Dialysis For Active People

Hearing the words "you need dialysis" can be terrifying. You may imagine a lifetime of being hooked to machines, unable to go on vacation or even keep your job. It might seem as though the active part of your life is over -- you couldn't be more wrong. In fact, there are many dialysis options that allow you to maintain control over your schedule and continue the active lifestyle that you currently enjoy.

Many people are familiar with dialysis centers -- medical facilities with machines capable of filtering bodily waste that failing kidneys cannot handle. Patients who receive their dialysis at such centers typically spend three to four hours in the center three times a week. Some centers offer early morning or evening appointments, which can be helpful for those who work regular hours. Patients with flexible work situations can schedule their work hours around their dialysis, and even bring a laptop, portable phone or notebook so that they can work while they dialyze. Others use that time to read, write letters, meditate, or even pay bills.

But not everyone's schedule can accommodate such a disruption; perhaps you have kids to pick up at school or a job with little flexibility. Do you have to redesign your life around your dialysis? Absolutely not.

Dialysis centers are not your only option. If you are willing to learn some new skills, you can dialyze in the comfort of your own home – privately, when and where you want to. There are two major types of home dialysis: home hemodialysis that filters the blood using a machine similar to what is found at dialysis centers, and home peritoneal dialysis which uses the lining of the abdomen to filter wastes and fluid out of the body.

The options for home dialysis are:

1. Conventional home hemodialysis: this method uses a needle in your arm to carry your blood to a dialyzing machine and another to return the filtered blood back to your arm. You, and your helper, will need to learn to use the machine, set up a treatment area in your house and store supplies. You will only need to visit your dialysis center once a month. Since the machine is in your home, you can dialyze early in the morning, late at night, or any other time that fits into your schedule. Some people choose to dialyze more often than three times a week, sometimes even daily, because they find that they feel better and have more energy.

2. Nocturnal home hemodialysis: this method uses the same kind of machine as conventional home hemodialysis, but you use it for 6-8 hours 3-7 nights a week. The more frequent, slower dialysis is easier on your heart and people often find that they feel better with this method than they do with conventional dialysis.

3. Continuous ambulatory peritoneal dialysis: this method uses your peritoneum, the lining of the abdomen, to filter wastes and fluid out of your blood through a catheter placed into your abdomen. Several times a day you will place two liters of fluid into your abdomen through the catheter, allow it to stay in place for a few hours, and then remove it. You can go about your regular activities while the fluid is in place. You can do the exchanges when it is most convenient for you, and can travel without difficulty. You can even have your supplies delivered to you on vacation. Since your exchanges are done through the catheter, there are no painful needle sticks.

4. Continuous cycling peritoneal dialysis: this method is similar to continuous ambulatory peritoneal dialysis, but it uses a machine to do the exchanges while you sleep.

While being on dialysis does require some lifestyle changes, they need not be as dramatic as some people think. There is no need to stop working or avoid vacations, and no need to see yourself as chronically sick. A critical evaluation of your lifestyle, along with guidance from your nephrologist, can help you choose the dialysis method that is best for you.

Delia Chiaramonte, M.D.

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