What type of dialysis should I have?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Dialysis is a process that does the work for your kidneys when you have kidney failure. There are two types of dialysis: hemodialysis and peritoneal dialysis. You will need to decide what type of dialysis is best for you. Consider the following when making your decision:

• Each type of dialysis has pros and cons. By learning as much as you can about both types, you will be able to make the best decision for yourself.
• Dialysis can help you feel better and live longer, but it is not a cure for kidney failure. After you start dialysis, you will need to stay on it.
• If your needs change later, you can switch types of dialysis.
• Both types of dialysis can be expensive. But Medicare or insurance may cover most or all of the costs. The dialysis center or hospital can help you find the best way to pay for your treatment.
• It is hard to make decisions when you are very ill. Discuss your choices with your doctors and your loved ones so that you can know you are making the best decisions.

Whichever type you choose, it is very important that you go to the dialysis center or do the exchanges as often as your doctor tells you to. Following your treatment schedule will allow you to stay as healthy as possible and feel better. It will also help you avoid being in the hospital.

Medical Information

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What is kidney failure?

How well your kidneys work is called kidney function. If you have chronic kidney disease and are not able to control the disease, your kidney function will continue to get worse. When kidney function falls below a certain point, it is called kidney failure. Kidney failure has harmful effects throughout your body. It can cause serious heart, bone, and brain problems and make you feel very ill.

When you have kidney failure, either you need to have dialysis or you will need a new kidney. Some people are good candidates for kidney transplant. Others are not. Even if you decide to have a kidney transplant, you will probably need to have dialysis while you wait for a kidney donor.

What are the types of dialysis?

Dialysis is a process that does the work of healthy kidneys when you have kidney failure. Dialysis filters wastes, removes extra fluid, and restores the proper balance of chemicals in the blood.

There are two basic types of dialysis: hemodialysis and peritoneal dialysis.

• Hemodialysis uses a man-made membrane called a dialyzer to clean your blood. You are connected to the dialyzer by tubes attached to your blood vessels. Before hemodialysis treatments can begin, your doctor will need to create a site where blood can flow in and out of your body. This is called the dialysis access. Usually the doctor creates the access by inserting a small tube (called a shunt or catheter) into blood vessels in your forearm. An access may be created on a short-term basis through a catheter inserted in your neck, upper chest, or groin.
• Peritoneal dialysis uses the lining of your belly, which is called the peritoneal membrane, to filter your blood. Before you can begin peritoneal dialysis, your doctor will need to place a catheter in your belly to be the dialysis access.

What should I know about the types of dialysis?

You will need to watch what you eat with both types of dialysis, although the diets are slightly different. A dietitian will work with you to develop an eating plan based on the type of dialysis you choose.

No one type of dialysis is best for everyone. Each type has pros and cons that you will need to weigh as you make your decision.

Types of dialysis

	Hemodialysis:	Peritoneal dialysis:
Pros	Is most often done by trained health professionals who can watch for any problems. Can be used even if you have abdominal problems, such as a hernia or adhesions, or active inflammatory bowel disease (Crohn's disease, ulcerative colitis). Allows you to be in contact with other people having dialysis, which may help provide emotional support.	Gives you more freedom. It can be done at home or in any clean place. You may be able to do it while you sleep. You can do it by yourself. Does not require as many food and fluid restrictions as hemodialysis, and it does not use needles. Does not require the use of blood thinners, so it may be a better choice if you have bleeding problems or take medicines that interfere with blood clotting.
Cons	Usually needs to be done at a hospital or dialysis center on a fairly set schedule. It usually is done 3 days a week and takes 3 to 5 hours a day. Causes you to feel tired on the day of the treatments. Can cause problems, including low blood pressure and blood clots in the dialysis access. Increases your risk of bloodstream infections.	Must be done every day of the week. May be hard to manage because of the technical aspects of the procedure. Increases your risk for an infection of the lining of the belly called peritonitis.

If you need more information, see:

• Hemodialysis.
• Peritoneal dialysis.
• Chronic Kidney Disease.

Your Information

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Your choices are:

• Have hemodialysis.
• Have peritoneal dialysis.

The decision about whether to have hemodialysis or peritoneal dialysis takes into account your personal feelings and the medical facts.

Making a decision about hemodialysis or peritoneal dialysis

Reasons to choose hemodialysis	Reasons to choose peritoneal dialysis
You feel more comfortable having professionals handle the procedure. You prefer a procedure that does not have to be done every day of the week. You have abdominal problems that mean you cannot choose peritoneal dialysis. Are there other reasons you might choose hemodialysis?	You live far from a dialysis center or have trouble getting around. You will not have as many fluid or diet restrictions as you would on hemodialysis. You have bleeding problems or take medicines that interfere with blood clotting. Are there other reasons you might choose peritoneal dialysis?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about the different types of dialysis. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have a disease or condition that means I can only choose one type of dialysis.	Yes	No	Unsure
I like the independence that peritoneal dialysis offers.	Yes	No	Unsure
I think I would benefit by contact with other people who also have kidney failure.	Yes	No	Unsure
I can handle the needle sticks that are part of hemodialysis.	Yes	No	Unsure
I prefer to take charge of my own care as much as possible.	Yes	No	Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to choose one type of dialysis over the other.

Check the box below that represents your overall impression about your decision.

Leaning toward hemodialysis

Leaning toward peritoneal dialysis

Return to the topic Chronic Kidney Disease.

Credits

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Author	Jeannette Curtis
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	D.C. Mendelssohn, MD, FRCPC - Nephrology
Last Updated	November 13, 2007