Dialysis Choices: What to Know

Dialysis—a mechanical process that filters wastes from the blood—is not a cure for kidney disease, but it will preserve your life and help you feel better when your kidneys can no longer do their job.

You can choose one of two dialysis types. Hemodialysis uses a machine, called a dialyzer, to filter wastes and remove extra fluid from the blood as well as to restore electrolyte balance. Peritoneal dialysis uses a natural filter inside your body—the lining of your belly, called the peritoneal membrane—to do the same.

After starting dialysis, most people with kidney disease feel better within a week or two. But it can take a month to see a change in your symptoms.

The Basics

Hemodialysis

• Weeks or months before hemodialysis treatments begin, your doctor creates an access site, a connection between an artery and a vein, typically in the forearm. (If you need emergency hemodialysis, your doctor will place a temporary access tube in your neck or near the groin.)
• After the site heals, you’ll be connected to the dialyzer by tubes attached to your blood vessels through the access, where blood flows in and out of your body during your dialysis sessions.
• Though it’s possible to receive hemodialysis at home, you’ll probably go to a hospital or dialysis center. You may have timing choices, such as every day for shorter periods, long nighttime dialysis, or three times a week for three to five hours a day.

Peritoneal Dialysis

• You will be taught how to do peritoneal dialysis at home, on your own schedule.
• Before you begin, your doctor will place a catheter in your belly.
• Through the catheter, a dialysis fluid (called dialysate) fills the belly and pulls out extra minerals and fluids from the bloodstream. These wastes then drain out of the body along with the dialysis fluid into a collection bag.
• The process is called an exchange. You will usually complete four to six exchanges every day.

Advantages

Hemodialysis

• You don’t have to do it yourself; trained health professionals manage the process and watch for any problems.
• It takes a shorter amount of time and on fewer days each week than peritoneal dialysis.
• You’ll be in contact with other people having dialysis, which may give you emotional support.
• Home hemodialysis can give you more flexibility in when, where and how long you receive each treatment.

Peritoneal Dialysis

• You don’t need to travel to a dialysis center for treatment; it can be done at home or in any clean place, including when you travel or while you sleep.
• You can do it by yourself.
• It doesn’t require as many food and fluid restrictions as hemodialysis.
• It doesn’t use needles.

Challenges

Hemodialysis

• You may experience fatigue on treatment days.
• It can cause problems such as low blood pressure or blood clots in the dialysis access.
• It increases your risk of bloodstream infections.
• Home hemodialysis may require changes to your home. You and a friend or family member will need to complete training.

Peritoneal Dialysis

• You must perform exchanges every day. 
• You may find the procedure hard to do.
• It increases your risk for peritonitis, an infection of the belly lining.

Dialysis of either kind is your choice. Talk with your doctor and family about the benefits and side effects.