of dialysis. Hemodialysis is time-consuming and leaves the patient with little freedom to enjoy other activities. Often the patient with kidney failure doesn't feel well enough to consider other activities, even if hemodialysis weren't so time consuming. In spite of the blood-cleaning function of dialysis, the body's toxins still have an effect. People with kidney failure are often flushed or sweating.
I knew a young man in high school whose father had been undergoing dialysis for a number of years. He was in constant pain and eventually committed suicide to escape from the pain and hopelessness of his situation.
A gentleman who was a patient in a long-term care facility where I worked had himself admitted so that we could perform hospice care on him. He had voluntarily ceased his dialysis treatments and knew that he was going to die. His blood pressure was often so high that it was impossible to measure. His appetite was very poor and his skin was usually clammy. He was constantly nauseated and sometimes in terrible pain. He died within a week. I have always remembered him for his gentle personality and friendly attitude in the face of his illness and impending death.
A man in another long-term care facility where I worked had been dialysis for many years. His skin eventually began breaking down and in spite of our best efforts, he developed severe bed sores because he was constantly oozing B.M. and the acidic quality of the stool ate away at his skin. He had been a doctor and my mother, who was a nurse at the facility, conferred with him. Between his medical knowledge and their frank discussion, he made the decision to discontinue his dialysis treatments. After two days he slipped into a coma and was dead within five days.
There are several causes for kidney failure. This website sums them up with simple, easily understandable terminology.
http://www.kidneypatientguide.org.uk/site/fail.php