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End-Stage Kidney Disease (ESKD) / Dialysis

End-stage kidney disease (ESKD) occurs when your kidneys have less than 15% of their function left. For many reasons, this is a very critical stage of chronic kidney disease (CKD) and the life expectancy of patients with ESKD is significantly reduced. Strict management of fluid intake is critical for reducing the chance of heart complications, as the risk for congestive heart failure and heart attacks increase at this level.

At Florida Kidney Physicians, our nephrologists believe that aggressive evaluation, early treatment, and a proactive physician will reduce the mortality rate of patients with CKD or ESKD. At stage 4 of CKD (severe loss of kidney function, with GFR below 30 cc/min), we provide our patients with an educational class to provide in-depth knowledge of what kidney failure is and what your treatment choices are so you can decide which modality will be best for you.

Treatment Options: Kidney Transplant

For those with kidney failure, a kidney transplant is often the first choice for treatment for a couple of reasons. Many people prefer a transplant over dialysis and are willing to take the risk of the surgery because they believe a transplant offers more freedom and a better quality of life than dialysis. In addition, studies show that people with kidney transplant live longer than those who are on dialysis.

Receiving a donor kidney may very well enable you to enjoy the lifestyle you had before you got kidney disease and live a longer life, although you will have to take anti-rejection drugs every day. These drugs can suppress your immune system, increasing your risk for infections and certain types of cancer.

While a kidney transplant is successful and lasts for many years, many people will need more than one kidney transplant during a lifetime. Learn more about kidney transplant

Treatment Options: Dialysis

Dialysis is not a cure but a treatment that cleans and purifies your blood when your kidneys are not doing an adequate job and your overall health is at stake.

Planning ahead is vital – decisions regarding which type of dialysis option you will receive must be made well in advance of kidney failure. This will allow for the best treatment options with the highest quality of life and the best chance for long-term survival.

Our nephrologists respect each individual patient’s wishes and choice as long as it is a well-educated, thought-out decision. They spend a great amount of time with each patient at CKD stage 4-5 to make sure you and your family are a decisive part of your treatment choice.

Types of Dialysis

Home Dialysis Therapy

Second to transplant, home therapy is the next best option for kidney replacement available for patient independence, satisfaction, and improved quality of life. On home dialysis, many patients continue to work and remain very active. Patients can even plan traveling when they desire.

A nurse specialized in your therapy will work with you individually at the center to get you started. Most patients are well trained within 5 days, but we will continue your training until you are ready. As long as you are in home therapy, your nurse will always be available to answer any questions 24 hours a day, 7 days a week. No holiday is an exception.

Your nephrologist will monitor your monthly kidney labs and see you a minimum of once every month, or as many times necessary to adjust your prescription if needed.

Peritoneal Dialysis

Peritoneal dialysis (PD) is considered an outstanding treatment option due to gentle daily therapy that mimics your own kidneys’ function. Daily therapy is a definite survival advantage in dialysis patients. You have better control of fluid gains, blood pressure control, and your diet is more forgiving for phosphorus and potassium restrictions. Patients have less fatigue and better quality of life.

This is a privileged and patient-responsible therapy that is easy, but strict hygienic standards are a must. This option has the least chance of infections. In the rare event that an infection is present, this can be treated as outpatient and may not require hospitalization.

Peritoneal dialysis is the safest therapy and performed very well at home by patients themselves. Also, you are NOT exposed to a synthetic filter that your body can react to. There are no needles, and no direct blood contact is involved.

PD relies on your natural abdominal (peritoneal) lining to act as a filter membrane by using the very rich network of blood vessels that feed your abdominal cavity. A special clean solution is infused into the abdomen through a PD catheter during your daily dialysis schedule. It is the most gentle, organic form of dialysis available and requires the least invasive procedures. 

PD requires a small catheter to be implanted in the stomach about 5-7 inches away from your belly button. It is a minor day surgery procedure with the least scars. The catheter can be “embedded” if you plan months ahead and dialysis is not required for an estimated 6 months or so. If dialysis is needed sooner, the catheter is placed and externalized, ready to use. We want to avoid emergency surgery since the catheter must heal for 2 weeks after placement for proper healing. 

Support is important and at all times, you will have direct access to the PD nurse who works with our nephrologists. Our DSI program is one of the fastest growing PD programs with an excellent transplant rate. Any CKD stage 4 or 5 patient can sign up for an education class at DSI with our home dialysis nurse at (813) xxx-xxxx.

Home Hemodialysis

Home hemodialysis (HHD) includes a compact dialysis machine to have at home for almost daily therapy, 5-6 times per week. When choosing hemodialysis as your choice, you are required to have an AV (arteriovenous) fistula access surgically implanted in your arm. Hemodialysis does use needles, and the surgery should be done during CKD stage 4 as an outpatient procedure, as it will take months to heal. The AV fistula is only to be used at the time when dialysis is needed.

For patients with small veins and arteries, an AV graft may be inserted. This form of access is second choice to a native AV fistula. For more information, visit Fistulafirst.org.

Home hemodialysis is more beneficial than in-center dialysis (which is only three times a week) due to its more continuous but slower speed schedule. Dialysis patients have increased mortality the greater the amount of days between treatments or with more than 48 hours without therapy.

According to the Freedom Study, home hemodialysis has demonstrated the following benefits over conventional in-center hemodialysis:

  • Improved filtering (fewer uremic symptoms)
  • Fluid control
  • Phosphorus and potassium control
  • Fewer headaches
  • Less nausea and vomiting
  • Dropping blood pressure effects
  • Requires less blood pressure medication, which reduces heart complications

Our nephrologists fully support this therapy due to its reported benefits. It is their second choice if dialysis must be started and PD is not available.

Home hemodialysis is fully supported by our dedicated HHD nurse. Like all successful HHD patients, you will overcome the fear of self-cannulation of your AV fistula or graft access. Be ready, and avoid a temporary permacatheter that limits the efficiency of your dialysis session and has the highest risk of infection (infection is the second leading cause of death in dialysis patients).

In-Center Therapy

In-center dialysis is a less desirable option than in-home therapy due to the increased risk of infection and the reduced number of therapy sessions per week. In-center dialysis can be administered through an AV (arteriovenous) fistula access that is surgically placed in your arm through an outpatient procedure. This needs to be done during stage 4 of the disease before dialysis is needed because it takes months to heal.

If your AV access is not ready at the time you need to start dialysis, you will have to be hospitalized in order to place a temporary permacatheter in your neck vein, start dialysis, and get surgery for AV access at once. This requires an average of 3-4 hospital days, which also increases the risk of hospital-acquired infections. Our nephrologists discourage this plan of action but it will be necessary if no access is available.

Nocturnal Hemodialysis

Nocturnal hemodialysis (NHD) offers “through the night” dialysis at the center for a slower but longer treatment of 6-8 hours three nights per week. High blood flow rates are necessary to achieve the best cleaning/filtering therapy. Treatments are administered by registered nurses with the aid of certified LPNs and dialysis technicians.

This is more beneficial than conventional in-center dialysis due to the longer treatments, but not as good as daily nocturnal home hemodialysis, which has limited availability in the United States due to the minority of patients aware of it, plus lack of resources and established insurance reimbursement. Our nephrologists always keep up with available home therapies to give more options to all of our patients.

Nocturnal hemodialysis is for patients who are not candidates of any of the above discussed options. Transportation to the center three times a week is required at the scheduled time available. We will work with you to make the most convenient appointments; however, due to the number of patients we care for in-center, it is impossible to accommodate all of our patients’ requests. Some patients are eligible for the Sunshine Van line to provide transportation at a preset schedule. 

For more information on dialysis, visit our Patient Resources page. If you are looking for a highly skilled, compassionate kidney doctor in the Tampa area, call Florida Kidney Physicians today at (813) 910-0030 or use our online appointment request form. We have 19 nephrologists who see patients in 7 locations throughout Hillsborough and Pasco County.

Florida Kidney Physicians - Kidney Disease - Hypertension - Nephrologists in the Tampa Bay Area - Nephrology - High Blood Pressure - Kidney - Kidney Transplant