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Hemodialysis vs. Peritoneal Dialysis - 1 of 3

I was recently asked by a reader of this blog:

"I have been so focused on [my] AV Fistula that I did not think much about Peritoneal Dialysis. I have a great wife and son so I want to be able to keep my job as long as possible. It seems like PD would give me a lot more freedom to do that. Any thoughts on HD vs. PD?"


This is indeed an important question to ask one's self when one is nearing the stage of needing a form of kidney replacement therapy to sustain one's life. In this article I will list my personal views about hemodialysis (HD) vs. peritoneal dialysis (PD). I will share with you some facts about both, as well as my opinions on why I chose the modality I did.


Lets start with the easy stuff: Here are some facts about HD and PD:


Dialysis is defined as: "A medical procedure to remove wastes and additional fluid from the blood after the kidneys have stopped functioning." There are two types of dialysis:


Hemodialysis is defined as: "A mechanical procedure used to remove toxins and waste from the blood. Blood is removed from an artery, purified by a machine, and returned to the body."


Peritoneal dialysis is defined as: "A method of dialysis in which fluids are pumped into the abdomen resulting in the removal of wastes from the blood."


How Hemodialysis Works (NKUDIC)

In hemodialysis, your blood is allowed to flow, a few ounces at a time, through a special filter that removes wastes and extra fluids. The clean blood is then returned to your body. Removing the harmful wastes and extra salt and fluids helps control your blood pressure and keep the proper balance of chemicals like potassium and sodium in your body.

One of the biggest adjustments you must make when you start hemodialysis treatments is following a strict schedule. Most patients go to a clinic—a dialysis center—three times a week for 3 to 5 or more hours each visit. For example, you may be on a Monday-Wednesday-Friday schedule or a Tuesday-Thursday-Saturday schedule. You may be asked to choose a morning, afternoon, or evening shift, depending on availability and capacity at the dialysis unit. Your dialysis center will explain your options for scheduling regular treatments.

Researchers are exploring whether shorter daily sessions, or longer sessions performed overnight while the patient sleeps, are more effective in removing wastes. Newer dialysis machines make these alternatives more practical with home dialysis. But the Federal Government has not yet established a policy to pay for more than three hemodialysis sessions a week.

Illustration of a dialyzer.

Several centers around the country teach people how to perform their own hemodialysis treatments at home. A family member or friend who will be your helper must also take the training, which usually takes at least 4 to 6 weeks. Home dialysis gives you more flexibility in your dialysis schedule. With home hemodialysis, the time for each session and the number of sessions per week may vary, but you must maintain a regular schedule by giving yourself dialysis treatments as often as you would receive them in a dialysis unit.



How PD Works (NKUDIC)

In PD, a soft tube called a catheter is used to fill your abdomen with a cleansing liquid called dialysis solution. The walls of your abdominal cavity are lined with a membrane called the peritoneum, which allows waste products and extra fluid to pass from your blood into the dialysis solution. The solution contains a sugar called dextrose that will pull wastes and extra fluid into the abdominal cavity. These wastes and fluid then leave your body when the dialysis solution is drained. The used solution, containing wastes and extra fluid, is then thrown away. The process of draining and filling is called an exchange and takes about 30 to 40 minutes. The period the dialysis solution is in your abdomen is called the dwell time. A typical schedule calls for four exchanges a day, each with a dwell time of 4 to 6 hours. Different types of PD have different schedules of daily exchanges.

One form of PD, continuous ambulatory peritoneal dialysis (CAPD), doesn’t require a machine. As the word ambulatory suggests, you can walk around with the dialysis solution in your abdomen. Another form of PD, continuous cycler-assisted peritoneal dialysis (CCPD), requires a machine called a cycler to fill and drain your abdomen, usually while you sleep. CCPD is also sometimes called automated peritoneal dialysis (APD).


In the next segment, I will discuss the differences of each modality, the pros and cons and the things one should consider when the time for dialysis nears.


Other resources:

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)

American Association of Kidney Patients (AAKP)

Kidney School

How Dialysis Works (Animation) from

Second Day, Post-Op Pictures

Now THIS is my personal version of a motivational poster!

Its almost been a month

Tomorrow will be one month that I've had my kidney. In celebration, I offer this mosaic of images from that first day. Notice how bloated I was right after surgery! (click on the image to see it in a larger format on my Flickr page)

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