If you are not sure whether to choose haemodialysis or peritoneal dialysis, this article may be able to help you
Let’s start with some basics. Whats is dialysis? Dialysis is an artificial method of filtering the blood to remove toxins, excess salts and water – in other words, the normal role of the kidneys.
There are two types: haemodialysis (HD) and peritoneal dialysis (PD). This article discusses the pros and cons of the two types. Both provide about 5% of the function of two kidneys and control the symptoms of kidney failure.
Peritoneal dialysis is done at home, and offers continuous treatment and does not require as much disruption to your daily activities – especially if you choose automated peritoneal dialysis (APD).
Haemodialysis is usually done at a dialysis centre, and is ideal for patients with less urine output. Peritoneal dialysis is not a good option for very obese patients or people who have had a lot of abdominal surgery.
Peritoneal dialysis
Pros
- Independence
- Travelling easier (none) – leading to more mobility and flexibility
- Can drink more than if on HD, often under 2L a day
- As continuous, more like normal kidneys, and so can improve well-being
- No needles required
- Good as a bridge a transplant
- Can preserve arteries and veins for future haemodialysis access (e.g. a fistula)
- Although PD is every day, it takes less time overall than going to a dialysis centre (when you consider travelling to and from the centre, waiting, recovery time etc).
Cons
- Done every day; no days off
- PD catheter may affect body image
- Swimming/bathing may be more limited
- Potential for weight gain due to glucose (sugar) in dialysis fluid
- Blood glucose can be more difficult to control in diabetes
- Storage space is required at home for supplies and fluid
- Potential for infection in the catheter.
Haemodialysis
Pros
- Less work for you – nurses carry out dialysis for you
- Patients usually have three dialysis sessions per week and rest for the other four days
- Easier to increase dialysis dose
- Company of other patients
- Easier to ask nurses and doctors to see you. In an emergency, medical help can be accessed quickly
- No need to have equipment or supplies to your home (unless you choose home haemodialysis).
Cons
- Need to travel to a dialysis centre at least three times a week. This may be at a distant hospital, or a more local ‘satellite unit’
- Patients may not be given the option to schedule their dialysis when/where they wish. For example, they may be given ‘slots’ on Monday/Wednesday/Friday mornings at a certain hospital (or satellite unit) and not much choice to change them
- ‘Access’ to the bloodstream is required, either a fistula (or graft) in the arm, or a HD ‘line’ in the neck
- These access sites carry bacteria and get infected
- More strict fluid restriction is often required (less than 1.5L a day).
Summary
We have described the two types of dialysis. There are pros and cons of each. One is not ‘better’. After discussion with your doctors and nurses, most patients should have a choice between them.
Other resources
This is a good comparison of HD and peritoneal dialysis on the NKF (US charity) website.
Last Reviewed on 27 April 2024