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Dialysis is a process for removing waste and excess water from the blood, and is used primarily to provide an artificial replacement for lost kidney function in people with renal failure. Dialysis may be used for those with an acute disturbance in kidney function (acute kidney injury, previously acute renal failure), or progressive but chronically worsening kidney function–a state known as chronic kidney disease stage 5 (previously chronic renal failure or end-stage renal disease). The latter form may develop over months or years, but in contrast to acute kidney injury is not usually reversible, and dialysis is regarded as a “holding measure” until a renal transplant can be performed, or sometimes as the only supportive measure in those for whom a transplant would be inappropriate. 

The kidneys have important roles in maintaining health. When healthy, the kidneys maintain the body’s internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfate). The acidic metabolism end-products that the body cannot get rid of via respiration are also excreted through the kidneys. The kidneys also function as a part of the endocrine system, producing erythropoietin and calcitriol. Erythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation. Dialysis is an imperfect treatment to replace kidney function because it does not correct the endocrine functions of the kidney. Dialysis treatments replace some of these functions through diffusion (waste removal) and ultrafiltration (fluid removal).

“If someone is at the stage where they need to go on dialysis,” says kidney disease expert Dr. Lloyd E. Ratner, M.D, “they will most likely eventually need a transplant to live, so the question boils down to doing a transplant now or later. Secondly, in general, dialysis only brings up kidney function to about 17 percent — not a lot at all. Only 25 percent of people can continue to work at a job while on dialysis. It’s not a life. It’s painful, it’s time-consuming, and it should be seen as a last resort. It’s of utmost importance that there be a plan in place for a transplant. The sooner one gets started on it, the better, because there is a lot of testing that will need to get done on the potential donors to ensure that they are indeed the best match. Nobody wants to be held up in bureaucratic traffic when his or her life is on the line, G-d forbid.”

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