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Treatment for Kidney Failure: Kidney Dialysis & Kidney Transplant

Dialysis filters blood through an "artificial kidney," removing waste products and toxins from the blood. Acute renal failure may require a period of dialysis during treatment. Chronic failure requires long-term dialysis.

Kidney dialysis is not a cure for chronic renal failure: Without regular treatment, toxins build up in the body. The treatment can cause malnutrition, so following a renal diet while on dialysis is vital. Ninety percent of people on long-term dialysis require treatment for osteodystrophy.

The two different forms of kidney dialysis are hemodialysis and peritoneal dialysis.

Hemodialysis

Hemodialysis passes the blood through a machine that filters the blood and returns it to the body. The procedure lasts three to four hours, and requires three sessions a week. Hemodialysis is performed in a hospital. Between sessions, the patient has no kidney function, and must monitor diet and symptoms carefully.

Hemodialysis sessions often leave people feeling drained and light-headed. Since a heightened risk of infection is associated with the procedure, any signs of fever or illness should promptly be reported to a doctor. In addition, long-term hemodialysis may cause a slight increase in the chances of developing kidney cancer.

Peritoneal Dialysis

Peritoneal dialysis uses the peritoneum, the abdominal membrane, as a filter. The abdominal cavity is filled with a special fluid injected through a small tube that is attached to the body. The fluid is drained and replaced on a daily schedule.

Peritoneal dialysis may be performed in the home, making it more convenient than hemodialysis. The main complication is peritonitis, or inflammation of the peritoneum. The main indication of peritonitis is a cloudy color to the drained fluid. The condition is serious, and requires antibiotic treatment.

Two separate forms of peritoneal dialysis are available. Automated peritoneal dialysis (APD) uses a small machine to exchange the fluid automatically, and can be used while the individual sleeps. Continuous Ambulatory Peritoneal Dialysis (CAPD) calls for the fluid to be replaced four times a day, every four to six hours. The procedure lasts between thirty and forty minutes.

Kidney Transplant Options

A kidney transplant is the only way to restore renal function. However, a transplant is not a cure: Transplant recipients must take regular medication to prevent organ rejection. In addition, the number of people requiring kidney transplants far outnumbers the organs available for transplant. Waiting lists for suitable kidneys may range from months to years.

Donated organs come from three sources: A family member may donate a kidney, the donated organ may come from a close family friend or partner, or it may become available from a person who died and had made prior arrangements to donate an organ. Organs from family members have the best chance of providing a suitable blood and tissue match.

To be considered for a transplant, patients must undergo a series of blood tests and x-rays to determine eligibility. People with cancer or heart conditions are not good candidates; the transplant would have little chance of success.

When a potential organ becomes available, the organ must be matched to the patient's blood type and HLA factors. HLA stands for "human leukocyte antigen," genetic markers that appear on the surface of white blood cells. The closer the match is between the donor's HLA and the recipient's, the lower the odds that the organ will be rejected.

Anti-Rejection Drugs

Once the transplant is complete, daily anti-rejection immunosuppressant drugs are required as part of treatment for kidney failure. The medication must be taken on a long-term basis to prevent organ rejection. Immunosuppressant drugs suppress the body's immune system, preventing it from perceiving the foreign organ as a threat.

Possible side effects include an increased risk of infection, weight gain, acne, and unwanted facial hair. Rarer and more severe complications include diabetes, bone density problems (osteodystrophy), hypertension, and cataracts. Kidney and liver damage can occur with long-term use.

The combination of Rapamune® (sirolimus) and cyclosporine had been used until recently to prevent rejection. Cyclopsporine can cause confusion, seizures, swelling, and loss of muscle control, and it can adversely affect kidney function. In 2003, the FDA relabeled Rapamune, allowing higher doses to be used by people with low rejection risks after three to four months of treatment with both medications. The higher dosage of Rapamune is intended to replace the Rapamune/cyclosporine combination. This development is expected to have a positive impact on transplanted kidney function.

New Kidney Transplant Research

Research into kidney transplants often centers on reducing the chance of organ rejection. An article in the April 2003 issue of the British Medical Journal reported on the use of antibodies in combination with immunosuppressants. Combining anti-rejection medication with anti-interleukin-2 receptor antibodies reportedly cut the chances of short-term organ rejection in half.

Resources

Cyclosporin.com. (updated 2003). Cyclosporine.

Dingwall, R. (updated 2001). Haemodialysis. Renal Unit of the Royal Infirmary of Edinburgh.

Dingwall, R. (updated 2004). Kidney transplantation. Renal Unit of the Royal Infirmary of Edinburgh.

Dingwall, R. (updated 2001). Peritoneal dialysis. Renal Unit of the Royal Infirmary of Edinburgh.

National Institute of Diabetes, and Digestive and Kidney Disorders. (2001). Treatment methods for kidney failure: Kidney transplantation [NIH Publication No. 03-4687].

U.S. Food and Drug Administration. (2003). FDA approves new Rapamune labeling likely to improve transplanted kidney functioning.FDA Talk Paper.