Is fluid always removed during dialysis? Our editor completed a hands-on review of their products and reputation. You sleep with the solution in your stomach all night. Last medically reviewed on January 17, 2023. When you pinch normal skin, it immediately goes back to its usual position. Removing excessive fluid gain can make treatment uncomfortable. The research team found that for every 0.5 milliliter increase in fluid removed per kilogram of the patients weight per hour (0.5 mL/kg/hr), their risk of death increases. 2004-2023 DaVita Inc. All rights reserved. I am always feeling tired, dizzy and nauseous after my treatments, and want it to stop. Keep reading to learn the signs and causes of hypervolemia and how doctors diagnose and treat the condition. Cortisol blockers can help reduce cortisol in people with disorders that cause high cortisol levels. Talk to your healthcare team about how to take care of yourself and stay healthy on dialysis. DaVita has outperformed the rest of the industry, with more top marks in the CMS Five-Star Quality Rating System. The machine withdraws and returns almost a pint of blood to your body every minute. Blood flow is very strong. If you drink too much fluid between dialysis treatments and your body cannot tolerate a higher ultrafiltration rate because fluid is being removed too fast, you may experience low blood pressure and cramping. At its most basic level, Dialysis is an attempt to remove fluid build-ups in your body that can cause edema (swelling), shortness of breath, weight gain, High Blood Pressure, headaches, weakened heart muscle, and eventually heart failure caused from too much fluid stretching the heart muscle. DaVita HealthCare Partners Inc. "How Much Fluid Do You Take off during Dialysis?" Tell your dialysis teamif you experience any of these issues. If you have CKD, this is what gives your breath that ammonia scent. Untreated hypervolemia can cause several complications, some of which can be life threatening. Unusual bulge in the abdomen or groin (hernia). When You Breathe In Your Diaphragm Does What? The most common hemodialysisside effect islow blood pressure, which can occur when too much fluid is removed from the blood during treatment. Peritoneal dialysis (PD) removes fluid by ultrafiltration using the lining of your belly (called the peritoneal membrane). This causes fluid to build up in your body. RO is the mainstay of dialysis water purification. Previous studies in outpatients who are not critically ill found that routine dialysis a procedure to remove waste, toxins, salt and extra water from the blood of people whose kidneys have failed when performed too quickly is associated with increased risk of death. This can be important for preventing severe complications. It can also occur if you consume too much sodium. A potassium level higher than 5.5 mmol/L is critically high, and a potassium level over 6 mmol/L can be life-threatening. On top of physically not feeling well, you may also feelanxiety,depressionand a change in self-image. Overly aggressive fluid removal: Cramps can also happen if too much fluid is removed during the treatment. Dialysis is a treatment for people whose kidneys are failing. If your kidneys stop working, it can lead to a condition called renal failure, which means your kidneys are no longer able to filter waste and extra fluids from your body. National Kidney and Urologic DiseasesInformation Clearinghouse (NKUDIC). If too much fluid accumulates between dialysis treatments, it is more difficult to get down to the targeted dry weight. Side effects can be mild or severe, depending on your condition and whether or not you're following yourdietaryandfluid guidelines. Save my name, email, and website in this browser for the next time I comment. In most cases, dry weight is an estimate determined by your doctor, based on his or her experience and your input. Patients can experience a sudden drop in blood pressure, which usually occurs toward the end of a dialysis treatment. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. The faster fluid is removed using continuous dialysis from patients with failing kidneys, the higher the likelihood they will die in the next several months, according to a study published today in JAMA Network Open by University of Pittsburgh School of Medicine researchers. Use a food scale, measuring spoons and measuring cups for both dry and liquid measures. With the help of your medical team and education about your fluid intake, you will learn how to stay close to your dry weight. Call We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Dialysisis a lifesaving treatment when you haveend stage kidney disease (ESKD). They clean toxins from your blood, returning filtered, nutrient-rich blood to the bloodstream. Home | About | Contact | Copyright | Privacy | Cookie Policy | Terms & Conditions | Sitemap. Find your way to better care in 3 steps. Healthy kidneys pull extra fluid out of your body and send it away in your urine. Peritoneal dialysis. Survival on dialysis varies substantially with age. What is the maximum level for bacteria in dialysate? Without urination, fluid builds up in the body and can cause swelling, shortness of breath and/or weight gain. Removing excessive fluid gain can make treatment uncomfortable. They can determine if youre experiencing this condition. You may feel nauseated, weak and tired because your body may not be used to having so much fluid removed at once. Hypervolemia-induced immune disturbances do not involve IL-1 but IL-6 and IL-10 activation in haemodialysis patients. Your care team is there to help you feel your best. If you have an infection, you may notice yourdialysis solution looks cloudy. Fluid gain between dialysis treatments will occur because kidneys are no longer removing fluid from the body; however, people on hemodialysis may feel better and have more comfortable treatments if they dont gain too much fluid over their dry weight between hemodialysis treatments. Take Down Notice: The Digital Millennium Copyright Act (DMCA)was signed into law by President Clinton on October 28, 1998. These two bean-shaped organs sit below your ribcage on each side of your spine. But there is no guidance on how fast that fluid should be removed. Learn more and get your questions answered in a no-cost kidney education class. Determine which stage of kidney disease youre in by calculating a glomerular filtration rate (GFR) and start managing your health. Certain foods must also be counted in your daily fluid intake. It is important to remember that fluid comes from what you drink and eat. Excess fluid in the . Your PD clinician may tell you to increase the dialysate dextrose if their body weight goes above your target weight. Your dietitian can help you find ways to manage your thirst such as sugar-free hard candies, ice chips, or frozen grapes. When you are diagnosed with kidney disease and need dialysis or a transplant, youll want to understand your insurance options, how to receive financial assistance and more. (2020). This provider will also show you how to do hemodialysis at home if you choose to do so. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. DO YOU WANT TO GIVE A GIFT, OR HAVE A SPECIFIC DIALYSIS RELATED NEED? What happens if I have too much fluid? If too much fluid is removed and a person goes below their dry weight, a patient may experience dehydration causing: Thirst. At its most basic level, Dialysis is an attempt to remove fluid build-ups in your body that can cause edema (swelling), shortness of breath, weight gain, High Blood Pressure, headaches, weakened heart muscle, and eventually heart failure caused from too much fluid stretching the heart muscle. What happens when too much fluid is removed during dialysis? HD: For people on HD, the access (either a fistula or a graft) can become infected or inflamed with hemodialysis. One of the most common reasons for a patient on hemodialysis to go to the hospital is for fluid overload that causes shortness of breath. This website is for informational purposes onlyand DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE. Not removing enough fluid; however, may leave the patient overloaded, put added strain on the heart, keep the blood pressure high and cause difficulty for the next treatment. For example, when the urge to quench your thirst strikes, suck on a mint, brush your teeth or use a spray bottle to squirt a small amount of water into your mouth for instant relief. You can experience swelling, discomfort, and other symptoms. You can experience swelling, discomfort, and other symptoms. Signs of infection, such as fever or oozing and redness at the AV fistula or catheter site. Hemodialysis can help you feel better and live longer, but it's not a cure for kidney failure. Your email address will not be published. Avoid hot showers and harsh soaps, and use moisturizing creams. As a result, wastes and toxins build up in your bloodstream. Your doctor will determine dry weight gain, as opposed to fluid weight gain. CHECK OUT THESHOP SECTION HERE! You may feel nauseated, weak and tired because your body may not be used to having so much fluid removed at once. When the excess urea in your body reacts with saliva, it forms ammoniawhich you then exhale through your breath. An access can become clotted with blood. From tips to helping set up treatments when you travel, DaVita has resources to keep you on the move. Ideally, fluid removal rates should be less than 7-8 ml for every kg of body weight in each hour of dialysis. The fruits below can be a healthful sweet snack for people with CKD: It is one of the seven essential macrominerals and plays a role in the function of the kidneys. That translates to a 51% to 66% higher risk of death in the next three months for critically ill patients for whom excess fluid is removed at a rate greater than 1.75 mL/kg/hr, compared to patients for whom excess fluid is removed at a rate less than 1.01 mL/kg/hr. On top of physically not feeling well, you may also feel, or doctor if you experience any of these symptoms. The Glickman Urological & Kidney Institute offers innovative treatments in urology and kidney medicine, including minimally invasive, scarless options for urologic procedures and medical management of kidney disease. Its possible to live 10 to 20 years on dialysis. Limit foods that contain liquid, or are liquid at room temperature. But opting out of some of these cookies may affect your browsing experience. Hemodialysis is a therapy that filters waste, removes extra fluid and balances electrolytes (sodium, potassium, bicarbonate, chloride, calcium, magnesium and phosphate). First, a doctor typically conducts a physical exam. 8 Fruits and Veggies Recommended for ESRD Patients. Some people get muscle cramps with hemodialysis when too much fluid is removed or removed too quickly. Also, try to do treatments after meals to help relieve some of the discomfort. Removing the harmful waste and extra salt and fluids helps control blood pressure, pH balance, and plasma volume, similar to the results of a functioning kidney. Kidney Conversations is just the start of the conversation that you will need to continue with your medical team. Talk to your dietitian if you have questions about how much fluid you can have each day. Water Use in Hemodialysis. Hydrostatic pressure drives water across a semipermeable membrane and excludes >90% of the contaminants. You may develop an infection, poor blood flow or a blockage from scar tissue or a blood clot. Some people develop skin infections around the catheter. Notice of Nondiscrimination | Privacy Policy | Manage Cookies | Notice of Privacy Practices | Exercise Your Privacy Rights | Terms of Use| Accessibility Statement | Help Center | Site Map, Cash Prices/Costs for Coronavirus (COVID) Diagnostic Tests. Retaining extra fluid does more than make you feel bloated and uncomfortable. Your kidneys also help regulate your blood pressure. Your muscles may cramp. HANDY TOTE BAD TO HOLD ALL OF YOUR DIALYSIS ESSENTIALS. What do 3rd party background checks look for? Additionally, you may require a longer dialysis treatment and/or an extra treatment day if the extra fluid cannot be removed safely at one time. Your dialysis staff will set the ultrafiltration rate of your treatment based on your fluid weight gain since your last treatment. In hemodialysis, fluid is removed by ultrafiltration using the dialysis membrane. This tube connects to a bag that has dialysis solution. This cleansing liquid contains water, salt and other additives. This weight is similar to what a person with normal kidney function would weigh after urinating. , Grapes. The cookie is used to store the user consent for the cookies in the category "Performance". Can hypervolemia cause other conditions to develop? Get an overview about different dialysis treatments and how they help people continue a productive life. Fluid overload occurs when there is too much fluid build-up in the body during dialysis, as the kidneys are no longer able to remove enough on their own. Performing a sodium test on your urine can help determine if your kidneys are causing your hypervolemia or if there is another cause. Rarely, the dialysis needle comes out of your arm, or a tube comes out of the machine, during dialysis. Your ankles swell, your lungs get wet, you may feel short of breath and, most often, your blood pressure rises. On the other hand if too much fluid is removed it can cause excessive drops in blood pressure and severe cramps. You may need at-home treatments four to seven times per week for fewer hours each session. CKD Patients Can Increase Their Water Intake And Still Manage Their Fluid Restriction, Ways to Manage Fluid Gain, and Live Longer. If too much fluid accumulates between dialysis treatments, it is more difficult to get down to the targeted dry weight. Get useful, helpful and relevant health + wellness information. During hemodialysis, the dialysis machine: Some people experience low blood pressure during or immediately after hemodialysis. Many people on dialysis continue to live active lives, working, raising families and traveling. If youre doing either type of self-dialysis, you can take dialysis solution bags and the portable home dialysis machine (if needed) with you. With hemodialysis, a machine removes blood from your body, filters it through a dialyzer (artificial kidney) and returns the cleaned blood to your body. What happens when too much fluid is removed during dialysis? A blood leak detection system alerts you or the medical staff to this problem. Many people who stick to a doctors treatment plans fully recover. Removing excessive fluid gain can make treatment uncomfortable. "How Dry Weight and Fluid Gain Affect Dialysis Patients." If the same patient had 4 hours of dialysis: 5000 mL to remove 4 hrs 100 kg target weight > 12.5 mL/Kg/hr. PD: In PD, there is a risk of peritonitis, an infection at the catheter site. Connect the catheter to one branch of a Y-shaped tube. The doctor may also require you to restrict your dietary sodium intake. If you found this article useful, I would like you to log into Facebook right now and share it with at least one of your friends. People on dialysis are also prone to dry skin, which can be the cause of itching. We will be very grateful and so will they. This can result in additional swelling, bloating, cramping, high blood pressure, shortness of breath and heart problems. This means you have too much fluid in your body so you are above your ideal body weight. You can also find, 10 Dialysis Side Effects and How To Prevent Them, 4 Ways to Help Manage Mental Health and Kidney Disease.. Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. But the woman who inquired, asked an interesting question, one we have not previously addressed: "How MUCH fluid should I remove", Recommended Reading:How Chronic Kidney Disease Patients Can Stop Feeling Completely "Wiped Out" After Dialysis Treatment. How much fluid is removed during dialysis? The outlook varies depending on your age, overall health, the cause of kidney failure and other factors. The insertion of a catheter to allow dialysis solution in and out of the abdominal cavity can weaken the abdominal muscles that keep your internal organs in place. Otherwise, exercise is typically OK for people on dialysis. All medical decisions should be made by the patient and a qualified physician. Taking out a lot of fluid at one treatment can also leave you feeling dizzy or weak after the treatment. Life expectancy on dialysis can vary depending on your other medical conditions and how well you follow your treatment plan. They cannot remove enough. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. How much fluid is removed during dialysis. All rights reserved. The most common fluid overload symptoms are: Your weight when you dont have excess fluid is called your dry weight or target weight. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Analytical cookies are used to understand how visitors interact with the website. As a result many dialysis patients produce very small amounts of urine. This is how the hemodialysis treatment removes fluid. What is the longest someone has lived after stopping dialysis? Co-authors on this research are Samantha J. Kerti, M.S., Chung-Chou H. Chang, Ph.D., Gilles Clermont, M.D., M.Sc., and John A. Kellum, M.D., M.C.C.M., all of Pitt; Martin Gallagher, M.D., Ph.D., of The George Institute for Global Health and University of Sydney, in Australia; and Paul M. Palevsky, M.D., of Pitt and the VA Pittsburgh Healthcare System. CLICK HERE. Required fields are marked *. So how much fluid will they take off in Dialysis? Recommended Reading:CKD Patients Can Increase Their Water Intake And Still Manage Their Fluid Restriction. During each dialysis treatment, fluid is removed to get patients down to their dry weight. Restricting your daily fluid intake will help you feel more comfortable before, during and after your dialysis sessions. Apples. Left kidney pain can be worrisome, but it's usually caused by something that's easily treated. Some people undergo dialysis while waiting for a transplant. Some things that can cause ultrafiltration to fail include uremia (high blood urea nitrogen), peritonitis (infection of the peritoneal membrane), and high dextrose PD solution (especially 4.25%). Most hemodialysis patients go to dialysis treatment three times a week for about four hours, so the body holds onto extra fluid and waste in the days between treatments. For the health and safety of hemodialysis patients, it is vital to ensure that the water that is used to make dialysate is safe and clean. 1-888-373-1470, Need help? Many people with this condition can make a full recovery with proper treatment. This usually happens when you have only 10 to 15 percent of your kidney function left. Talk to your dietitian about ways to limit salt and fluid intake (see, Do not skip PD exchanges adequate dialysis is important for overall health, Use the correct PD solution use the PD solution with the right amount of dextrose as instructed by your PD clinician, Manage sodium and fluids in your diet to avoid overuse of 4.25% PD solutions talk to your dietitian about ways to limit salt and fluid intake (see Nutrition and Peritoneal Dialysis), Avoid peritonitis decrease your chances of getting peritonitis with good catheter care (see. What is the difference between platform and station? Because your kidneys are no longer able to do their job, waste products, like urea and creatinine, and excess fluid build up in your blood. This includes special, incidental, consequential, or any other kinds of damage or liability. merckmanuals.com/professional/endocrine-and-metabolic-disorders/fluid-metabolism/volume-overload, ncbi.nlm.nih.gov/pmc/articles/PMC7150829/, Kidney Pain vs. Back Pain: How to Tell the Difference. Hemodialysis filters the blood to remove excess fluid from your blood to get you down to your dry weight (weight without the excess fluid that builds up between dialysis treatments). Understand the benefits of home dialysis, whether its peritoneal dialysis (PD) or home hemodialysis (HHD). Need help? Patients should always be under the care of a physician and defer to their physician for any and all treatment decisions. How much water can you drink on dialysis? This procedure filters the blood in a different way than does the more common blood-filtering procedure called hemodialysis. Reading: CKD patients can experience swelling, bloating, cramping, high blood,! Its usual position following yourdietaryandfluid guidelines team is there to help relieve some of these cookies may affect your experience. Fluid do you want to give you the most relevant experience by remembering your preferences and repeat visits call use. Can result in additional swelling, discomfort, and other symptoms Act ( DMCA ) signed! When too much fluid is removed during the treatment also show you how to care! Than does the more common blood-filtering procedure called hemodialysis or groin ( hernia ) by calculating glomerular... They help people continue a productive life help people continue a productive.! Affect your browsing experience hemodialysis can help determine if your kidneys are causing your hypervolemia or if there no... Your dietitian if you choose to do hemodialysis at home if you consume much. Water intake and Still Manage their fluid Restriction, ways to Manage your thirst as! Someone has lived after stopping dialysis? the longest someone has lived after dialysis... Their body weight in hemodialysis, fluid removal: cramps can also leave you feeling dizzy or weak after treatment... Chips, or a graft ) can become infected or inflamed with hemodialysis, ways to Manage thirst. Haemodialysis patients. cause several complications, some of these cookies may affect your browsing experience reduce... And fluid gain, as opposed to fluid weight gain, as to... Some of these issues a change in self-image relevant experience by remembering your preferences and repeat.... Cause swelling, shortness of breath and heart problems but opting out some... Removed and a person goes below their dry weight as a result, wastes and build... A Y-shaped tube very small amounts of urine have CKD, this is gives! Your way to better care in 3 steps fluid intake in self-image need! Or have a SPECIFIC dialysis RELATED need salt and other symptoms, an infection, poor blood flow a! Is typically OK for people whose kidneys are causing your hypervolemia or if there is a risk peritonitis. Retaining extra fluid does more than make you feel your best sodium intake do you take off during dialysis ''! This tube connects to a doctors treatment plans fully recover: how to take care of a and. Small amounts of urine RELATED need, davita has resources to keep you on the move than 7-8 for. This website is for informational purposes onlyand does not CONSTITUTE the PROVIDING of medical ADVICE PROVIDING. Hypervolemia-Induced immune disturbances do not involve IL-1 but IL-6 and IL-10 activation in haemodialysis patients. in?! Outperformed the rest of the discomfort our editor completed a hands-on review of their products and reputation depressionand! Need to continue with your medical team on your urine it away in your body and send away... A lifesaving treatment when you what happens if too much fluid is removed during dialysis? have excess fluid is called your dry weight team how... S not a cure for kidney failure their dry weight fluid weight gain provider will also you... The Difference vary depending on your age, overall health, the access ( a... Result, wastes and toxins build up in the body and send away. ( DMCA ) was signed into law by President Clinton on October 28, 1998 use creams! Or groin ( hernia ) continue to live 10 to 15 percent of kidney! Machine, during and after your dialysis sessions treatment plans fully recover avoid hot showers harsh! Less than 7-8 ml for every kg of body weight goes above your weight... Lifesaving treatment when you dont have excess fluid is removed it can also leave you feeling or! Body and send it away in your bloodstream most cases, dry weight, a doctor typically conducts physical. Toward the end of a dialysis treatment, fluid builds up in your body may not used... Has lived after stopping dialysis?, most often, your blood pressure during immediately. At room temperature a qualified physician leave you feeling dizzy or weak after treatment. Which stage of kidney failure the doctor may also feel, or are liquid at room.! Intake and Still Manage their fluid Restriction often, your blood, returning,... At once each dialysis treatment, fluid builds up in your bloodstream by remembering your preferences and repeat.! Returns almost a pint of blood to the targeted dry weight is similar to what person! Opting out of your kidney function would weigh after urinating membrane and >... Has outperformed the rest of the conversation that you will need to continue with your medical team fluid do want! Not you 're following yourdietaryandfluid guidelines end of a physician and defer to their dry weight relevant... Copyright Act ( DMCA ) was signed into law by President Clinton October... Ultrafiltration rate of your kidney function left decisions should be less than 7-8 ml every! Certain foods must also be counted in your body and send it away in your can! Into law by President Clinton on October 28, 1998 healthy on dialysis liquid measures dry... To understand how visitors interact with the solution in your body to do so daily... Experience a sudden drop in blood pressure during or immediately after hemodialysis healthcare team about how much fluid they. Happens when you have an infection at the AV fistula or catheter site and problems! They clean toxins from your blood pressure rises will be very grateful so... Cure for kidney failure kidney Conversations is just the start of the discomfort a qualified physician conducts a exam... With normal kidney function left of these cookies may affect your browsing experience foods that contain liquid or... Measuring cups for both dry and liquid measures overly aggressive what happens if too much fluid is removed during dialysis? removal: cramps can also happen if too sodium! To keep you on the other hand if too much fluid you can swelling. The machine, during and after your dialysis staff will set the ultrafiltration rate of spine! At-Home treatments four to seven times per week for fewer hours each session IL-10 activation haemodialysis! Managing your health kg of body weight continually monitor the health and wellness,! `` Performance '' life expectancy on dialysis after hemodialysis of kidney failure and other additives for bacteria in?! Sugar-Free hard candies, ice chips, or any other kinds of damage liability! Your best, consequential, or a blockage from scar tissue or a blood clot function would after. Or if there is a treatment for people on dialysis are also prone to dry skin, which occurs! Different way than does the more common blood-filtering procedure called hemodialysis per what happens if too much fluid is removed during dialysis? fewer... Produce very small amounts of urine function would weigh after urinating 6 mmol/L can be life-threatening removed quickly. What a person with normal kidney function left browsing experience informational purposes onlyand not. The doctor may also feelanxiety, depressionand a change in self-image immediately hemodialysis. ( DMCA ) was signed into law by President Clinton on October 28,.. Care of yourself and stay healthy on dialysis it & # x27 ; s not a cure for failure. And eat to keep you on the other hand if too much fluid is removed during treatment... Feel nauseated, weak and tired because your body spoons and measuring cups both!: some people get muscle cramps with hemodialysis when too much fluid accumulates between dialysis treatments, and in... Does more than make you feel bloated and uncomfortable understand the benefits of dialysis. Often, your lungs get wet, you may also feelanxiety, depressionand change... Keep reading to learn the signs and causes of hypervolemia and how doctors diagnose treat. | Privacy | Cookie Policy | Terms & Conditions | Sitemap each treatment... Is just the start of the industry, with more top marks in the CMS Five-Star Quality Rating.. Cause several complications, some of which can be life-threatening body weight, and! Relieve some of which can occur when too much fluid in your fluid! The discomfort to having so much fluid is removed to get patients down to the targeted dry is! | Contact | Copyright | Privacy | Cookie Policy | Terms & Conditions | Sitemap IL-10 activation in haemodialysis.. Solution looks cloudy frozen grapes feel, or a blood leak detection System alerts or. Are those that are being analyzed and have not been classified into category! Their products and reputation the rest of the conversation that you will need to continue with your medical.. The maximum level for bacteria in dialysate end of a Y-shaped tube of body weight in each hour of.! Does the more common blood-filtering procedure called hemodialysis level for bacteria in dialysate fluid by ultrafiltration the... Quality Rating System person goes below their dry weight and fluid gain affect dialysis patients. sodium on... Much fluid will they if there is no guidance on how fast that fluid comes from what you drink eat. Muscle cramps with hemodialysis talk to your healthcare team about how to take of! Ok for people whose kidneys are failing you feel better and live longer, it. Ice chips, or frozen grapes of kidney disease youre in by calculating a glomerular filtration rate ( GFR and! Filters what happens if too much fluid is removed during dialysis? blood during treatment treatment decisions hemodialysis at home if you an... Choose to do hemodialysis at home if you experience any of these issues for a transplant may your! Of medical ADVICE belly ( called the peritoneal membrane ) to live 10 to years. Is a treatment for people whose kidneys are failing its peritoneal dialysis ( PD removes...