Dialysis in Children

Dialysis is a procedure that is done routinely on people who have acute or chronic kidney (renal) failure. It filters waste and extra fluid from the blood. That is something that would normally be done by the kidneys. Dialysis may also be used to prevent kidney failure if someone has been exposed to or swallowed toxic substances. There are two types of dialysis that may be done on your child: peritoneal or hemodialysis.

Peritoneal dialysis can be done at home. But you must be trained first. This method uses the lining of the belly (abdominal) cavity to filter the blood. This cavity is the space that holds organs, such as the stomach, intestines, and liver. The lining is called the peritoneum. First, a surgeon places a thin, flexible tube (catheter) into your child's belly. After the tube is placed, a sterile cleansing fluid (dialysate) is put through the catheter into the peritoneal cavity. The fluid is left in the belly for a certain period of time. This fluid absorbs the waste products and toxins through the peritoneum. The fluid is then drained from the belly, measured, and discarded. This process of filling and draining fluid is called an exchange.

There are two different types of peritoneal dialysis:

• Continuous ambulatory peritoneal dialysis (CAPD). CAPD does not need a machine. The exchanges can be done 3 to 5 times a day, during waking hours.
• Continuous cyclic peritoneal dialysis (CCPD). CCPD needs the use of a special dialysis machine that can be used in the home. This type of dialysis is done automatically, even while your child is asleep. You may also hear this type of dialysis called automated peritoneal dialysis.

Hemodialysis is done in a dialysis center or hospital by trained health care professionals. With correct training and help, hemodialysis can also be done at home. A special type of access, called an arteriovenous (AV) fistula, is placed surgically. It is usually placed in your child's arm. This involves joining an artery and a vein together. An AV graft using a synthetic tube or mesh may also be used. An external, central, I.V. (intravenous) catheter may also be inserted. But this is less common for long-term dialysis. Your child will then be connected to a large hemodialysis machine. Blood is pumped through a tube into the machine to filter out the wastes and extra fluid. The filtered blood then flows through another tube back into your child's body. Hemodialysis is usually done several times a week. Each session lasts for 4 to 5 hours. It may be helpful to bring games or reading materials for your child to keep them busy during this procedure.