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Patient Decision Aid (BETA test)

Introduction

As your kidney function declines, one of your biggest choices is whether to get dialysis or conservative kidney management (CKM).
 
Dialysis is not for everyone. Dialysis can’t cure kidney failure, but it may help you live longer and feel better. The older and sicker you are, the less likely it is that dialysis will help you. Some people will live as long and feel better with CKM, which does not include dialysis.
 
It’s your choice whether to have CKM or dialysis.
 
This tool is to help you decide if CKM or dialysis is right for you. You can use it to talk with your healthcare team and loved ones about your decision.
 
It should take 15 to 25 minutes to complete.  You can come back to it, or share it with someone you trust by using the email button or printing your responses.  How you respond is anonymous and confidential.

 Conservative Kidney Management (CKM)
No dialysis or transplant
Dialysis
How does this treatment work?CKM is a treatment option for managing kidney failure. It involves:
• Treating symptoms
• Preventing or managing problems.
• Protecting remaining kidney function.
• Psychosocial care.
• Helping plan for the future.
 
CKM does not include dialysis, but it does include all of the other parts of kidney care and support.
 
The goal of CKM is to live well without dialysis.
 
To learn more about CKM click here.
Dialysis is a medical treatment that does some of the kidneys’ work to remove toxins and water from your body. It will not cure kidney disease or stop kidneys from getting worse. Dialysis will not treat other medical problems like diabetes or heart conditions.  It requires a great deal of time and effort. Patients' experiences vary widely. In general, the healthier you are, the more likely you are to find it helpful. There are two main types of dialysis.
 
To learn more about dialysis and to see how it actually works, click here.
Peritoneal dialysis
This type of dialysis happens inside your body. Fluid goes in and out of your belly through a tube. Clean fluid goes in, fluid with toxins is flushed out. You can do this at home.
Hemodialysis
This type of dialysis happens outside your body. A machine filters your blood and then returns it to your body. Hemodialysis is usually done in a special dialysis unit in a clinic or hospital.
How will I feel?Many factors affect how you will feel with CKM or dialysis such as other health problems and your overall health.  The following section of this tool will help you determine how CKM or dialysis may benefit you personally.
How long will I live?Many factors affect how long you’ll live with CKM or dialysis.  You may have weeks, months, or years on either treatment. Some factors that affect how long you’ll live include:
  • your kidney function
  • other health problems (e.g., diabetes, heart disease).
  • your lifestyle (e.g., weight, exercise, diet, blood pressure).
  • your overall health (physical and mental health).
The following section of this tool will help you determine how CKM or dialysis may benefit you personally.
Are there side effects?You won’t have the side effects or problems that you would have from dialysis.Dialysis risks include low blood pressure, muscle spasms, infections, abnormal heart rhythms and low levels of protein in the blood.
Peritoneal dialysis
There are fewer problems with low blood pressure and muscle cramps compared to hemodialysis, but greater problems with low levels of protein in the blood.
Hemodialysis
Some people feel unwell during the dialysis treatment (4 hours) and most people feel tired and washed out for 6-8 hours after treatment. There are more problems with low blood pressure and muscle cramps than peritoneal dialysis.
How much time will this treatment take?You are in control of your own time.  There are no regular treatments.Peritoneal dialysis
Peritoneal dialysis needs to be done every day. The procedure takes 30-60 minutes and is done 4 times a day. You can also do it overnight while you sleep (8-10 hours) by using a machine.  You can fit the dialysis around your personal schedule.
Hemodialysis
Hemodialysis is done 3 times a week.  Each treatment usually takes 4 hours. The time spent in the dialysis unit will be about 5-6 hours.  This does not include travel to and from the dialysis unit.  You will be given a fixed appointment. You can request changes, but it will depend upon availability and your dialysis needs.
Will I need surgery?No surgery is neededYou will need surgery to create a dialysis access. This will most likely be noticeable, but your clothing will usually cover it.
Peritoneal dialysis
A flexible plastic tube will be placed in your belly to allow fluid to drain in and out.
Hemodialysis
You will have surgery on your arm to connect an artery to a vein, which makes the vein grow large.  This is needed so two large needles can be placed into it while you are connected to the dialysis machine.


If this surgery is not successful or possible, a flexible tube will be placed in your neck.
Who will do my treatment?It is recommended that every 1-3 months you have a check-up with a doctor and/or other members of your care team to monitor your health. Community resources such as home care can be accessed for you.  Between visits you can call your team with questions or concerns.Between visits you can call the kidney care team. The team includes a kidney doctor (nephrologist), nurse, dietician and social worker.
Peritoneal dialysis
You will do your own treatment at home. You may need the help of family or friends.
Hemodialysis
Specialized medical staff at the dialysis unit will do the treatment for you.
Will I need special training to do my treatment?You won’t need special training.Peritoneal dialysis
You will need 1-2 weeks of training.
Hemodialysis
You won’t need special training.
Will I have food and fluid restrictions?Your medical team will offer advice on diet and fluid intake. If you prefer not to change your eating and drinking habits, just let the team know.Peritoneal dialysis
You will have many food and fluid restrictions.
Hemodialysis
You will have many food and fluid restrictions.
Will I need equipment and supplies to do this treatment?Your medical team may recommend some home monitoring equipment such as a blood pressure machine, but it’s optional.Peritoneal dialysis
Equipment and supplies are provided. You will need to have room in your home to store these supplies and equipment.
Hemodialysis
Treatments are done at dialysis units.  They have all the necessary equipment and supplies.
Can I change from one treatment to another?You can change your mind. All options may still be possible.You can change your mind. All options may still be possible.
 
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