“Dialysis”

How does that word make you feel? Uneasy or afraid? Tired and resigned? Or maybe you’re more confused than anything else. If you’re feeling any of these things, you are not alone.

An estimated 10% of the global population suffers from chronic kidney disease (CKD). Over 2 million people around the world receive treatment for it. For those who have progressed to end-stage renal disease (ESRD), dialysis is vital.

In this article, we’ll talk about the two main types of dialysis: peritoneal dialysis and hemodialysis. By understanding the difference between them, you’ll have a better idea of which is right for you.

But before we get into specifics, let’s talk about what dialysis really is and what it entails.

What is dialysis and why is it done?

Dialysis is a procedure that cleanses and removes toxins from the blood. It filters out waste material, as well as excess salt and water, and helps control blood pressure.

Normally, this cleansing would be a job for your kidneys. Dialysis becomes a necessity when kidney function has been severely compromised.

Without dialysis, you will start to experience some (or all) of the following symptoms: nausea, fatigue, shortness of breath, and swelling of the hands and feet. Toxins build up in the body, and this could eventually lead to death.

That's why a regular schedule should be maintained, no matter which type of dialysis you choose. Treatment can only be successful if you commit to a set routine. This is true for both hemodialysis and peritoneal dialysis.

But while these treatments may have that in common, they really are very different. There are pros and cons to each.

We’ll talk about that more later. First, let’s start with hemodialysis.

How does hemodialysis work?

Hemodialysis requires blood to be pumped out of your body and into a machine. You are connected to this machine via tubes. The machine acts as an artificial kidney and filters out waste and toxins. The “clean” blood is then returned to your body.

There are two options for undergoing hemodialysis:

• In-center hemodialysis
  Patients visit dialysis clinics 3 to 5 times a week, for 4 to 5 hours each session. Trained healthcare professionals administer the treatment. They will connect you to the dialysis machine. You’ll have to stay in the center while hemodialysis is underway, but you're free to spend your time doing other things. You can sleep, read, or watch TV, for example.

• Home hemodialysis
  Other than having to get your own hemodialysis machine at home, the procedure is more or less the same as in a clinic. However, this treatment requires assistance from someone else—usually a family member or a friend. You and your assistant will need training to effectively perform home hemodialysis.

To begin either type of hemodialysis, minor surgery needs to be done. An access point into your bloodstream will be created. It can take anywhere from 2 to 8 weeks from the day of the operation until hemodialysis can actually begin.

In the meantime, a soft tube (catheter) can be installed as a temporary access point. This is usually attached to the blood vessels of the neck or groin.

Peritoneal dialysis also requires a catheter, although it is used quite differently.

How does peritoneal dialysis work?

Like hemodialysis, minor surgery is required before peritoneal dialysis. A catheter is put in place so a cleansing fluid can flow through it and into your body. This fluid is called the dialysate.

The inner lining of your abdomen (the peritoneum) has many veins and arteries. In peritoneal dialysis, this lining acts as a natural filter. As blood flows through it, waste products and toxins are drawn out and absorbed by the dialysate.

When the filtering process is done, the dialysate is drained from the abdomen. 

There are two types of peritoneal dialysis: CAPD and APD. Both can be performed at home and do not always require a health professional or assistant. But you will need to receive training to do this on your own.

• Continuous Ambulatory Peritoneal Dialysis (CAPD)
  Here, "continuous" means it can be done while you go about your daily activities, like work or school. You start by putting the dialysate fluid into your body via the catheter and leaving it for a few hours to filter. Then you drain it and replace it with fresh dialysate. This fluid exchange is done around 3 to 5 times a day and takes 30 to 40 minutes each time.

• Automated Peritoneal Dialysis (APD)
  APD is a lot like CAPD, except the fluid exchange is performed automatically by a machine at home. It is usually done at night, while patients are sleeping. Each treatment takes 8 to 10 hours.

One drawback of peritoneal dialysis in general is that it’s rarely a long-term solution. This is true for both CAPD and APD. Having to switch to hemodialysis after years on peritoneal dialysis is unfortunately common.

It may not be possible to totally prevent complications from peritoneal dialysis. But on the bright side, a lot of research is being done in this area. Medical researchers are aiming to make peritoneal dialysis a more long-term treatment option.

Hemodialysis vs. Peritoneal Dialysis: Pros and Cons

So now that you have a better grasp of the available options, which seems more appealing to you? Is APD preferable to CAPD? Perhaps you’d rather have hemodialysis three times a week instead of peritoneal dialysis every day?

All the treatment options we’ve presented are effective, but they do have their own pros and cons. Let’s take a look at those here, along with a brief summary of each treatment:

In-center hemodialysis

• Frequency: 3-5 days a week, 4-5 hours per session

• Location: Dialysis clinic

• Personal Equipment: None required

• Pros:

  - As many as 4 dialysis-free days every week
  - No training needed since healthcare professionals are present
  - No need to buy equipment or tools

• Cons:

  - Scheduling regular appointments with clinics
  - Frequent travel to clinics is necessary
  - Very strict dietary and fluid restrictions

Home hemodialysis

• Frequency: 3-5 days a week, 4-5 hours per session

• Location: Home (or other preferred routine location)

• Personal Equipment: Hemodialysis machine

• Pros:

  - No appointments and travel to clinic needed
  - Freedom to choose when to have dialysis sessions
  - Dialysis can be performed overnight, lessening disruptions to routine

• Cons:

  - Training for both patient and a partner is required
  - Very strict dietary and fluid restrictions
  - Cost of a home hemodialysis machine (if not reimbursed)

Continuous Ambulatory Peritoneal Dialysis (CAPD)

• Frequency: 3-5 times per day, 30-40 minutes per session

• Location: Home (or any reasonably clean environment)

• Personal Equipment: Bags of dialysate fluid, empty bags to collect waste, tubing and clips to connect bags to catheter

• Pros:

  - No appointments and travel to clinic needed
  - Freedom to choose when to have dialysis sessions
  - Fewer dietary and fluid restrictions
  - CAPD equipment can be carried around (e.g. workplace or school)

• Cons:

  - Needs to be done daily, can be disruptive to routine
  - Having a permanent catheter can be unsettling
  - Risk of peritonitis (infection of the lining of your abdomen)
  - Some training required
  - May not be a long-term option

Automated Peritoneal Dialysis (APD)

• Frequency: Once a day (as you sleep), 8-10 hours per session

• Location: Home (or other preferred regular location)

• Personal Equipment: APD machine

• Pros:

  - No appointments and travel to clinic needed
  - No disruptions for dialysis during the day
  - Fewer dietary and fluid restrictions
  - Minimal training required

• Cons:

  - Cost of an APD machine (if not reimbursed)
  - Having a permanent catheter can be unsettling
  - Risk of peritonitis (infection of the lining of your abdomen)
  - May not be a long-term option

It is important to note that there are times when a specific type of dialysis is the only option. For example, it can be impossible to do peritoneal dialysis on those who are obese. The same is true for someone who has had multiple abdominal surgeries. Hemodialysis is the only option in these cases.

Remember to always consult your doctor before making any major decisions about your kidney health.

The Final Say

Do you feel less confused about peritoneal and hemodialysis now? We hope the answer is yes!

Our goal has been to lessen any anxiety you may be feeling by giving you as much knowledge as we can. We hope this article has helped you figure out what might work for you.

Dialysis can be daunting. But armed with the right information, you can face it with confidence and calm.