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Dialysis is a method of cleaning the blood, removing excess fluid from the body and performing other functions of the kidneys when the kidneys are not functioning properly. There are two main types of dialysis—hemodialysis and peritoneal dialysis. Acute hemodialysis and peritoneal dialysis are used to treat children with acute kidney failure. Chronic (long-term) hemodialysis and peritoneal dialysis are used to treat children with chronic kidney failure. Acute hemodialysis is also used to treat children who have ingested certain toxins (poisons) that must be removed from the body quickly.
Though no form of dialysis can replace all of the kidney's functions, medical studies have shown the following benefits for correctly administered dialysis:
If your child has kidney failure, his or her nephrologist will help you decide whether hemodialysis or peritoneal dialysis is best for your child, based on medical and lifestyle factors. Where and how frequently your child's dialysis treatments take place and how long they take to complete will depend on the type of dialysis chosen.
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:
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.
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