Conditions + Treatments

Kidney Dialysis In-Depth

LIke ThisLIke ThisLIke ThisLIke ThisLIke This

Contact the Division of Nephrology

We understand that you may have a lot of questions when dialysis is being considered as a treatment option for your child.

  • What is it?
  • How long will it take?
  • How will it help my child get better?

We’ve tried to provide some answers to those questions here, and when you meet with our experts, we can explain your child’s options fully.

It’s important to remember that filtering blood is one of several roles the kidneys play in your child’s body. Dialysis takes over that function, but your child may also need to follow a special diet and take medicines to compensate for the other things that a fully functioning kidney may do, such as regulating certain vitamins and minerals.

Does my child have to go to the hospital for dialysis?

Not necessarily. There are two types of dialysis: peritoneal dialysis is performed at home; and hemodialysis is performed at the hospital or at a dialysis center.

What’s the difference between peritoneal dialysis and hemodialysis?

Peritoneal dialysis and hemodialysis use two different methods to reach the same goal – cleaning your child’s blood. Neither has been scientifically proven to be more effective than the other.

Which type of dialysis is right for my child?

Both types are effective treatments. In most cases, you can choose the type of dialysis that works best for your child’s and your family’s specific situation. Your child’s doctor will be happy to discuss your options with you.

Please be assured that regardless of which option you choose, our staff will make sure that you have all the information and training you need to take care of your child.

Peritoneal dialysis

Peritoneal dialysis is a type of dialysis that can be performed at home. Most families who choose this option do continuous cyclic peritoneal dialysis (CCPD). This is an automatic process that uses a special dialysis machine, and it can be done while your child is asleep.

How does peritoneal dialysis work?

Peritoneal dialysis works by filling your child’s abdomen with a special solution called dialysate. In your child’s abdomen, the dialysate absorbs waste from your child’s blood the way water absorbs powdered iced tea mix. After the dialysate has absorbed the waste from your child’s blood, it drains out of her abdomen.

The process of filling your child’s abdomen with dialysate, giving it time to absorb the waste from her blood, and draining out of her body is known as an “exchange.”

How is peritoneal dialysis performed?

First, your child’s surgeon will insert a soft, hollow tube (catheter) into her abdomen, near her navel. This is a permanent tube that will carry the dialysate in and out of her abdomen. It is not uncomfortable, and easily concealed under clothes.

Each night, as your child sleeps, the dialysis machine will automatically:

  1. measure out the correct amount of dialysate
  2. bring it to the correct temperature
  3. transfer it to her abdomen through the catheter

The dialysate will stay in her abdomen, cleaning and filtering blood, for a period of time determined by her doctor. Then it will drain back out through the catheter into a sterile drainage bag that is emptied each morning.

This constitutes one exchange, and usually takes about an hour. Generally, around 10 exchanges are performed each night.

Hemodialysis

Hemodialysis is performed in a hospital or in a dialysis center.

Your child is connected to a large machine called a dialyzer that takes blood out of her body in a continuous process, cleans and filters it, and returns it to her bloodstream. Only a very small amount of her blood is filtered at a time.

Several weeks before your child’s first treatment, her doctor or another dialysis specialist will create an “access point” – an opening though which her blood is transported to the dialyzer and then back into her body after it has been cleaned. Depending on your child’s age and how long the course of dialysis is likely to be, his access point might be:

  • a catheter – a small, soft tube inserted into one of your child’s main blood vessels, often under her collarbone or in her neck
  • an arteriovenous (AV) fistula - a surgeon will connect two blood vessels in your child’s arm. This access point may be used for longer-term dialysis. This requires that the hemodialysis be performed through two tubes connected to needles that must be placed into the fistula, but it lessens the risk of infection that comes with using a catheter.

How often would my child need to have hemodialysis performed?

Hemodialysis is generally performed three times per week, and younger children may need it four times per week.

How long does each session take?

Each session lasts between three and four hours. If you are going to a dialysis center, it can be helpful to bring games or reading materials for your child. At Boston Children's Hospital, our Child Life specialists and other dialysis staff members are there to make sure your child is comfortable and engage her in constructive play and/or provide tutoring as appropriate.

Hemodialysis is much more efficient than peritoneal dialysis, which is why it does not need to be performed every day.

Long-term outlook

What’s the long-term outlook for my child?

Unfortunately, chronic kidney disease is irreversible, and most children on dialysis will need a kidney transplant. at some point. Thanks to efforts on the part of Boston Children's and other institutions, children under 18 are automatically moved to the top of the waiting list for donor kidneys.

FAQ

Q: Does my child have to go to the hospital for dialysis?

A: Not necessarily. There are two types of dialysis: peritoneal dialysis is performed at home; and hemodialysis is performed at the hospital or at a dialysis center.

Q: Which type of dialysis is right for my child?

A: Both types are effective treatments. In most cases, you can choose the type of dialysis that works best for your child’s and your family’s specific situation. Your child’s doctor will be happy to discuss your options with you.

Please be assured that regardless of which option you choose, our staff will make sure that you have all the information and training you need to take care of your child.

Q: What’s the long-term outlook for my child?

A:Unfortunately, chronic kidney disease is irreversible, and most children on dialysis will need a kidney transplant at some point. Thanks to efforts on the part of Boston Children’s and other institutions, children under 18 are automatically moved to the top of the waiting list for donor kidneys.

Questions to ask your doctor

When you find out that your child needs to go on dialysis, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you.

Lots of parents find it helpful to jot down questions as they arise – that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed.

If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.

Some of the questions you may want to ask include:

  • What factors should I take into consideration when choosing between peritoneal dialysis and hemodialysis?
  • What nutritional concerns should I be aware of when my child is on dialysis?
  • What are my child’s options if she needs to go to college or travel?

Emergency preparedness

It’s important to recognize that despite the best planning, an emergency may still occur. If this should happen, knowing what to do can make a stressful situation much easier to deal with.

If you cannot leave your home, call Boston Children’s Dialysis Unit at (617) 355-5997 for instructions.

Explore these online resources for helpful information and checklists about:

  • meal planning
  • infection control for dialysis patients after a disaster

More in-depth, detailed information is available here:

Boston Children's Hospital contact numbers:

  1. Dialysis Unit:  617-355-5997
  2. Operator:  617-355-6000 and ask for the Renal Fellow on call
END STAGE RENAL DISEASE ACT
In 1972, Congress passed the End Stage Renal Disease Act, ensuring that Medicare will cover dialysis and kidney transplants for anyone who with end stage renal disease who is eligible for social security.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944

Close