Why Come to UC San Diego Health?
Dialysis is a lifesaving service for individuals with diminished kidney function. Our internationally known dialysis program offers a range of treatment options for people with end-stage renal disease (ESRD), including
Our state-of-the-art dialysis center is open six days a week, and operates four shifts a day (each handling 18 patients). Most people who receive their dialysis care at UC San Diego Health will be seen by their doctor once a week (or four times a month).
Our dialysis center is directly connected to the hospital and emergency room, and there is always a physician on site.
Our physician-scientists are actively involved in clinical research investigating new therapies and developing understanding of chronic kidney disease progression, hypertension and acute kidney injury.
Our multidisciplinary team includes a dietitian and social worker to help manage the physical, social and psychological aspects of ESRD.
When Is Dialysis Needed?
The main role of the kidneys is to filter extra water, electrolytes and waste products from your body. Dialysis is necessary to help filter blood when kidneys are no longer able to support the body's needs (end stage renal disease or ESRD).
When the level of kidney function is significantly diminished (usually less than 10 percent of what is considered normal), people develop symptoms of kidney failure that may include:
- Metallic or bitter taste in the mouth
- Severe fatigue
- Poor appetite
- Sleep disturbance
- Shortness of breath
- Significant leg swelling
When your kidneys shut down completely, dialysis or transplantation is required to keep you alive.
What Is Dialysis?
Dialysis is artificial purification of the blood. It supports kidney function by:
- Removing extra water, electrolytes and waste products from your body
- Helping to control blood pressure
- Keeping a safe balance of certain electrolytes/minerals in your body (e.g., sodium, potassium, magnesium, phosphorus)
Types of Dialysis
There are two main types of dialysis:
Peritoneal dialysis (PD)
The type of dialysis you will receive depends on your individual situation and lifestyle preference. It is important that you learn about both types and talk to your physician before deciding which is right for you.
It is not uncommon for patients to switch from one type of dialysis to another at some point in their lives.
Hemodialysis cleans your blood using a dialysis machine. During this type of dialysis, a small amount of blood is withdrawn from your body and ran through a special filter to remove the waste products. This filtered blood is then returned to your body. This process continues for several hours.
Hemodialysis can be performed in our dialysis center or at home.
In-center hemodialysis is usually done three times a week for about four hours each time. You can wear regular clothes and sit in a comfortable chair during treatment. To pass the time you can watch TV, listen to music, read, eat, or take a nap. In-center hemodialysis at UC San Diego Health is performed in our hemodialysis treatment center attached to UC San Diego Medical Center. Or, you can be referred to one of our community clinics operated by UC San Diego Health physicians. (The location will depend on where you live and what is most convenient for you.)
Short daily hemodialysis: This type of hemodialysis is performed by the patient and a partner at home five to six days a week for two to three hours each time.
Nocturnal hemodialysis: This type of hemodialysis is performed by the patient and a partner at home three times a week at night for six to eight hours.
Peritoneal dialysis is a type of dialysis that uses a natural filter (inner lining of your belly or peritoneal membrane) to clean your blood.
Peritoneal dialysis is done daily at home, usually while you sleep.
This type of dialysis uses sterile solution that goes into your belly via a plastic tube. Waste products and extra fluids travel from your blood into a sterile fluid that is located in your belly; the fluid that collects here is then discarded. This process is repeated several times overnight by a dialysis machine while you are asleep.
Potential benefits of peritoneal dialysis include:
More free time (dialysis is done at night which gives you days to yourself)
More freedom to travel
Diet for peritoneal dialysis patients is usually less restricted
Fluid removal from your body is gentler (done over more hours) compared to a typical hemodialysis session
Preparing for Dialysis
It is recommended you prepare for dialysis in advance so it does not become a medical emergency when your kidneys begin to shut down.
Preparing for dialysis does not automatically mean initiation of dialysis. Your physician will determine with you when you are ready and/or need to start dialysis.
Preparing for Hemodialysis: Vascular Access
Before starting hemodialysis, a vascular access (VA) must first be formed. A VA is the entry point into a vein where blood is removed and returned to the body.
Types of vascular access for hemodialysis:
Arteriovenous fistula (AVF)
This is the preferred form of vascular access as it is associated with the best survival rate and fewest complications compared to other types of vascular access for dialysis. AVF is created by a vascular surgeon during outpatient surgery. It takes about three months from the time of placement to when the access is mature and can be used for dialysis. It is recommended that patients undergo AVF surgery a year prior to the anticipated start of dialysis to allow for unexpected delays.
Arteriovenous graft (AVG)
This is the second preferred form of vascular access and is used if/when your surgeon determines that your blood vessels are too small to create an AVF. During an AVG, your surgeon will use artificial material to supplement your own blood vessels. Since this type of access requires only about two weeks of maturation time, you can wait to have it done until you are almost ready to begin dialysis.
Tunneled catheter (TC)
This is the least preferred type of dialysis access and should only be reserved for urgent-start (emergency) dialysis, or if a patient does not have big enough veins to support either AVF or AVG. This type of vascular access is placed by an interventional radiologist and can be used immediately. Due to increased risk of infection associated with tunneled catheter, it should be removed as soon as more permanent access (AVF or AVG) can be established.
Preparing for Peritoneal Dialysis
Dialysis access for peritoneal dialysis consists of a soft plastic tube (catheter) which is placed in the abdomen by a surgeon a couple weeks before peritoneal dialysis is initiated.
Coping with Dialysis
The transition to dialysis might put emotional stress on you and your family. You may need to make some adjustments in your daily routine, diet and lifestyle. To help patients cope, we have highly dedicated social workers who can help you learn how to thrive on dialysis.
Our team endeavors to get appropriate patients on the transplant list before they begin dialysis or as soon as possible after they start dialysis.
Kidney transplantation is associated with better quality of life and longer life than dialysis in the majority of patients.
Our transplant surgeons and nephrologists are leaders in innovative research and sophisticated, minimally invasive surgical techniques for kidney removal.
Learn more about kidney transplantation at UC San Diego Health.