Acute & Chronic Hemodialysis & Peritoneal Dialysis

What to Expect

In hemodialysis, a dialysis machine and a special filter (an artificial kidney) are used to clean your child's blood. In order to extract the blood for dialysis, your child's doctor needs to create an access point—called a venous access—in the blood vessels or will need to insert a dialysis catheter (which looks like a large IV). The venous access is typically in the arm and is created during outpatient surgery. Usually, children receive general anesthesia to undergo this procedure. The venous access or dialysis catheter will remain in your child for as long as he or she is on dialysis.

Depending on your child’s specific situation, hemodialysis may be performed acutely as an inpatient (during a hospital stay) or as an outpatient in a dialysis center.

If hemodialysis is performed in a dialysis center, you can expect to bring your child in for treatment three (or sometimes more) times a week for about four hours each time. When hemodialysis is provided to patients who are admitted to the hospital, treatment frequency may be as often as every day depending on the specific reason your child needs hemodialysis.

Sometimes the access point used for dialysis can become blocked or narrowed and cause problems with dialysis treatment. If this happens to your child, an interventional radiologist can perform a dialysis intervention to remove the blockage or open up the narrowed vein.

In peritoneal dialysis, a surgeon places a catheter (a flexible plastic tube) into the lining of your child's stomach. This catheter is inserted during surgery that requires general anesthesia. If your child is medically stable, it is possible that he or she will not begin dialysis for two to three weeks after having the catheter inserted, so that scar tissue can form to hold it in place for the dialysis. For some cases of acute kidney injury, peritoneal dialysis may begin immediately after the catheter is placed.

During peritoneal dialysis, a special cleansing fluid called dialysate is pumped into the lining of the abdomen through the catheter. The membrane that covers the intestines and other abdominal surfaces acts as a filter to allow the body’s waste products to move into the dialysis fluid. After the filtering process is finished, the fluid leaves the body via the catheter, and the cycle can be performed again. The catheter will remain in your child’s body as long as he or she is receiving dialysis.

There are two types of peritoneal dialysis:

• Continuous ambulatory peritoneal dialysis (CAPD). This procedure occurs continuously without the aid of a machine while your child goes about his or her normal daily activities. Continuous ambulatory peritoneal dialysis (CAPD) is performed by placing cleansing fluid into the abdominal cavity and draining it out several hours later. This cycle is called an exchange. About three to five exchanges are performed each day during waking hours.
• Automated peritoneal dialysis (APD). In this procedure, a machine called a cycler delivers and then drains the cleansing fluid several times (generally eight to 10 times) per dialysis session. Automated peritoneal dialysis (APD) is usually done overnight while your child sleeps, and it is the type of peritoneal dialysis chosen most frequently for children in the U.S.

In addition to the dialysis itself, it is important that your child follow a special diet that may include increasing protein intake and limiting potassium, phosphorus, sodium and fluid. His or her doctor and a dedicated kidney dietician will work together to provide more details about this diet, since diet limits are customized for each child on dialysis. Your child will also require specific medicines to help treat the other medical conditions that develop when the kidneys cannot function normally.

Key Points to Remember

• When the kidneys are not performing their usual functions of cleaning and filtering the blood, dialysis can be used to replace some of these functions, but no form of dialysis can replace all of the kidney’s functions.
• For children who have acute kidney injury, the doctor may use acute (short-term) hemodialysis or peritoneal dialysis until the kidneys regain the ability to remove the body’s waste products.
• For children who have chronic kidney disease and who are not able to receive a transplant before the need for dialysis arises, the doctor may use chronic (long-term) hemodialysis or peritoneal dialysis until the child is medically ready to receive a kidney transplant.
• The nephrologist will determine which type of dialysis is appropriate based on your child's kidney condition and overall health.