As kidney function declines, waste products normally eliminated from the body by the kidneys build up to levels that are unhealthy. At this stage of Chronic Kidney Disease (CKD Stage 5), children may be tired and have difficulty concentrating in school. The goal of all children with CKD Stage 5 is a kidney transplant. However, approximately 75% of children at this stage are prescribed a course of dialysis before a transplant. Dialysis may be necessary to make certain children are in the best shape possible for a transplant, and sometimes a donor kidney is not available before the need for dialysis.
There are 2 types of dialysis. Both clean the blood of waste products and neither is better than the other. Medical and other factors that are unique to each child needing dialysis help determine the type of dialysis chosen.
Peritoneal dialysis (PD) is performed at home. The sac surrounding the intestines (known as the peritoneal cavity) contains thousands of tiny blood vessels. Children receiving PD have a special catheter inserted into this sac by a surgeon. The catheter is not uncomfortable and can be easily concealed under clothes. It remains in place until PD is no longer needed. A special sterile solution is instilled into the sac and helps draw out fluid and waste products from these blood vessels.
Most children receiving PD use a machine known as a cycler. Patients and their families receiving PD with a cycler are trained in its use. Each night, a child receiving PD has the catheter connected to tubing from the cycler. The cycler then performs the dialysis, generally as the child sleeps. In the morning, the catheter is disconnected from the cycler.
Children receiving PD keep a log of their blood pressure, weight, and aspects of the treatment that can be obtained from the cycler. The children are evaluated at least monthly by the Dialysis Care Team and logs are reviewed at that time.
The major potential complication of PD is infection. Infection can occur in the tissues under the skin and surrounding where the catheter exits the skin (known as an exit site infection) or in the peritoneal cavity itself (known as peritonitis). These infections can cause pain and can sometimes make it difficult or impossible to continue PD. Children receiving PD and their families will be trained in sterile techniques to prevent infections and it is vital to follow these techniques consistently.
Hemodialysis is performed at a dialysis center. Blood is pumped out of the body and through an artificial filter known as a dialyzer. The cleaned blood is then pumped back into the body. Generally these treatments are performed 3 days a week and each session takes 4 hours.
In order to perform hemodialysis, children must have an “access point”, an opening in the blood stream that allows blood to be pumped through the dialyzer and back. Depending upon a child’s age and how long the hemodialysis is anticipated to likely be needed, the access point may be:
- Catheter. A special catheter that allows blood to be taken from and returned to the child is inserted into one of the main blood vessels, usually in the neck. It remains in place until another access point is established or until hemodialysis is no longer needed.
- Arteriovenous (AV) fistula. A surgeon connects an artery to a vein in the arm. This connection directs a large volume of blood to the vein. Two needles are inserted into the vein, one to direct blood to the dialyzer and the other back to the child. An AV fistula can generally be created in a child weighing more than 60-70 pounds. The AV fistula has a much decreased risk of infection compared to a catheter and allows more normal activities, such as bathing and play.
A team of dialysis professionals is available to help you and your child. This Dialysis Care Team includes:
- Pediatric Nephrologist
- Pediatric Dialysis Nurses. These nurses perform the patient and family training and are available 24/7.
- Registered Renal Dietician
- Renal Social Worker. The process of dialysis and kidney failure can be emotional for children and their families. This can be made harder by financial and other burdens. Social work assistance is available and almost universally invaluable. Often children and families benefit from counseling support and the renal social worker can help identify appropriate local resources.