Dialysis

Getting the Care You Need

At Lahey Hospital & Medical Center, we offer both hemodialysis and peritoneal dialysis. If dialysis is needed, your provider will explain the differences and help you determine which one would be the best fit for you.

Creating Access

Both types of dialysis require minor surgery before treatment begins to create an access that allows treatment to take place. The nephrology team at Lahey works closely with our transplant and vascular surgeons to plan your procedure.

Hemodialysis

For hemodialysis, minor surgery is required to create a vascular access so that blood can reach the dialysis machine and be returned after the filtration process has been completed. There are three types of vascular access:

• Arteriovenous fistula (AVF)—Created by connecting an artery and vein.
• Arteriovenous graft (AVG)—This uses a synthetic tube to connect an artery to a vein.
• Venous catheter—This provides a temporary alternative by inserting a small, soft tube usually into a large vein in your neck. A catheter is typically used if you need to start dialysis before you have a vascular access created.

If your access is an AVF or AVG, the dialysis nurse or technician will place two needles into the access at the beginning of each treatment. These needles connect to tubing that takes blood to and from the dialysis machine.

If a venous catheter is used, the blood is taken directly to and from the catheter and no needles are required.

An AVF is the best type of access because it lasts longer and is less likely to clot or be the source of infection. It can take a fistula three to six months to be ready to use, so your nephrologist will refer you to have this placed when you are getting close to needing dialysis.

We discourage using venous catheters because of the high rate of bloodstream infections associated with them. However, we do use them when they are the only option we have at the time.

Peritoneal Dialysis

For peritoneal dialysis, a peritoneal dialysis catheter (a soft plastic tube) is inserted into your belly. This tube is attached to a bag of the dialysis fluid so it can drain in and out of your abdomen.

The catheter is surgically inserted at least two weeks before you start peritoneal dialysis to allow the catheter site to heal.

Education and Training

If you need dialysis, you probably have questions about what to expect and the steps you should take to prepare for treatment. Our team includes nephrologists, social workers, nurses, nurse practitioners, nutritionists and others committed to educating you about your condition and your options for treatment.

If your treatment plan includes peritoneal dialysis, we offer a training program taught by a registered nurse to make sure you understand each step of the process so you can self-administer your care with confidence.

Flexible and Convenient Treatment for Kidney Disease

There are two main types of dialysis:

• Hemodialysis
• Peritoneal dialysis

Both types of dialysis help your body eliminate harmful waste and excess fluid that accumulate with kidney failure. This process helps control your blood pressure and balances important electrolytes in your blood, like potassium and sodium.

Hemodialysis

Hemodialysis is sometimes called an artificial kidney. During treatment, your blood flows through a filter called a dialyzer, which then removes unwanted substances from your body. The first step in hemodialysis is minor surgery to create a vascular access. This provides a way to connect you to the dialyzer. The dialyzer contains multiple thin, hollow fibers. As your blood goes into the dialyzer, dialysis solution running outside the blood that contains hollow fibers helps clear the blood of the waste products it contains. The cleaned blood then returns to your body.

Peritoneal Dialysis

Peritoneal dialysis uses the lining of your abdomen (peritoneum) to filter your blood while it’s inside your body. It allows you to give yourself dialysis in a nonclinical setting, such as your home. Before treatment begins, you’ll have a soft tube (catheter) surgically placed in your abdomen.

During treatment, dialysis solution goes from a bag through the catheter and into your abdomen. When the bag is empty, you place a cap on the catheter and continue with your daily schedule. The dialysis solution absorbs the waste and any excess fluid in your body and you later drain it into an external bag. You throw away that drain bag and start the process again with a fresh bag of dialysis solution. This process is called an exchange. You will complete an exchange four to six times a day, depending on your dialysis needs. This process is commonly done at night using a cycler (automated PD) which does these exchanges while you sleep.

Peritoneal dialysis offers several advantages, including:

• Ability to travel
• Fewer doctor’s visits
• Increased autonomy
• Less impact on daily activities
• More flexibility in your schedule
• Reduced cost