End stage renal disease (ESRD) has many causes but no cure. When almost all kidney function is lost, one of the existing treatment types must be used to maintain life. You can choose the type of treatment that best fits your lifestyle and your medical condition.

Most ESRD treatment costs are paid for by the federal Medicare program. Medicare does not tell you where you must receive care. You make this choice. However, other factors can influence this choice.

Do you want to receive a transplant? Do you want to start a type of dialysis? Do you prefer hemodialysis or peritoneal dialysis? Do you want to do the treatments at home? There are many choices to make at the start of treatment and they can cause confusion. Some choices may not be suitable for you because of medical reasons. Your health care team will give you more information and help you make these choices.

If you want a kidney transplant, you may go to any Medicare-approved transplant hospital to receive one. If you have a different insurer you may be told to go to certain hospitals. These may or may not be close to where you live. You must make sure that the non-Medicare insurer will pay the transportation costs to the transplant hospital if it is not near where you live. Medicare pays no transportation costs to reach a transplant hospital.

Most often you want to be cared for by a particular doctor. Doctors have 'privileges' (are on staff) at certain hospitals and dialysis centers. Your doctor may not be on the staff of the dialysis facility closest to where you live. If you want to receive treatment at a facility where your doctor is not on staff, you may have to select a different doctor or go to the facility where your doctor is on staff. Discuss your concerns and choices with your health care team.

There are medical reasons why some forms of therapy cannot benefit some persons. Discuss any problems connected with a type of treatment with your health care team and choose the best type for you and your medical condition. Later, when you have been on dialysis for some time, or the transplanted kidney no longer works, you may decide to use another type of treatment, e.g. you may start on peritoneal dialysis (PD) and then switch to hemodialysis (HD) in the unit or at home.

Transplantation places one healthy kidney into your abdomen. This one kidney is sufficient to replace the work of your two failed kidneys.

A kidney transplant can be the first form of treatment you receive or it can be selected later after receiving dialysis treatments for some time. Transplantation is the preferred treatment for certain people.

You may receive a transplant from a living related donor, a donor who is not related but willing to donate a kidney, or you may receive a kidney from someone who has recently died (cadaveric).

There is a regional matching service that is funded by the federal government. It updates the list of those waiting for a kidney, does the blood typing and tissue matching for the possible cadaveric transplant.

If a living donor is willing to give you a healthy kidney, this donor must be evaluated for medical fitness and compatible blood type. Depending on the type of donor, waiting time for a kidney will vary. A cadaver donor wait will be longer than a living donor due to the shortage of cadaveric donors. The surgery will take from 2 to 4 hours and your stay in the hospital will be 5-7 days.

Your doctor will prescribe several new medications to prevent rejection by your body of your new kidney. You will have to take these medications as long as the transplanted kidney works. Transplantation can offer you the greatest potential to return to a healthy and productive life.

Dialysis treatments can be done either in a facility or your own home. Home treatment allows you more choice about when to start and end your treatment than you have in a facility. Facilities treat many persons and must keep close to scheduled shifts for treatment start and finish times. Also, transportation to and from facilities must be considered.

Both hemodialysis and peritoneal dialysis can be done at home. Hemodialysis is a little more complicated to do at home. You must have the help of a partner as well as space for the machine and supplies to do home hemodialysis. Peritoneal dialysis is usually always done at home and a partner is not needed. If you decide to do home dialysis you will be trained by facility staff to do so safely.

Those performing any dialysis treatment always practice universal precautions. In facilities, you will see direct care staff wear gowns, gloves and face protectors. These protection measures are taken for your safety and staff safety.

Hemodialysis is a treatment that cleans and filters your blood by removing the waste products and extra fluid that your kidneys can no longer eliminate. Hemodialysis requires a machine and an artificial kidney that is called a dialyzer. During the hemodialysis treatment your blood is pumped by the machine through tubing to the dialyzer. In the dialyzer, your blood is filtered, waste products and extra fluid are removed. The filtered or 'cleaned' blood is then returned to your body.

In order to remove and return blood to your body, an access to your blood vessels must be made. This access is made during a surgical procedure in which a fistula is created or a graft is inserted under your skin. The fistula or graft is put in the lower or upper arm if possible; other places can be used if the arm is not suitable. Your surgeon will determine which access is best for you.

If treatments must be started before a fistula is created or a graft is inserted, a temporary catheter may be placed externally (outside your body) to allow for immediate access to your blood vessels.

Once your access has healed (matured) it can be used for treatment. Two needles are placed in the access at the start of each treatment and taken out at the end of each treatment. One needle is used to remove your blood for cleansing (filtering) and the other is used to return the filtered blood to your body.

Hemodialysis treatments are usually performed three times each week. The length of your treatment is decided by your doctor but usually lasts from 3 to 5 hours. The time depends on your body size, any remaining kidney function and activity level. During your treatment you can read, watch TV or socialize with others close to you in the facility.

Hemodialysis treatments are available in a dialysis facility (in-center) which may or may not be part of a hospital. Many units are in buildings that are not part of a hospital setting. Trained staff performs in-center dialysis treatments.

Peritoneal dialysis is a treatment where the peritoneal membrane (lining around the inside of your intestinal wall) is used to filter and cleanse the impurities, waste products and extra fluid from your body. Peritoneal dialysis uses a fluid called dialysate to remove fluid and waste products from your abdominal cavity and place them in the dialysate. The dialysate fluid acts like a magnet that attracts waste and excess fluid from the body.

Peritoneal dialysis uses a catheter that is surgically put into the abdominal cavity and attached to the bag of dialysate solution for the treatment. After the treatment, the catheter is disconnected from the bag of dialysate and covered to keep it clean.

You or your partner, in the comfort of your own home, perform the treatment. The treatment can be done safely in other locations so that you have the most flexible treatment arrangement. You can do the procedure at work or at school as well.

When your physician decides that your catheter is ready to use, training sessions will be arranged to teach you the best and safest way to perform dialysis. Trained dialysis staff will work with you to make your dialysis therapy and transition to independence as easy as possible. Trained staff are available to you on-call every day for emergencies if you have difficulty with your treatment at home.

The types of peritoneal dialysis are:

Continuous ambulatory peritoneal dialysis (CAPD);

CAPD is done several times during the day. A set amount of fluid is placed into the abdominal cavity through your catheter. This fluid remains in the abdominal cavity for several hours and is then drained. The process is repeated 4 or 5 times daily. Each exchange takes about 30-40 minutes. The exchange schedule can be flexible to meet your needs. No machine is used for this type of treatment. YOU are in control.

Continuous cycling peritoneal dialysis (CCPD).

CCPD is done at night using a machine called a cycler. The system automatically does the exchanges for you while you are sleeping. Most consumers must spend 8 to 10 hours every night to complete this process.

Peritoneal dialysis must be done every day. During your training, you are taught to follow specific procedures that allow you more freedom than on hemodialysis. It is a commitment that can be easy to follow. With encouragement from your family and health care team your lifestyle will require only minimal adaptation.