Kidney Dialysis

If your child’s kidneys are unable to filter their blood due to chronic kidney disease (CKD), and won’t recover normal kidney function, your child will need either dialysis or a kidney transplant. If your child has acute kidney injury (AKI), a course of dialysis can support their kidneys until their kidney function returns.

About one-third of children with end-stage renal disease (ESRD) can go directly to a transplant. For others, dialysis can help the others be in their best condition to ensure the most successful transplant possible.

Your child’s doctor may also recommend a course of dialysis if:

• She is waiting for a transplant and a suitable donor has yet to be identified.
• A kidney transplant is not yet the right option.
• She has just had an unsuccessful kidney transplant.

While dialysis takes over the kidneys’ function of filtering blood, your child may 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.

Peritoneal dialysis

Peritoneal dialysis works by filling your child’s abdomen with a special solution called dialysate. 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 the abdomen.

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

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

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

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

• Measure out the correct amount of dialysate
• Bring it to the correct temperature
• Transfer it to your child's abdomen through the catheter

The dialysate will stay in the abdomen, cleaning and filtering blood, for a period of time determined by your child's 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 automatically 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 the body in a continuous process, cleans and filters it, and returns it to your child's bloodstream. Only a very small amount of their blood is filtered at a time.

Several weeks before your child’s first treatment, their doctor or another dialysis specialist will create an “access point." This is an opening though which blood is transported to the dialyzer and then back into your child’s body after it has been cleaned.

Depending on your child’s age and how long the course of dialysis is likely to be, the access point might be:

• A catheter: A small, soft tube inserted into one of your child’s main blood vessels, often under their collarbone or in their 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. This reduces the risk of infection that comes with using a catheter.

Hemodialysis is generally performed three times per week, and younger children may need it four times per week. Each hemodialysis 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 help make sure your child is comfortable and can take part in constructive play and/or provide tutoring as appropriate.

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. 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.

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.

Lots of parents find it helpful to jot down questions before their visit with their child’s doctors to be sure all of their concerns are addressed. If your child is old enough, you may want to suggest that they write down questions for their doctors 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 they need to go to college or want to travel?

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 placed at the top of the waiting list for donor kidneys.

We perform about 3,500 chronic dialysis treatments per year in our seven-bed dialysis unit designed especially for kids. Our dialysis nurses will do everything they can to make sure your child is comfortable during their treatments. In addition to the nurses, our unit also includes specially trained dietitians, tutors, Child Life specialists, and pharmacists, making us the only full-service dialysis unit in New England.

Year after year, Boston Children’s is consistently ranked among the top pediatric hospitals in dialysis management by U.S. News & World Report.

Boston Children’s is home to the world’s most extensive research enterprise at a pediatric hospital. In our End-Stage Renal Disease Program — which includes the dialysis unit and our Kidney Transplant Program — our treatment is informed by our research.

We have many partnerships with top research, biotech, and health care organizations, and we work together to improve kids’ health.

Our Transplant Research Program provides a rich environment for collaboration of scientists and physicians in the areas of transplantation and immunology. We currently participate in as many National Institutes of Health-sponsored pediatric kidney transplant research studies as any other program in the nation.

If your child has end-stage renal disease, dialysis can filter their blood but not take over the other roles of the kidney, such as regulating the amounts of some important vitamins and minerals released into the bloodstream and controlling blood pressure. For that, your child needs to take medication and follow a special diet. Our researchers are currently involved in several clinical trials to assess the safety and efficacy of medications aimed at fulfilling this pharmaceutical component of treating end-stage renal disease. We’re committed to developing better anti-rejection medication with the goal of more successful transplants and fewer side effects.