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 cause other complications.

Disease State

There are two types of renal failures: 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.

Treatment Options

In renal dialysis, the patient must be connected to a machine that mechanically removes 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 modalities in renal dialysis:

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).

Hemodialysis (HD)

For hemodialysis 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 hemodialysis 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. Hemodialysis is typically performed at a dialysis center or in a hospital by trained healthcare professionals. It is usually performed 3 times a week and lasts for four to five hours.

Key Challenges

Current methods of dialysis not only puts a lot of burden on a country’s healthcare system but are also very disruptive to the patient’s lifestyle. Patients on dialysis have to adapt their lifestyle and routine to the schedule of the therapy.

* Center for Medicare and Medicaid (CMS)

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