Treating end-stage kidney disease
Learn about all the treatments options available to people with end-stage kidney disease (ESKD).
What is RRT?
Renal replacement therapy (RRT) is recommended for people experiencing ESKD. If your kidneys are not working properly, extra fluid and waste will build up in your blood. RRT essentially replaces your filtration capabilities one of two ways:
- Kidney transplant — This procedure replaces one of your kidneys with a healthy kidney, allowing you to filter your blood naturally.
- Dialysis — This process filters your blood artificially. Hemodialysis filters your blood with a machine. Peritoneal dialysis involves filling your abdominal cavity with a solution that absorbs extra fluid and waste over time, after which it is drained and replaced.
ESKD in the U.S.
Nearly 808,000 people in the U.S. are living with ESKD.1
69%
on dialysis1
31%
with a kidney transplant1
What happens during hemodialysis?
During hemodialysis, your blood is filtered through a machine that removes waste and excess fluid (water). Then the clean blood is returned to your body. The process takes about three to five hours and is typically done two to four times a week.
Side effects of dialysis2
People undergoing hemodialysis may experience side effects. Keep in mind, not everyone experiences all of them. Ask your care team about how to manage them.
- High or low blood pressure
- Muscle cramps
- Anemia
- Bone disease
- Fluid overload
- Itching
- Sleep problems
- Depression
- Joint pain and stiffness
- High or low potassium levels
Choosing a dialysis site
Hemodialysis can be done in a dialysis center, a hospital, or even at home. The site you choose affects how often you receive dialysis.
Dialysis center or hospital
Dialysis centers are located across the country. If you choose a dialysis center or hospital, you can expect to receive dialysis three times a week. Each session takes three to five hours.
At-home dialysis
You can receive hemodialysis at home, using a machine that is specifically designed for home use. If you choose at-home dialysis, you can expect to receive dialysis six or seven days a week. Each session takes about two hours.
1. Arteriovenous (AV) fistula
An AV fistula is the most common access type. It is made by connecting an artery and a vein, typically in the arm. An AV fistula increases blood flow for efficient dialysis. It also widens the vein, making access easier. An AV fistula usually takes four to sixteen weeks to prepare.
2. Arteriovenous (AV) graft
An AV graft requires a minor surgery to connect the vein and artery by placing a small tube (implant) between them. An AV graft increases blood flow for efficient dialysis. An AV graft is often placed about two weeks prior to hemodialysis.
3. Catheter
If you need to have hemodialysis before your AV fistula or AV graft are ready, or if those options won’t work for you, your doctor may choose to place a catheter for access. A catheter is made of soft plastic tubing and is placed in a large vein in the neck or upper chest. It can be used immediately after it is placed.
Creating your AV fistula
An AV fistula is the preferred2 way to gain access for hemodialysis. If this option is right for you, there are two ways to create it. One is surgical and one is not.
- Surgical — The most common way to create an AV fistula is surgery, during which the artery and vein are sutured together. This is typically done on an outpatient basis, and it usually takes an hour or more to perform.3 Surgery has been the standard approach for more than 50 years. But it does require an open incision and leaves a scar.
- Nonsurgical — A newer way to create an AV fistula is an endovascular approach, which uses a minimally invasive procedure that does not require open surgery. Instead, a special device fuses the artery and vein together without sutures or an implant. This approach leaves no scar, and in some cases reduces the risk of certain potential complications of AV fistula creation.4,5
The endovascular AVF journey
Getting an endovascular AV fistula prior to dialysis follows four stages.
1. Selection
A simple in-office test (ultrasound imaging) can determine if you are a good candidate for an endovascular AV fistula.
2. Creation
The minimally invasive procedure using the Ellipsys™ system usually takes 30 minutes or less to perform.6
3. Maturation
Follow-ups over a six-week period help establish if the AV fistula is mature enough to support hemodialysis.
4. Cannulation
Cannulation occurs when the AV fistula is ready to allow regular hemodialysis.
This procedure is not for everyone. Please talk to your doctor to see if it is right for you. Risks may include total/partial occlusion or stenosis of the anastomosis, failure to achieve fistula maturation, Steal Syndrome, hematoma, infection, and need for vessel superficialization or other maturation assistance procedures. Although many patients benefit from the use of this device, results may vary. Your doctor should discuss all terms, potential benefits, and risks with you.
Less invasive, long-lasting
Learn more about the Medtronic Ellipsys vascular access system for endovascular AVF creation.
Caring for your AV fistula
It is very important to take good care of the fistula. If your fistula isn’t working well, you may not be getting enough dialysis.
Sometimes, however, there can be issues with your fistula. The most common issue is when a fistula narrows because your body sends extra cells to “repair” the fistula. These cells can build up, slowing blood flow and making dialysis less effective.
If your fistula has narrowed, you may need a maintenance procedure to treat it.
Treating a narrowed fistula
There are several minimally invasive maintenance (nonsurgical) options doctors use to open a narrowed fistula. Two of the most common include:
Traditional balloon
During this procedure, an inflatable balloon is placed into the fistula through a small tube (catheter). The balloon is inflated in the narrowed section of the fistula to open it back up again. Then the balloon is deflated and removed.
Drug-coated balloon
A drug-coated balloon uses the same procedure as a traditional angioplasty balloon, but with one important difference. This balloon is coated with a specialized drug called paclitaxel that can help delay the re-narrowing of your fistula in the future. So, it not only widens the fistula, but it also helps keep it open longer.
Proactive treatment, fewer options
The Medtronic IN.PACT™ AV drug-coated balloon (DCB) uses specially formatted technology to keep your fistula open longer than other options.*7
Treatment with the IN.PACT AV DCB is prescribed by your doctor. This treatment is not for everyone. Please talk to your doctor to see if it is right for you. Your doctor should discuss all potential benefits and risks with you. Risks may include pain, hemorrhage, arterial or venous aneurysm/thrombosis, dissection, infection, perforation or rupture, death. Although many patients benefit from the use of this treatment, results may vary.
*Compared to angioplasty balloons.
References
1
Kidney disease statistics in the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease#. Accessed on October 31, 2023.
2
Hemodialysis: About. Mayo Clinic. Available at: https://www.mayoclinic.org/tests-procedures/hemodialysis/about/pac-20384824. Accessed on October 31, 2023.
3
University of Utah. Arteriovenous Fistula (AV Fistula). Health University of Utah. https://healthcare.utah.edu/cardiovascular/treatments/arteriovenous-fistula.php. Accessed on October 31, 2023.
4
Mallios A, Bourquelot P, Franco G, et al. Mid-term results of percutaneous arteriovenous fistula creation with the Ellipsys vascular access system, technical recommendations and an algorithm for maintenance. J Vasc Surg. December 2020;72(6):2097–2106.
5
Beathard GA, Litchfield T, Jennings WG. Two-year cumulative patency of endovascular arteriovenous fistula. J Vasc Access. May 2020;21(3):350–356.
6
Hull JE, Jennings WC, Cooper RI, Waheed U, Schaefer ME, Narayan R. The Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access. J Vasc Interv Radiol. February 2018;29(2)149–158.e5.
7
Lookstein RA, Haruguchi H, Ouriel K, et al. IN.PACT AV Access Investigators. Drug-Coated Balloons for Dysfunctional Dialysis Arteriovenous Fistulas. N Engl J Med. August 20, 2020;383(8):733–742. Highlighted results reported at both 180 and 210 days.