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Kidney dialysis is a treatment that helps the kidneys perform functions that they are no longer able to do. Dialysis will not cure kidney disease and usually can't reverse permanent kidney failure, but it means that people can live longer, more normal lives.
Just as healthy kidneys do, dialysis keeps your body's fluids and chemicals in balance.
Dialysis does the following:
- It removes extra salts, water, and fluids to keep them from building up in the body
- It maintains a safe level of certain chemicals in your blood, like potassium, sodium and bicarbonate
- It helps control your blood pressure
When Do You Need Dialysis?
Dialysis is needed when you develop end stage kidney failure, sometimes called end-stage renal disease or ERSD. That usually happens when you've lost about 85 to 90 percent of your kidney function. There are some types of kidney failure that improve with treatment. This is usually true for "acute" kidney failure, when dialysis is only needed for a shorter time.
But in end stage kidney failure (ERSD), your kidneys don't recover and you will need to have dialysis treatments for the rest of your life. At this stage, some people are candidates for a kidney transplant, in which case they are put on a waiting list for a new kidney.
Different Types of Dialysis
There are two kinds of dialysis treatments. Your doctor and healthcare providers will decide which type is best for you.
- Hemodialysis: A special filter is used to clean your blood (a dialyzer) and the filter connects to a machine. Your blood then flows through the tubes, into the filter, and wastes and extra fluids are removed. The cleaned blood returns to your body through another set of tubes.
- Peritoneal dialysis (PD): A solution called dialysate flows through a tube in your abdomen. After several hours, the dialysate has removed the wastes from your blood and can be drained from the abdomen. After that, your abdomen is filled again with new dialysate and the wastes are cleaned out again.
There are two forms of PD:
- Continuous ambulatory peritoneal dialysis (CAPD): This form doesn't require a machine as it is ambulatory, meaning you can walk around with the dialysis solution in your abdomen.
- Continuous cycler-assisted peritoneal dialysis (CCPD): This method uses a machine called a cycler to fill and drain your abdomen. Often this is done while you sleep. This form is also called Automated peritoneal dialysis (APD).
How Long Do the Dialysis Treatments Take?
The time required for your dialysis will depend on several things:
- How well your kidneys function
- Your size
- How much fluid weight you have gained since your last treatment
- How much waste you have in your body
Hemodialysis usually lasts about four hours and is done three times a week.
Peritoneal dialysis is on a different schedule and varies by the type of PD you have. The process of filling and draining solution from your abdomen is called an "exchange." The time the solution is in your abdomen is called the "dwell time." Usually you have four exchanges daily, each with a dwell time of four to six hours.
Where Do You Get Your Dialysis?
Dialysis can be done in a hospital, dialysis facility or at home. In a hospital or dialysis facility, a nurse or trained technician gives you your treatment. At home, you can do it yourself or have a family member help you. If you are going to do dialysis at home, you will need to have the required training.
Does Medicare Cover Dialysis?
- Medicare does cover dialysis treatments if you meet the requirements.
- You qualify if you are diagnosed with end-stage kidney failure or ERSD
- Your doctor has written a prescription (an order) for dialysis treatment
- The facility where you get your treatments must be Medicare-approved
If you receive your dialysis inpatient in a hospital, your treatment is covered by Medicare Part A. Both outpatient dialysis facilities and home dialysis are covered by Medicare Part B. It's important to know that there are specific things that must be done for home dialysis to be approved.
How is Home Dialysis Covered by Medicare?
Medicare home dialysis is a bit more complicated than treatments received in the hospital or dialysis facility. Medicare pays for the following:
- Outpatient doctor's services
- Self-dialysis training (this includes instruction for you and the person helping you with home dialysis treatments)
- Home equipment and dialysis supplies like the machine, water treatment system, alcohol and sterile drapes, etc.
- Certain home support services, which might include visits by a trained dialysis facility worker to check on your home treatment or to help in emergencies.
- Other services like laboratory tests relating to your dialysis
NOTE: A new payment system called the ESRD Prospective Payment System went into effect on January 1, 2011. Under this payment system, you'll continue to pay 20 percent of the Medicare-approved amount for all covered dialysis related services. However, if you're in a Medicare Advantage Plan (like an HMO or PPO) or have a Medicare Supplemental Insurance (Medigap) policy that covers all or part of your coinsurance, your costs may be different. For more cost information, you should review your plan materials or call your benefits administrator. You can also get more information at www.medicare.gov under Kidney Dialysis.
Some services that are NOT covered are:
- Paid dialysis aides to help you at home
- Lost pay when you get your self-dialysis training
- A place to stay while being treated
- Blood or packed red blood cells for self-dialysis unless part of a doctor's service
How Do I Find a Dialysis Facility?
Your kidney doctor will know where you can get your dialysis treatments since they frequently work with the facilities and their patients. But you can choose any facility that you want, as long as it is Medicare-approved so your treatment will be mostly paid for.
How Will I Feel With Dialysis Treatments?
People usually wonder if dialysis is painful. There might be some discomfort when needles are inserted, but most patients say they have no other problems. Sometimes, your blood pressure will drop slightly, but that usually goes away with regular treatments.
Dialysis patients also want to know if they will feel better. Most people report that they do feel better and less tired, have a better appetite. But even if you feel fine, you will need to continue with your dialysis treatments.
How Will Dialysis Affect My Life?
Dialysis patients often say they feel more normal, except for when they receive their treatment. Many dialysis patients are able to go back to work after they've become accustomed to their treatments. But that depends on your job – work that requires physical labor may not be advised. You can also travel if you make arrangements to receive your dialysis at other facilities while you are away.