Dialysis is a procedure that can help patients with end stage renal disease to increase quantity and quality of life. However, there are several inherent risks associated with dialysis, which are more profound in patients at risk of complications, such as the elderly or those with other concurrent health conditions.
There are two main types of dialysis in practice: hemodialysis and peritoneal dialysis. The efficacy of both types is equivalent, so the decision is usually made based on individual choice. However, there are some characteristics that make one option more suitable for certain patients.
Benefits of hemodialysis
The primary benefit of hemodialysis is that it only involves a dialysis session three times a week, with four days each week without the need to go to a medical clinic for dialysis.
Each session typically lasts approximately 4 hours, so at least 12 hours each week should be reserved for dialysis treatment and other activities should be planned around this. In most cases, hemodialysis is carried out in a medical clinic, so regular travel to receive dialysis may also be necessary. However, training for hemodialysis at home may allow the procedure to be undertaken in the home environment.
Hemodialysis is recommended for people who are unable to carry out the dialysis procedure themselves, due to visual impairment, dementia, or other conditions.
Disadvantages of hemodialysis
Hemodialysis is associated with a restriction in the intake of fluid and dietary changes, which may be difficult for some people to adjust to. Some foods may be recommended to be cut out of the diet completely, and fluid intake is typically restricted to several cups a day, depending on the circumstances.
The ongoing need for hemodialysis can make activities that would be simple for other individuals more difficult. For example, if a patient who requires dialysis plans to travel to another country, they would need to research and arrange access to the appropriate dialysis facilities in the countries that they will visit.
Benefits of peritoneal dialysis
The primary advantage of peritoneal dialysis is increased comfort and ease of use, as the dialysis can be carried out at home, without the need for regular visits to a medical clinic for the dialysis to occur. The equipment that is used is less bulky than that of hemodialysis and can be transported with the individual if they wish to travel or relocate.
This type of dialysis is also associated with less strict restrictions on the diet and intake of fluids when compared to those of hemodialysis.
Peritoneal dialysis is recommended for children under two years, people with some remaining kidney function and those who are not affected by other serious health conditions (e.g., cardiovascular disease or cancer.)
There are two types of peritoneal dialysis, as follows:
- Continuous ambulatory peritoneal dialysis (CAPD): Beneficial due to portability of the equipment used, which increases freedom of movement, but requires at least two hours a day to perform dialysis.
- Automated peritoneal dialysis (APD): Beneficial as there is no need for dialysis during the day, but a dialysis machine needs to be kept in the house.
Disadvantages of peritoneal dialysis
Peritoneal dialysis needs to be carried out every day, which is a major disadvantage for people who find it disruptive.
Additionally, some people find the presence of the catheter in the abdomen, which is left there permanently, inconvenient. This also increases the risk of peritonitis or thickening and scarring of the peritoneum. These complications may lead to a switch to hemodialysis for some individuals.
Peritoneal dialysis is also associated with a reduction in protein levels in the blood, which may lead to the presentation of symptoms such as fatigue, weight gain, and malnutrition.
Reviewed by Susha Cheriyedath, MSc