Treatment Options
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So Many Options
At Lower Manhattan Dialysis we offer several modalities of dialysis so that you can choose the best type of dialysis to fit your lifestyle. You can choose whether to be cared for in our center, or to take care of yourself at home. We offer in-center hemodialysis, home hemodialysis, ambulatory peritoneal dialysis, and cyclical peritoneal dialysis “while-you-sleep”.
Hemodialysis
Hemodialysis involves using a machine to pump blood through a filter and back into the body in a continuous circuit. This is usually performed three times per week for between 3 and a half to four hours per session. Access to the blood is obtained either through a fistula that is created surgically in the arm and then accessed by inserting needles at each session, or by having a semi-permanent catheter surgically inserted into a neck vein. A fistula is the preferable access as it allows for a more efficient dialysis with virtually no risk of infection. However, it takes time for a fistula to be ready for use and if dialysis is needed more urgently a catheter may be necessary temporarily.
Hemodialysis is usually done in an outpatient dialysis center, where nurses and technicians perform the treatment, but also may be performed at home where the patient and a caregiver are trained to perform it. For those who dialyze at home, we have a nurse on call 24/7 to help with any issues that may arise.
Peritoneal Dialysis
Peritoneal dialysis is done at home and involves no blood at all; it uses the body’s own blood vessels as the filter. A catheter is surgically implanted into the abdomen and the patient is trained to instill a specialized sterile fluid (called PD fluid) into the catheter. While the PD fluid dwells in the abdomen the toxins filter across the very thin blood vessels in the abdomen and into the PD fluid. When the fluid is drained out, the toxins are removed with it. Each filling and draining of the abdomen is called an exchange and most patients perform four to five exchanges throughout the day (continuous ambulatory peritoneal dialysis or CAPD). They can also choose to perform their exchanges by connecting their catheter to a machine called a cycler which performs the exchanges for them while they sleep (continuous cycling peritoneal dialysis or CCPD). Peritoneal dialysis is performed daily, but it can be scheduled to allow for the freedom to be able to go to work, school, or perform other activities. As with home hemodialysis, we have a nurse on call 24/7 should any issues arise.
Kidney Transplantation
Kidney transplantation remains the best alternative for end stage renal disease for those patients who are eligible. At Lower Manhattan Dialysis Center, we pride ourselves in referring our patients for transplantation as quickly as possible, and we have some of the highest transplantation rates in New York.
As beneficial as transplantation can be, most patients with kidney failure will tend to be on dialysis for a period of time prior to receiving a new kidney; sometimes for a period of years. This is why it is very important to seek out a dialysis center with an excellent track record in measures of life span and good health on dialysis in addition to a good transplantation record. Transplantation also has its own set of risks and complications which can at times be severe, and therefore, transplantation may not be for everyone. For many of those patients who are not interested in or are not eligible for transplantation, a good dialysis center can keep them functioning well on dialysis for long periods. In our own experience, we can happily report that we have had some patients remain well on dialysis for over 30 years!
We can help you choose the best type of dialysis to fit your lifestyle.
You can choose whether to be cared for in our center, or to take care of yourself at home. We offer in-center hemodialysis, home hemodialysis, ambulatory peritoneal dialysis, and cyclical peritoneal dialysis “while-you-sleep”. Feel free to reach out to discuss with our doctors, nurses, and social workers the different dialysis modalities and decide which is best for you.
If a patient has kidney disease but he doesn’t yet need dialysis, he should see a nephrologist with special expertise in dialysis since there are a number of medical treatments that have been shown to slow down the course of kidney failure so that the need for dialysis may be postponed for many months and even years in some cases. Studies have shown that patients with chronic kidney disease have better outcomes if they are referred to a nephrologist early.
If the possibility of future dialysis has been mentioned to you, you might want to seek a consultation or a second opinion from an expert nephrologist.