Chronic Kidney Disease: Dialysis Options and How to Manage Them

Chronic diseases manifest in very diverse ways, but they all have one thing in common: they accompany the patient throughout their life. While some are more manageable, others require treatments that can profoundly alter daily routines. A clear example is dialysis, a kidney replacement procedure that removes waste products and excess water from the body. This process is carried out through a machine known as a dialyzer, on which the patient permanently depends, unless they undergo a transplant.

Dialysis is the primary treatment used for Chronic Kidney Disease (CKD), a condition that causes progressive and irreversible kidney deterioration. In Spain, approximately 50,000 people suffer from CKD. Of these, half have received a kidney transplant, while the other half remain on dialysis. The choice of treatment depends on the stage of the disease. Professionals at Hospital Clínic Barcelona state that at stage 5, kidney replacement should be considered, either through dialysis, transplant, or conservative medical treatment.

Some people can manage CKD with conservative treatment, focusing primarily on symptom control through medication. However, when replacement therapy is necessary in addition to dialysis, a kidney transplant is an option. Currently, 33% of people on dialysis are on the transplant waiting list, of whom half will be eligible. If kidney function does not recover, which is rare, the patient will be on dialysis for life.

There are two types of dialysis: hemodialysis and peritoneal dialysis.

There are two types of dialysis: hemodialysis and peritoneal dialysis. Both options are viable, provided there are no absolute contraindications, and one or the other is chosen based on the patient's needs. Hemodialysis is performed using an arteriovenous fistula or a vascular catheter, allowing the patient's blood to be extracted and filtered in the dialyzer. In peritoneal dialysis, on the other hand, a narrow, flexible tube is inserted into the abdomen to fill the peritoneal cavity with dialysis fluid. This fluid acts for a few hours, allowing toxic substances and water to pass from the peritoneum into the fluid, which is then emptied and replaced with clean fluid.

Another important difference between the two types of dialysis lies in the location and frequency with which it is performed. Peritoneal dialysis is performed daily at the patient's home and can be manual or automatic. Manual dialysis requires the patient to change the bag three or four times a day, while automatic dialysis involves a machine filling and emptying the fluid overnight while the patient sleeps. Hemodialysis, on the other hand, is performed three days a week (alternating), in four- or five-hour sessions. It is generally performed in a specialized center, but can also be performed at home after training for both the patient and the support person.

Dialysis generally does not cause serious side effects or major complications. During hemodialysis, some people experience discomfort when the arteriovenous fistula is inserted or a feeling of dizziness due to the drop in blood pressure during the session. During peritoneal dialysis, it is common to experience abdominal distension during the first few weeks or discomfort due to the inner end of the catheter. In both cases, it is essential to maintain good care of vascular accesses or catheters, as well as follow strict hygiene standards.

With the night dialysis program, patients live their normal lives during the day, and between 10:30 and 11 p.m. they connect to the dialysis machine. Dr. Francesc Maduell, Head of the Dialysis Department at Hospital Clínic Barcelona

Machine dependence among dialysis patients significantly impacts the daily lives of those with CKD. However, a pioneering program at Hospital Clínic Barcelona allows patients to perform dialysis at night . More than 60% of them lead very active lives. According to Dr. Francesc Maduell, head of the dialysis department, "during the day they lead normal lives, and between 10:30 and 11:00 p.m. they connect to the dialysis machine." In addition, additional benefits are achieved, such as a reduced need for medication.

Another limitation of dialysis is the dependence on a machine, which can make traveling uncomfortable for those undergoing this treatment. However, for people on hemodialysis, there are associations that facilitate the location of dialysis units near the travel destination, allowing them to continue their treatment. In the case of peritoneal dialysis, the companies that supply the equipment offer the option of shipping the necessary products to the destination, eliminating the need for the patient to transport the supplies. On the other hand, those who wish to take the machine on a plane can do so.

Starting dialysis treatment can be an emotionally challenging process, causing mood swings, disruptions in family relationships, excessive demands, constant complaining, difficulty sleeping, and fear of the future. These reactions are normal and part of the adjustment process. Disorders such as stress, anxiety, and depression are also common. Therefore, it is essential to have emotional support from both specialized professionals and those close to you.