Treating kidney disease if prevention fails

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When the kidneys reach the stage of uremia (see the earlier section "Progressive changes"), there's no alternative to dialysis, a mechanical cleansing of the blood, or transplantation of a healthy kidney. Two techniques are currently in use for dialysis:

t Hemodialysis requires that the patient's artery be hooked to a tube that runs through a filtering machine. This machine draws blood from the body, cleanses it, and sends it back into the patient's bloodstream. When the patient is moderately well, hemodialysis is done three times a week in a hospital-like setting. Hemodialysis can be associated with complications like infections and low blood pressure. The patient usually has to go to the center to have it done.

t Peritoneal dialysis may be done at home. A tube is inserted into the peritoneal cavity, the body cavity containing the stomach, liver, and intestines. A large quantity of fluid is dripped into the peritoneal cavity, and the body wastes are drawn out into the peritoneal cavity. After several hours, the fluid is drained out with its wastes. Glucose must be placed in the fluid, and this complicates control of the patient's diabetes. Peritoneal dialysis usually must be done daily, and it's possible to travel while undergoing this type of dialysis. Peritoneal dialysis may be associated with infection of the tube, just like hemodialysis.

There's little difference between these two forms of dialysis in terms of long-term survival. The decision to go with one over the other is based on convenience and whether your insurance has better coverage for one or the other.

For patients with diabetes, transplantation works better than dialysis, but healthy kidneys are difficult to come by in the United States, so 80 percent of all kidney failure patients use dialysis while 20 percent have kidney transplants. A transplanted kidney is foreign to the recipient, so his or her body tries to reject it. That's why the recipient receives antirejection drugs, which unfortunately complicate diabetes control, especially steroids. Transplantation works best if the kidney is from a donor closely related to the recipient; this arrangement reduces the chance of rejection. Control of the blood glucose is essential to prevent damage to the new kidney.

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