Dialysis Management
Hemodialysis & Peritoneal Dialysis

Dialysis is a life-sustaining treatment that performs the kidneys' waste-removal and fluid-balancing functions when kidney failure has occurred. It is not a cure, but it is a highly effective treatment that allows patients to live active, meaningful lives. Having a knowledgeable, accessible, and compassionate nephrology team managing your dialysis care is essential to maximizing your quality of life and long-term survival on dialysis.

At Associated Kidney Specialists of the North Bay, our nephrologists provide comprehensive dialysis management for patients on both in-center hemodialysis and peritoneal dialysis across our service area. We see dialysis patients at multiple dialysis facilities throughout Napa, Solano, Sonoma, and Lake Counties, and we maintain close communication with dialysis facility staff to ensure seamless, coordinated care.

We believe dialysis patients deserve more than just prescription management. Our approach encompasses the full complexity of ESRD care — from optimizing dialysis adequacy to managing the nutritional, cardiovascular, bone, and psychological challenges that accompany kidney failure.

In-center hemodialysis typically involves three sessions per week at a dialysis facility, each lasting 3–5 hours. We manage every aspect of HD treatment — writing and optimizing the dialysis prescription, reviewing adequacy parameters (including Kt/V and URR), managing dialysis access complications, and addressing the many metabolic issues that arise.

Dialysis Access: Vascular access is the lifeline of hemodialysis. We strongly advocate for arteriovenous fistulas (AVF) as the preferred access due to their superior long-term outcomes and lower infection risk. We work with vascular surgery to plan and place fistulas and grafts early, and we troubleshoot access dysfunction — including stenosis and thrombosis — with timely referrals to interventional radiology.

Home Hemodialysis: For motivated and appropriate patients, home hemodialysis (more frequent, shorter sessions) offers superior outcomes including better blood pressure control, improved phosphorus management, and enhanced quality of life. We support and train patients interested in home HD.

Peritoneal dialysis uses the patient's own peritoneal membrane as a natural filter, allowing dialysis to be performed at home — either continuously throughout the day (CAPD) or overnight using a cycler machine (APD). PD offers significant lifestyle advantages: no needles, home-based therapy, and greater flexibility in scheduling.

Our nephrologists are experienced PD clinicians who provide thorough training, ongoing support, and timely management of PD complications including catheter infections (tunnel infections and peritonitis), membrane failure, and inadequate dialysis. We monitor PD adequacy with regular peritoneal equilibration tests and 24-hour collections, adjusting prescriptions to optimize clearance and fluid removal.

We work collaboratively with our patients and their families to determine whether hemodialysis or peritoneal dialysis is the better fit for each individual's lifestyle, anatomy, clinical status, and personal preferences — and we support patients through transitions between modalities when circumstances require it.