Chronic Kidney Disease Chapter 18

A Miracle of Medicine: Kidney Dialysis and Transplant


What Is Kidney Dialysis?

Dialysis treatment replaces the function of kidneys that have acute or end-stage kidney failure, usually when they've lost 85-90% of their function. In some cases of acute kidney failure, dialysis is needed only temporarily until the kidneys heal. In chronic or end-stage kidney failure, the kidneys do not get better and dialysis will be necessary for the rest of the person's life (unless they get a kidney transplant). READ MORE

In hemodialysis, a dialysis machine filters blood from the body as it flows out from an access port (entrance), usually in the person's arm or leg. The "dirty" blood circulates through the dialysis machine, where artificial membranes filter and cleanse it. The purified blood is then returned through the port back into the person’s bloodstream.

Peritoneal dialysis uses the lining of the abdomen, the peritoneum, as a filter because it is rich in arteries and veins. Dialysis fluid is placed into the abdominal cavity through a permanent access port in the abdomen. The fluid remains there long enough for wastes in the blood to transfer to it and is then drained out of the abdomen. LESS


Risks of Dialysis

The many risks associated with kidney dialysis may be related to the dialysis or to the underlying kidney disease. They include:

  • Anemia

  • Bone diseases

  • Hypertension

  • Fluid overload

  • Pericarditis (inflammation of the membrane surrounding the heart)

  • Hyperkalemia (high potassium levels)

  • Nerve damage

  • Infection



Kidney Transplant

When people's kidneys can no longer filter blood properly, they need to consider either dialysis or a kidney transplant. To receive a kidney transplant, the recipient must be healthy enough to endure the transplant operation, which can take several hours. Doctors evaluate the health of the patient by performing physical exams, ensuring that the lungs and lower gastrointestinal tract are clear and healthy, and determining if the heart can handle the stresses of the operation. READ MORE

In the last decade, laparoscopic surgery, which requires only small incisions, has replaced conventional surgery for kidney removal, which required a larger opening and therefore a longer recovery time.

During the transplant operation, the surgeon places the new kidney in the recipient's lower abdomen, leaving the patient with three kidneys in all. The recipient's native kidneys will simply atrophy (shrink) as the new kidney takes over function. The new location of the transplanted kidney allows it to be easily attached to blood vessels in the lower part of the abdomen. It also simplifies connecting the ureter to the bladder. (The ureter is the tube that carries urine from the kidney to the bladder.)

The success rate for kidney transplant is above 90%. LESS


Two Types of Donors

There are two types of kidney transplants: cadaver, where the healthy matching kidney is provided by a deceased donor; and living donor, where a family member, friend, or good Samaritan donates a healthy kidney. Cadaver transplants require being put on a transplant list and waiting your turn, often for years, until a matching kidney becomes available. Living donor kidney transplants are preferred because they keep people off the transplant list, making more kidneys available for people without donors, and also because living donor kidneys tend to have higher function and last longer (20+ years).


Risks of Kidney Transplant

The risks associated with kidney transplant surgery include:

  • Rejection

  • Infection

  • Acute tubular necrosis (delayed graft function)

  • Hypertension

  • Cancer (due to medications that control rejection)


The material on this site is for informational purposes only and is not intended as medical advice. It should not be used to diagnose or treat any medical condition. Consult a licensed medical professional for the diagnosis and treatment of all medical conditions and before starting a new diet or exercise program. If you have a medical emergency, call 911 immediately.