Dialysis is a life-saving therapy for patients with severe chronic kidney disease (CKD) or end-stage renal disease (ESRD). When kidneys lose their ability to filter toxins and excess fluid, dialysis artificially performs this function, preventing dangerous waste buildup in the body.
There are two main types of dialysis: hemodialysis and peritoneal dialysis. Both aim to achieve the same outcome—removing waste products, excess electrolytes, and fluid—but they differ in method, access, and potential complications.
Hemodialysis
Hemodialysis is the most common method of dialysis and is often performed in specialized dialysis centers.
How It Works
- Typically performed three times per week, each session lasting 3–5 hours.
- A machine called a dialyzer (artificial kidney) filters blood.
- Blood is drawn from the patient’s body, passed through the dialyzer to remove toxins and excess fluid, and then returned to the body.
Vascular Access
Effective hemodialysis requires reliable vascular access:
- Fistula – Surgically connects an artery to a vein. It is the preferred method due to durability.
- Graft – Uses synthetic material to connect artery and vein, often chosen when veins are unsuitable.
Both access methods require time to heal and must be evaluated for patency (functionality). Clinicians check for a “thrill” (vibration) and “bruit” (whooshing sound).
Complications of Hemodialysis
- Hypotension (drop in blood pressure)
- Disequilibrium syndrome (neurological symptoms due to rapid fluid shift)
- Hemorrhage
- Air embolus (air bubble in bloodstream)
- Electrolyte imbalances
Precautions for Patients
Patients are advised to:
- Avoid compression or tight clothing over access sites.
- Avoid carrying heavy bags or sleeping on the arm with a fistula/graft.
- Avoid unnecessary blood draws or blood pressure readings from the access arm.
Peritoneal Dialysis
Peritoneal dialysis uses the body’s peritoneal membrane (lining of the abdominal cavity) as a natural filter.
How It Works
- A dialysate solution is infused into the peritoneal cavity via a catheter.
- Waste products diffuse across the peritoneal membrane into the dialysate.
- After a set dwell time, the fluid is drained and replaced with fresh solution.
- This cycle is repeated multiple times daily (Continuous Ambulatory Peritoneal Dialysis – CAPD) or overnight using a machine (Automated Peritoneal Dialysis – APD).
Catheter Access
A peritoneal catheter is surgically placed either at the bedside or in the operating room.Complications of Peritoneal Dialysis
Peritonitis (infection of the peritoneal cavity) characterized by:
- Cloudy or bloody drainage
- Fever
- Abdominal pain
- Malaise
Patient Considerations
- The procedure is home-based, giving more independence.
- Requires strict hygiene to prevent infection.
- Regular monitoring of drain fluid appearance and patient symptoms is essential.
Hemodialysis vs Peritoneal Dialysis: Comparison Table
| Feature | Hemodialysis | Peritoneal Dialysis |
|---|---|---|
| Where done | Dialysis center or hospital | Home or clinic |
| Frequency | 3 times/week (3–5 hrs per session) | Multiple daily exchanges or nightly cycles |
| Access required | Arteriovenous fistula or graft | Peritoneal catheter |
| Filtering agent | Dialyzer (artificial kidney) | Peritoneal membrane |
| Advantages | Efficient toxin removal, managed by staff | Home-based, more flexible, needle-free |
| Disadvantages | Time-consuming, vascular surgery needed | Risk of peritonitis, daily responsibility |
| Common complications | Hypotension, electrolyte shifts, infection | Infection, abdominal pain, catheter issues |
Choosing the Right Dialysis Method
The decision between hemodialysis and peritoneal dialysis depends on:
- Patient’s age and lifestyle
- Home support and hygiene capability
- Medical conditions (e.g., abdominal surgery may preclude peritoneal dialysis)
- Vascular access availability
- Patient preference and doctor’s guidance
Frequently Asked Questions (FAQs)
Q1. Which is better: hemodialysis or peritoneal dialysis?
Neither is universally “better.” The choice depends on medical suitability and lifestyle. Hemodialysis is more commonly used, but peritoneal dialysis offers independence for patients who can manage it at home.
Q2. Can dialysis cure kidney disease?
No. Dialysis replaces some functions of the kidney but does not cure CKD. A kidney transplant is the only long-term curative option.
Q3. How long can patients live on dialysis?
Many patients live for years or even decades on dialysis with proper management and medical care. Life expectancy depends on overall health and comorbidities.
Q4. Is dialysis painful?
Most patients tolerate dialysis well. Hemodialysis involves needle insertion, which may cause discomfort, while peritoneal dialysis is generally painless but may cause fullness in the abdomen.
Q5. Can patients travel while on dialysis?
Yes. Patients on peritoneal dialysis can travel with supplies. Hemodialysis patients may arrange treatments at dialysis centers in different locations.
