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Kidney Failure

The kidneys are the master chemists of the body. Normally you have two kidneys, one on either side of your spine under your lower ribs. They are pink and shaped like kidney beans. Each kidney is about the size of a clenched fist.

Kidneys remove wastes from the blood via the urine. They regulate the levels of water and different minerals needed by the body for good health. They also produce hormones that control other body functions.

Many other organs depend on the kidneys in order to work properly. When kidney function is no longer adequate, dialysis treatment or a kidney transplant is required.

Acute kidney failure occurs when your kidneys fail temporarily. If your kidneys are affected permanently, chronic kidney failure is the result.

There are a number of causes of acute kidney failure. In this situation, kidney function usually returns to normal, but dialysis may be needed until the kidneys begin to work again. Chronic kidney failure results from the slow deterioration of the tiny filters in the kidney (the nephrons) that remove wastes. Damage to the nephrons can be caused by conditions such as high blood sugar and high blood pressure. In some cases, good control of these may prevent the development of chronic kidney failure.

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There is no cure for chronic kidney failure. In the early stages, the only treatment needed may be a special diet or medication. When the kidneys are near the end of their function (less than 10% of their normal rate), either dialysis or transplantation is needed. This period is called end-stage renal disease or E.S.R.D.

Dialysis is a way to clean the blood by removing wastes and excess water. There are two types: hemodialysis and peritoneal dialysis. During hemodialysis, the blood is circulated through an artificial kidney machine. The artificial kidney cleans blood in almost the same way that health kidneys do. The treatment is performed usually three times a week, and can take between three and five hours each time.

Peritoneal dialysis works on the same principle as hemodialysis, but the blood is cleaned inside the body rather than through a machine. Your abdomen has a peritoneal cavity, lined by a thin membrane called the peritoneum that surrounds the intestines and other internal organs. The peritoneal cavity in the abdomen is filled with dialysis fluid that enters the body through a permanently implanted catheter. Excess water and wastes pass through the peritoneum into the dialysis fluid. This fluid is then drained from the body and discarded. The process is repeated between three and five times a day. In most cases, this treatment can be performed without assistance, at home or at work.

Hemodialysis can be done in a hospital dialysis unit, in a self-care centre, (with some assistance from the staff), or at home with the aid of a partner or nurse. Special training is required for self-care or home dialysis.

Peritoneal dialysis is also sometimes done in a hospital but, more usually, you are trained to do this independently at home.

A kidney transplant is another treatment option for many people with chronic kidney failure. With advances in organ transplantation and improved success rates, a transplant is now widely considered to be the best way of treating kidney failure. However, not all patients are suitable to have a transplant and often an organ is not available when needed.

Choosing a treatment depends on what is available in your community, as well as what is most appropriate for your particular needs. Each treatment has requirements, advantages, and considerations. Your healthcare team can provide information and support to help you make a decision about what is the best treatment for you. It is important to discuss all the options and ask any questions which you or your family may have.

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Reprinted with Permission - Copyright © 2000 Kidney Foundation of Canada.