Pros and Cons of Home and Clinic Dialysis

If you have kidney failure, also known as end-stage kidney disease, you may need dialysis as a treatment. At this point, the kidneys have very little ability to function. When you receive dialysis, something else does the work of your damaged kidneys.^1,2

There are 2 main types of dialysis: hemodialysis and peritoneal dialysis (PD). There also are 2 main options for where you can receive dialysis: in a dialysis center (clinic) or at home.^1,2

What is hemodialysis?

Hemodialysis is a type of dialysis in which a machine functions in place of your damaged kidneys. The dialysis machine moves your blood through a filter outside your body, which removes waste. You can either have hemodialysis done in a clinic or perform the dialysis with a helper at home.^1,2

With clinic hemodialysis, you go to a clinic to receive treatment with a dialysis machine. With home hemodialysis, you and your helper can perform the dialysis after you are both trained by medical staff. Dialysis given at home usually happens more times per week than dialysis given in a clinic.

What is peritoneal dialysis?

Peritoneal dialysis uses the lining of your belly to clean your blood. Before starting PD, your doctor places a tube called a catheter in your belly. During PD, a liquid pours into your belly through the catheter. This liquid soaks up wastes and fluids. Once it has been in your body for a certain amount of time, it drains out and new liquid pours in. This process is called an exchange.^1,2

Your doctor will train you to do PD at home. You will have to do several exchanges per day, every day. A machine called a cycler can also be used to do these exchanges. The timing and number of your exchanges depends on your health and lifestyle. Unlike home hemodialysis, you may be able to do PD by yourself.^1,2

Pros and cons of clinic dialysis

One benefit of having hemodialysis done at a clinic is that trained medical professionals perform the dialysis. That way, you do not have to worry about doing it yourself.^1,2

Another benefit is that it can help build community. You can make friends with other people getting dialysis at the clinic. Some people find it helpful to know others who are going through similar experiences.^1,2

The biggest downside of clinic hemodialysis is the rigid treatment schedule. The clinic schedules your session days and times. You will have to travel there at least 3 times a week. This can be challenging for some people. For example, if you do not drive, you will need to find alternate transportation.^1,2

Because more time passes between clinic sessions than between home sessions, you also may have limitations on the diet you eat and liquids you drink. These limitations help prevent waste buildup in your body between sessions.^1,2

Pros and cons of home dialysis

The biggest benefit of home hemodialysis and PD is the flexibility. You can do home hemodialysis whenever you and your dialysis partner are available. You can do PD anywhere that is clean and dry. With PD, you can go about your daily activities while the liquid is cleaning your blood. You can even do it while you are sleeping.^1,2

Also, home dialysis is gentler on the body and is performed more often than clinic dialysis. More frequent dialysis sessions may be better for you and have better long-term outcomes. They also can mean fewer diet limitations because your blood is being filtered more often.^1,2

The cons of home hemodialysis include:^1-4

• You need a dialysis partner to be available.
• You need space to store the supplies.
• You and your partner will need to go to training.
• For some machines, you may need special electrical connections or plumbing.
• Some insurance may not fully cover home dialysis. Most people can not afford it without insurance help.

The cons of PD include:^1,2

• You may not be able to swim or take baths.
• You must do PD every day, so you have no days off from treatment.
• Doing PD at home puts you at risk of getting an infection around the catheter.
• People with diabetes may not be able to do PD because the dialysis liquid contains sugar.

How to determine which dialysis is right for you

Talk with your healthcare team to decide whether doing dialysis at home or at a clinic is best for you. Your family and any caregivers may also have helpful input since they may be involved in giving you the dialysis.^1,2

It can help to think through the specifics of both options. For example:^1,2

• Which clinic could you use?
• How far away is the clinic, and how would you get there?
• If you do home hemodialysis, who will your dialysis partner be?
• When would you and your partner attend training for home hemodialysis or PD?
• Do you have space to store the supplies for home hemodialysis or PD?

Keep in mind that dialysis decisions do not have to be permanent. You can always start with one type of dialysis and then switch to another.^1,2