Haemodialysis is a treatment that cleans and filters your blood by removing the waste products and extra fluid that your kidneys can no longer eliminate. Haemodialysis requires a machine and an artificial kidney that is called a dialyzer. During the haemodialysis treatment your blood is pumped by the machine through tubing to the dialyzer. In the dialyzer, your blood is filtered, waste products and extra fluid are removed. The filtered or 'cleaned' blood is then returned to your body. In order to remove and return blood to your body, an access to your blood vessels must be made. This access is made during a surgical procedure in which a fistula is created or a graft is inserted under your skin. The fistula or graft is put in the lower or upper arm if possible; other places can be used if the arm is not suitable. Your surgeon will determine which access is best for you. If treatments must be started before a fistula is created or a graft is inserted, a temporary catheter may be placed externally (outside your body) to allow for immediate access to your blood vessels. Such a catheter is usually a temporary solution until real access can be created by the surgeon. Because of waiting lists for that procedure or in some patients who face major problems regarding creation of vascular access, a so-called tunnelled line may be inserted by a renal physician. The tunnelled line runs under the skin of the chest and is held in place by a little cuff under the skin. This catheter can stay in place for a few years if necessary. Once your access has healed (matured) it can be used for treatment. Two needles are placed in the access at the start of each treatment and taken out at the end of each treatment. One needle is used to remove your blood for cleansing (filtering) and the other is used to return the filtered blood to your body. Haemodialysis treatments are usually performed three times each week. The length of your treatment is decided by your doctor but usually lasts from 3 to 5 hours. The time depends on your body size, any remaining kidney function and activity level. During your treatment you can read, watch TV or socialise with others close to you in the facility. In Counties Manukau, several types of haemodialysis treatments are offered. Patients are expected to participate in an active way to stimulate their own health. Part of that is taking responsibility for your dialysis. The so-called incentre facility (Middlemore Hospital and Western Campus) where staff do the whole treatment for the patient, is reserved for fully dependent patients. Usually these are the 'sicker' patients. The next step is to assist in building up your dialysis machine and participating in the monitoring of your treatment. This is done in Western Campus and, even stronger in the MSC satellite. As you can see, the Western Campus facility contains a mix of dependent and more autonomous care patients. The ultimate goal of many patients is to take a machine home and do the dialysis in the home environment. In order to be able to do this, these patients come first to our training facility at the Western Campus. For those who would like to dialyse at home, but do not have the infrastructure, we have 'community care facilities' in Papatoetoe (2), Mangere and Pukekohe, where patients dialyse themselves in bedrooms of houses in the community that are completely set up for this treatment. There are no staff present.

Peritoneal dialysis is a treatment where the peritoneal membrane (lining around the inside of your intestinal wall) is used to filter and cleanse the impurities, waste products and extra fluid from your body. Peritoneal dialysis uses a fluid called dialysate to remove fluid and waste products from your abdominal cavity and place them in the dialysate. The dialysate fluid acts like a magnet that attracts waste and excess fluid from the body. Peritoneal dialysis uses a catheter that is surgically or radiologically put into the abdominal cavity and attached to the bag of dialysate solution for the treatment. After the treatment, the catheter is disconnected from the bag of dialysate and covered to keep it clean. You do not walk around with a bag stuck to your tummy. You or your partner, in the comfort of your own home, perform the treatment. The treatment can be done safely in other locations so that you have the most flexible treatment arrangement. You can do the procedure at work or at school as well. When your physician decides that your catheter is ready to use, training sessions will be arranged to teach you the best and safest way to perform dialysis. Trained dialysis staff will work with you to make your dialysis therapy and transition to independence as easy as possible. Trained staff are available to you on-call every day for emergencies if you have difficulty with your treatment at home. The types of peritoneal dialysis are: Continuous ambulatory peritoneal dialysis (CAPD): CAPD is done several times during the day. A set amount of fluid is placed into the abdominal cavity through your catheter. This fluid remains in the abdominal cavity for several hours and is then drained. The process is repeated 4 times daily. Each exchange takes about 30-40 minutes. The exchange schedule can be flexible to meet your needs. No machine is used for this type of treatment. YOU are in control. Continuous cycling peritoneal dialysis (CCPD): CCPD is done at night using a machine called a cycler. The system automatically does the exchanges for you while you are sleeping. Most consumers must spend 8 to 10 hours every night to complete this process. It usually makes daytime manual exchanges unnecessary. Peritoneal dialysis must be done every day. During your training, you are taught to follow specific procedures that allow you more freedom than on haemodialysis. It is a commitment that can be easy to follow. With encouragement from your family and healthcare team your lifestyle will require only minimal adaptation. One of the major advantages of CAPD/APD is that it closely mimics the way the kidneys work naturally. Whereas haemodialysis removes waste products and water from your body 3 times per week in just a few hours, CAPD/APD does this constantly i.e. much like healthy kidneys do. It is for this reason that CAPD is often the preferred method for patients with heart disease.

End stage renal disease (ESRD) has many causes but no cure. When almost all kidney function is lost, one of the existing treatment types must be used to maintain life. Specialist input from a skilled physician (renal physician, also called nephrologist) is necessary. Regular blood tests and urine tests are necessary to see how fast your kidney problem is progressing. The renal physician will look at many issues, like your fluid balance, the concentration of waste products in your body and the influence of renal disease on many of your body's functions such as blood pressure and your bones, to name a few. Together with the renal physician you will discuss when the moment has come to seriously think about one of the dialysis options, as mentioned above. He/she will then refer you to a predialysis educator. This is a nurse with special skills who will discuss with you the options that there are in dialysis, looking at your specific situation. Discuss any problems connected with a type of treatment with your healthcare team and choose the best type for you and your medical condition. Later, when you have been on dialysis for some time, or the transplanted kidney no longer works, you may decide to use another type of treatment e.g. you may start on peritoneal dialysis (PD) and then switch to haemodialysis (HD) in the unit or at home. For Information about Home Dialysis, click here: www.homedialysis.org

Transplantation places one healthy kidney into your abdomen. This one kidney is sufficient to replace the work of your two failed kidneys. In New Zealand, kidney transplantations are done in Auckland (Auckland City Hospital), Wellington and Christchurch. A kidney transplant can be the first form of treatment you receive or it can be selected later after receiving dialysis treatments for some time. Transplantation is the preferred treatment of end stage renal failure, but not all patients can profit from this option. Factors like severe heart or lung disease, being overweight, malignant diseases etc are contraindications i.e. you are not suitable to have a transplant operation. You may receive a transplant from a living related donor, a donor who is not related but willing to donate a kidney, or you may receive a kidney from someone who has recently died (cadaveric). There is a national matching service. It updates the list of those waiting for a kidney, does the blood typing and tissue matching for the possible cadaveric transplant. The waiting list is not a waiting list in the strict sense of the word. Since every kidney from cadaveric donors that becomes available is linked in the computer to the best match, some people are lucky and receive a kidney after just 6 months whereas others have to wait more than 8 years. The mean waiting time overall is roughly around 4.5 years. If a living donor is willing to give you a healthy kidney, this donor must be evaluated for medical fitness and compatible blood type. Depending on the type of donor, waiting time for a kidney will vary. A cadaver donor wait will be longer than a living donor due to the shortage of cadaveric donors. The surgery will take from 2 to 4 hours and your stay in the hospital will be 5 to 7 days. Your doctor will prescribe several new medications to prevent rejection by your body of your new kidney. You will have to take these medications as long as the transplanted kidney works. Transplantation can offer you the greatest potential to return to a healthy and productive life.