What Is Dialysis?

Dialysis is a medical process that substitutes for some functions of the kidneys when the kidneys are failing or have failed. Essentially, it filters and removes waste products, excess water, and electrolytes from the bloodstream — the same tasks healthy kidneys perform.  kidney transplantation is a form of renal replacement therapy (RRT).

In simple terms,  kidney transplantation procedure and its types refers to the different methods by which the body’s waste can be cleared when kidneys cannot do the job. There are several branches of  kidney transplantation , including hemodialysis, peritoneal  kidney transplantation , continuous renal replacement therapies (CRRT), and hybrid approaches such as hemodiafiltration.

 kidney transplantation is life-saving for many patients with end-stage renal disease (ESRD) or severe acute kidney injury. But it is not without trade-offs — the process has both benefits and risks, and patients often experience both hope and hardship.

In this post, I will explain the main  kidney transplantation procedure and its types, how they differ, when each is used, and also the medical coding (CPT, ICD‑10) systems underlying them. We’ll also explore the pros, cons, and future directions of  kidney transplantation.

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Why Is  kidney transplantation Necessary?

To understand the need for  kidney transplantation, one must first recognize what happens in kidney failure.

When kidneys lose sufficient function, the following issues arise:

• Waste products (e.g. urea, creatinine) accumulate in the blood

• Excess fluid builds up (leading to edema, hypertension, pulmonary congestion)

• Potassium, phosphorus, and other electrolytes become dysregulated

• Acid–base balance may shift (metabolic acidosis)

• Toxins and drug metabolites may not be cleared effectively

When kidney function drops below a critical threshold (often when glomerular filtration rate, GFR, is < 15 mL/min/1.73 m², or when symptomatic complications arise),  kidney transplantation becomes necessary to maintain internal balance and prevent life‑threatening complications.

Thus,  kidney transplantation becomes a life-sustaining therapy for patients with ESRD, or sometimes in acute kidney injury situations where renal recovery is hoped for.

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Branches & Main Types: Dialysis Procedure and Its Types

When we speak of  kidney transplantation procedures and its types, here are the major branches:

1. Hemodialysis

2. Peritoneal  kidney transplantation 

3. Continuous Renal Replacement Therapy (CRRT) / Slow Continuous Therapies

4. Hybrid / Advanced modalities (e.g. Hemodiafiltration, Portable or Wearable Dialysis)

Let’s explore each in more depth.

Hemodialysis

This is perhaps the most well-known form. In hemodialysis, the patient’s blood is circulated out of the body, passed through a dialyzer (an artificial filter), and then returned. The dialyzer uses semi‑permeable membranes to allow diffusion and convection of waste and excess fluid from blood into a  kidney transplantation fluid (dialysate) on the other side of the membrane.

Typical hemodialysis involves sessions (often 3 times per week, each lasting ~3–5 hours) in a  kidney transplantation center. Vascular access is crucial — commonly via arteriovenous fistula, graft, or central venous catheter.

Some variants include:

• Home hemodialysis: with appropriate equipment, patients can perform hemodialysis at home (often more frequently or longer sessions).

• Nocturnal hemodialysis: extended overnight sessions, either in-center or at home.

• Short daily hemodialysis: more frequent but shorter sessions.

Peritoneal Dialysis

In peritoneal dialysis, the patient’s peritoneal membrane (lining of the abdominal cavity) acts as the filter. Dialysis fluid (dialysate) is introduced into the peritoneal cavity via a catheter, sits there for a dwell time, and then drained, carrying waste and excess fluid with it.

Subtypes include:

• Continuous Ambulatory Peritoneal  kidney transplantation (CAPD): manual exchanges done several times per day.

• Automated Peritoneal  kidney transplantation(APD): a cycler machine carries out exchanges at night while the patient sleeps.

• Continuous Cycle PD / Tidal PD: continuous cycling with partial retention of dialysate etc.

Because peritoneal  kidney transplantation is continuous (or semi-continuous), it is gentler on the body in terms of fluid shifts, and gives more freedom (especially for home therapy) — but it carries its own risks (e.g. peritonitis).

Continuous Renal Replacement Therapy (CRRT) & Slow Continuous Therapies

This branch is often used in critically ill patients (e.g. in intensive care units) who are hemodynamically unstable and can’t tolerate conventional intermittent hemodialysis. CRRT runs continuously (over many hours or days), gradually removing fluid and solutes, hence less abrupt shifts in volume and pressure.

Variants in this branch include:

• Slow Continuous Ultrafiltration (SCUF)

• Continuous Venovenous Hemofiltration (CVVH)

• Continuous Venovenous Hemodialysis (CVVHD)

• Continuous Venovenous Hemodiafiltration (CVVHDF)

These modalities combine diffusion (as in  kidney transplantation ) and convection (as in hemofiltration) as needed.

Hybrid / Advanced Modalities

As technology evolves, more hybrid or advanced approaches appear. One such is hemodiafiltration, which combines diffusive and convective clearance in a single session. Some  kidney transplantation centers offer online hemodiafiltration.

Emerging research is exploring wearable dialysis devices, portable dialysis machines, and implantable artificial kidneys. These aim to reduce the burden, improve quality of life, and perhaps someday allow more “on-demand”  kidney transplantation .

Thus, when discussing  kidney transplantation  procedure and its types, one must consider not only the standard methods (hemodialysis, peritoneal) but the continuous and hybrid modalities that bridge into critical care or advanced therapies.

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Key Differences Between Hemodialysis and Peritoneal Dialysis

To compare the two major types under the umbrella “ kidney transplantation procedure and its types”:

In selecting among  kidney transplantation procedure and its types, the choice often depends on medical factors (hemodynamics, residual kidney function, comorbidities), lifestyle preferences, support systems, and infrastructure.

Medical Coding: CPT Codes for Dialysis

To provide completeness, let’s dive into how the  kidney transplantation procedure and its types get translated into medical billing and coding, particularly in the U.S. system (CPT codes).

CPT (Current Procedural Terminology) codes are used to describe medical procedures for billing and documentation. The  kidney transplantationcodes generally lie in the 90935–90999 range (as part of the larger CPT medicine section). AAPC+3Wikipedia+3Coding Clarified+3

Here are some of the important CPT codes associated with  kidney transplantationservices:

• 90935 — Hd procedure with physician evaluation (all components) Coding Clarified+2Molina Marketplace+2

• 90937 — Repeat hd evaluation (with or without revision of  kidney transplantation prescription) NCBI+3Molina Marketplace+3Coding Clarified+3

• 90940 — hd access flow study

• 90945 / 90947 — Other  kidney transplantation (non-hd) evaluation codes

• 90951–90970 — These codes cover ESRD (end-stage renal disease) related physician services / management over a month, depending on age and number of visits.

• 90963–90966 — Codes used for home  kidney transplantation patients’ monthly management

• 90989 —  kidney transplantation training, patient completed course

• 90993 —  kidney transplantation training, per training session

• 90997 — Hemoperfusion (different but sometimes aligned with  kidney transplantation codes)

• 90999 — Unlisted  kidney transplantation procedure (used when procedure doesn’t match standard codes)

Also, for inpatients or acute settings, certain modifiers or inpatient-outpatient bundling rules may apply.

In summary, when billing or documenting  kidney transplantation procedure and its types, these CPT codes allow providers and payers to identify which type of  kidney transplantation service was delivered, the level of evaluation, management, training, or special services.

Additionally, there are CPT codes related to  kidney transplantation circuit interventions (e.g. angioplasty of  kidney transplantation access) like 36901–36904 for vascular access / circuit procedures.

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Diagnosis Coding: ICD‑10 Codes for Kidney Transplantation

On the diagnosis side, physicians and coders use ICD‑10 (International Classification of Diseases, 10th revision) codes to capture underlying conditions, dependency on  kidney transplantation, encounters, and complications. These codes are often used in medical records, health statistics, reimbursement, and epidemiology.

Key ICD‑10 codes relevant to  the kidney transplantation procedure and its types include:

• N18.6 — End Stage Renal Disease (ESRD)

• Z99.2 — Dependence on renal dialysis (to indicate a patient is chronically dependent on  kidney transplantation)

• Z49 series — Encounters for care involving renal dialysis, e.g. Z49.0 (preparatory care for  kidney transplantation), Z49.1, Z49.2, Z49.3 (adequacy testing)

• Z91.15 — Patient’s noncompliance with renal dialysis (i.e. a code to indicate  kidney transplantation nonadherence)

• Z94.0 — Kidney transplant status (for patients who had a transplant, may be used in conjunction)

• Z4901, Z4902 — Fitting or adjustment of  kidney transplantation catheters (extracorporeal or peritoneal) CMS

• Z4931, Z4932 — Adequacy testing for hd