Pros and Cons of Hemodialysis and Peritoneal Dialysis

Healthy kidneys remove waste and extra fluids from your body. With chronic kidney disease (CKD), you may reach a point where your kidneys cannot do this anymore. This stage is called kidney failure or end-stage kidney disease.¹

When you have kidney failure, you may need dialysis treatment. In dialysis, something else does the job of your damaged kidneys. There are 2 main types of dialysis, hemodialysis and peritoneal dialysis (PD). Each type works a bit differently.¹

What is hemodialysis?

In hemodialysis, your blood is filtered by a dialysis machine outside your body. Your blood first leaves your body through small tubes and then is fed to the dialysis machine. The machine filters the blood. After this, the clean blood is pumped back into your body.^1,2

Hemodialysis can be done either in a clinic or at home. Clinic hemodialysis is given at a clinic at least 3 times a week. The clinic staff gives you the dialysis treatment, so you do not need to do anything during it. Home hemodialysis is given with a partner's help in your home. Home hemodialysis may be given more often than clinic dialysis.^1,2

What is peritoneal dialysis?

Peritoneal dialysis cleans your blood inside your body. It uses the lining of your belly to filter the blood. Before starting PD, you have a surgery to place a soft tube called a catheter into your belly. During PD treatment, a liquid dialysis solution enters your belly through the catheter. This solution soaks up waste and fluids in your body.^2,3

After some time, the solution drains out and new solution is added. This process is called an exchange. You may have to do several exchanges per day, every day. There are also machines that can do exchanges while you sleep.^1-3

PD is not done in a clinic. You perform PD yourself at home after receiving training from your doctor. The timing and number of your exchanges depends on your health and lifestyle. Unlike home hemodialysis, you can do PD without a partner if you can manage the fluid bags and other supplies on your own.^1-3

What are the pros and cons of hemodialysis?

Some people do not want or are not able to perform dialysis at home, so clinic hemodialysis is the best option for them. Another advantage of clinic hemodialysis is the chance to create a community with other people getting dialysis at the clinic.^1-3

One main disadvantage of hemodialysis is that it can limit your freedom. You need to either go to a clinic several times per week or travel with your home dialysis machine to receive hemodialysis. For home hemodialysis, you need a partner to help give you the treatment and space for the machine.^1,2

Also, because clinic hemodialysis is performed the least often, there is more time between treatments for fluid and waste to build up in your body. To prevent this buildup, you likely will have more restrictions on what you can eat. You may have to limit things like:^1,2

• Phosphorus
• Potassium
• Sodium
• Water

These diet limitations do not apply to home hemodialysis.^1,2

What are the pros and cons of peritoneal dialysis?

One of the biggest benefits of PD is the flexibility. As long as you have your supplies, you can perform PD anywhere that is clean and dry. This can make traveling easier. You can even do the exchanges overnight while you are sleeping.^1,3

With PD, you also may have fewer or less strict diet restrictions than with clinic hemodialysis. And studies suggest that people who use PD may live longer.²

PD can also be cheaper than home hemodialysis, which is not always fully covered by insurance. Specific costs will depend on your treatment and insurance.^2-4

The disadvantages of PD include:^1-4

• PD must be done every day with no days off.
• You may not be able to swim or take baths.
• There is a possible risk of infection around the catheter site.
• PD is not always an option for people with diabetes because the PD solution has sugar in it.

Luckily, no decision is permanent with any type of dialysis. If you try one type and do not like it, you can always change the type you use. Talk with your doctor, family, and friends to help you decide which type is right for you.³