Latest news with #peritonealdialysis

Health Line

Choosing Between Hemodialysis and Peritoneal Dialysis

For most people, hemodialysis and peritoneal dialysis are equally effective treatments for end stage renal disease. Factors such as your health, preferences, and the costs may influence your final decision. When kidney disease progresses to the point when your kidneys can no longer function effectively (also known as end stage renal disease, or ESRD), a doctor may recommend dialysis. What a lot of people don't know is that you can choose between different types of dialysis. Hemodialysis is the most common dialysis treatment. But in a 2024 survey, more than half of respondents reported having insufficient knowledge about peritoneal dialysis, a less common but equally effective dialysis option. Keep reading to learn more about the differences between hemodialysis and peritoneal dialysis, the pros and cons of each, and what to consider when making a decision. What does hemodialysis involve? Hemodialysis uses a machine called a dialyzer to filter your blood outside of your body. The dialyzer then returns the filtered blood to your body. People sometimes call a dialyzer an 'artificial kidney' since it does some of the work that healthy kidneys do. Because blood needs to leave and reenter your body, hemodialysis requires an access point. You typically need to undergo a surgical procedure for a doctor to create an access point, most often an arteriovenous (AV) fistula or AV graft, in your arm. If you only need temporary access, they may place a central venous catheter instead. People typically go to a dialysis center for 3- to 4-hour sessions three times a week. However, you can also opt for home hemodialysis, which allows for a more flexible schedule. While on dialysis, you'll also need to adjust your diet, including eating more protein and limiting salt and fluids. A renal dietitian will work with you to ensure you're meeting your nutritional needs. Hemodialysis can also cause side effects like itchy skin and muscle cramps. A potential complication is hypotension (low blood pressure). Some complications are related to the dialyzer itself, such as allergic reactions. Pros of hemodialysis life-preserving treatment you can sustain for years easier if you prefer to have a healthcare professional perform sessions can be done at home if preferred Cons of hemodialysis potentially increased time burden for travel less flexibility in scheduling if you go to a dialysis center challenging for people who have a fear of needles may need to dedicate space in your home for the machine and supplies if you choose home dialysis may require a dialysis partner if you choose home dialysis What does peritoneal dialysis involve? Instead of a dialyzer, peritoneal dialysis uses the lining of your abdomen as a filter. This means filtration takes place inside your body. You'll still require surgery before starting peritoneal dialysis, but instead of creating a fistula or graft in your arm, the surgeon places a catheter in your abdomen. The filtering process involves passing a sterile cleansing fluid into the catheter over 30 to 40 minutes. You then put a cap on the catheter and go about your day. After 4 to 6 hours, you can remove the cap and discard the solution. You do this three to five times a day. People on peritoneal dialysis still need to alter their diet, but they may be able to eat more than people on hemodialysis. Peritoneal dialysis also causes different side effects from hemodialysis, like weight gain and high blood sugar. However, some people may be able to avoid this problem by using nonglucose-based solutions, like icodextrin. The most significant complications are hernia and peritonitis, a bacterial infection of the abdominal lining. Proper technique and care of the catheter equipment can help prevent this. Continuous vs. automated peritoneal dialysis You can choose from one of two types of peritoneal dialysis. The procedure described above — continuous ambulatory peritoneal dialysis (CAPD) — doesn't require a machine. You may also opt for automated peritoneal dialysis (APD), which uses a machine to perform the exchanges while you sleep. People who elect peritoneal dialysis often undergo a peritoneal equilibrium test to help determine how often they need to perform exchanges and whether CAPD or APD may be a better fit. Pros of peritoneal dialysis typically as effective as hemodialysis greater flexibility in when and where you can perform dialysis doesn't require needles CAPD doesn't require a machine may be able to eat more than with hemodialysis can control fluid intake more regularly usually cheaper than hemodialysis may take less time overall when you account for appointments, travel, etc. Cons of peritoneal dialysis requires training to perform dialysis on your own performed every day, so you don't have days off more prone to user error requires ongoing care of catheter equipment need to dedicate storage space at home for supplies and fluids challenging for people with severe obesity or previous abdominal surgeries What are the key differences between hemodialysis and peritoneal dialysis? Some of the key differences between hemodialysis and peritoneal dialysis are as follows: Hemodialysis Peritoneal dialysis How it works a machine filters your blood your abdominal lining filters your blood Access point AV fistula, AV graft, or catheter for vascular access in your arm catheter in your abdomen Location dialysis center or home home Frequency and duration • in a center: 3 times a week for 3 to 4 hours • at home: flexible, but 3 to 7 times a week for 2 to 5 hours • CAPD: varies, depending on the results of a peritoneal equilibrium test • APD: overnight Side effects and risks • fatigue • itchy skin • muscle cramps • low blood pressure • blood loss • blood clots • infections • dialyzer reactions • fatigue • high blood sugar • weight gain • hernia • peritonitis • blood clots Dietary guidelines • limit sodium, potassium, and phosphorus • limit fluid intake • increase protein same as for hemodialysis but may have fewer restrictions What factors should you consider when choosing between hemodialysis and peritoneal dialysis? For most people, choosing the type of dialysis may come down to personal preference and what suits your lifestyle best. You may need to consider your: life and work schedule social support network ability to travel comfort level with performing the procedure on your own home situation and ability to safely keep equipment and supplies financial resources Even after you make your choice, you can still change it later. You can't undergo hemodialysis if a doctor can't securely access a vein. Some medical conditions may also prevent you from choosing a specific type of dialysis. You likely can't undergo hemodialysis if you have: a bleeding disorder heart failure fear of needles Likewise, a doctor won't recommend peritoneal dialysis if you have: an uncorrected hernia in your abdominal wall a pleuroperitoneal shunt, which is a medical device that relieves fluid buildup in the pleural space scar tissue in your abdomen from a previous surgery Which is more effective: Hemodialysis or peritoneal dialysis? Although hemodialysis is much more common than peritoneal dialysis, both are equally effective. A 2018 study concluded that the two techniques were comparable in prolonging survival. A 2023 study even found that peritoneal dialysis may be more effective in: maintaining stable blood pressure and heart rate reducing blood pressure clearing molecules like urea and albumin from the blood protecting residual kidney function However, the type of dialysis that will be most effective for you will depend on your specific health situation. How much do hemodialysis and peritoneal dialysis cost? The amount you pay for a dialysis session depends on whether you have insurance, the type of insurance, and what your insurance covers. Most people who need dialysis qualify for Medicare, regardless of age. Medicare covers 80% of treatment costs for either hemodialysis or peritoneal dialysis. Your Medicare coverage typically starts on the first day of the fourth month of dialysis but can be backdated to the first month if you choose home dialysis and meet specific conditions.