Renal disease refers to temporary or permanent damage to the kidneys that result in loss of normal kidney function. Renal failure can be a progressive disease or a temporary one depending on the cause and available treatment options. In renal failure the kidneys undergo cellular death and are unable to filter wastes, produce urine and maintain fluid balances of the body. This causes a build up of toxins in the body which can affect the blood, brain and heart, as well as other complications. Renal failure is very serious and can be deadly if left untreated.
There are two types of renal failure: acute and chronic.
Acute Renal Failure
Acute renal failure occurs suddenly and is usually initiated by underlying causes, for example dehydration, infection, serious injury to the kidney or the chronic use of over the counter pain medications. Acute renal failure is often reversible with no lasting damage. In such situation, renal function may be restored by treating the primary disease that is responsible for the damage, or by treating the kidneys with medication.
Chronic Renal Failure
In chronic renal failure, patients may not show any symptoms until the kidneys are extremely damaged. Chronic renal failure can be caused by other long term diseases, such as diabetes and high blood pressure. It can worsen over time, especially when the problem has gone undiagnosed and treatment is delayed. With treatment, a person with kidney failure can live a relatively normal life. In cases of patients with end stage renal disease, patient will require dialysis and/or a kidney transplant. However, for a kidney transplant, it is necessary to find a donor that has a similar tissue and blood type, which means that finding a kidney may still be difficult. Most people who need a kidney transplant must also be on dialysis until a match is found.
In renal dialysis, the patient must be connected to a machine that mechanically filters off toxins and waste materials from the body. Dialysis does not treat renal failure, but instead keeps a person alive by performing the crucial functions of the kidneys. A person may have to undergo dialysis as often as several times a day or as little as weekly, depending on the severity of the renal failure. A person with acute, reversible renal failure may need dialysis while the kidneys recover.
There are two types of Kidney dialysis that may be performed:
Peritoneal dialysis (PD)
Peritoneal dialysis is performed by surgically placing a special, soft, hollow tube into the lower abdomen. After the tube is placed, a special solution called dialysate is instilled into the peritoneal cavity. The peritoneal cavity is the space in the abdomen that houses the organs and is lined by two special membrane layers called the peritoneum. The dialysate is left in the abdomen for a designated period of time determined by the physician. The dialysate fluid absorbs the waste products and toxins through the peritoneum. The fluid is then drained from the abdomen, measured, and discarded. There are two main types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD), and Automated Peritoneal Dialysis (APD).
CAPD does not require a machine. Exchanges can be done three to five times a day, during waking hours. APD requires the use of a special dialysis machine that can be used in the home. This type of dialysis is done automatically, even when asleep.
Haemodialysis can be performed at home, dialysis center or hospital by trained healthcare professionals. At home, haemodialysis is done with the help of a partner, often a family member or friend. If you choose to do home haemodialysis, you and your partner will receive special training. A special type of access, called an arteriovenous (AV) fistula, is placed surgically, usually, in your arm. This involves joining an artery and a vein together. After access is established, patient will be connected to a haemodialysis machine which drains the blood. Wastes and excess water will be passed out from the blood through the membrane into the dialysate through a process called diffusion before the ‘clean’ blood is returned to the bloodstream.Haemodialysis is usually performed several times a week and lasts for four to five hours.
Globally, there are about 3 million ESRD patients in 2012 with a ~7% growth rate. Of these 3 million ESRD patients, approximately 2.358 million were undergoing dialysis treatment. The incidence is expected to increase with the growing number of aging population. The global dialysis products and services market was valued at US$ 77.61 billion in 2013 and is expected to grow at a CAGR of 5.9% from 2014 to 2020, to reach an estimated value of US$115.48 billion in 2020. This is according to a market report by Transparency Market Research and Fresenius Medical Care.
As of 31 December 2011, United States Renal Data System reported that there were 615,899 prevalent ESRD patients in the United States, with 397,000 receiving active dialysis. The cost of treating these ESRD patients was US$49.3 billion, with treatment costs consistently doubling in every decade before. This translates into a person per year cost of dialysis in the Medicare population of US$87,945 for HD patients and US$71,630 for PD patients. In 2011, 91.2% of the patients were on in-centre HD, 7.4% were on PD and a growing number of 1% were on home HD.