What is dialysis?

Dialysis is the process of removing waste products and extra fluid from the body by other methods, when the kidneys are not functioning well enough.

What is kidney failure?

Also called renal failure. It means the kidneys are not able to adequately remove waste and excess fluid from the body. It is of two types.
Acute Kidney Injury (AKI): When the function of previously healthy kidneys is compromised by an acute illness. There are chances that kidney function may completely or partially recover. Dialysis may or may not be needed.

Chronic Kidney Disease (CKD): It is an irreversible deterioration in kidney function and when it reaches the stage of dialysis it is called as End-Stage Renal Disease (ESRD).

What are different types of dialysis?

Peritoneal dialysis: A small tube (peritoneal dialysis catheter) is placed and dialysis fluid is flushed through it in the abdominal cavity. After sometime this fluid is drained and fresh fluid is instilled. Removal of waste products happens across the lining of abdominal cavity.

Hemodialysis: A dialysis catheter is placed in a large vein of body. Through this catheter blood is circulated through a special filter or dialyzer which also contains the dialysis fluid. Purified blood is then returned to the body through the same catheter.

What are the different types of hemodialysis?

The type and duration of dialysis which your child receives will be decided by the treating team based on several factors like age and weight of child, hemodynamic status and underlying disease condition. There are variations in hemodialysis:

Intermittent hemodialysis (IHD): Typically the patient receives dialysis for 3-4 hours in a day. Blood pressure and vital parameters need to be stable.

Slow low efficiency dialysis (SLEDD): Dialysis is performed at a slower rate over a longer duration, 6-8 hours or longer, in patients whose blood pressure is unstable.

Hemodiafiltration (HDF): It is a more efficient form of hemodialysis.

Continuous Renal Replacement Therapy (CRRT): This is slow continuous and gentle form of hemodialysis, used for critically ill children, who need multiple medications to maintain their blood pressure.

Is the process of dialysis painful?

Insertion of the peritoneal dialysis catheter or hemodialysis catheter is done as a bedside procedure in pediatric ICU under sedation and medications for pain control. Once the catheter is placed, the procedure of dialysis is not painful.

Does the child need to be admitted for dialysis?

Children with acute renal failure are already admitted and they receive dialysis mostly in the pediatric intensive care unit (PICU).

Children with chronic renal failure are admitted for initiation of dialysis or any procedure like catheter insertion or creation of AV fistula. Afterwards these children receive dialysis on OPD basis in the dialysis room of the hospital.