Hemodialysis vs Peritoneal Dialysis: What is the difference ?

"From the bitterness of disease, man learns the sweetness of health"

Due to the increasing prevalence of chronic diseases, including chronic kidney disease (CKD), there has emerged a considerable interest in the assessment of health outcomes among dialysis modalities, including the comparison between peritoneal dialysis (PD) and hemodialysis (HD). Both are dialysis options for end-stage renal disease patients in whom preemptive kidney transplantation is not possible.

In hemodialysis, a machine removes blood from your body, filters it through a dialyzer (artificial kidney) and returns the cleaned blood to your body. This is done either at a dialysis facility or at home.

Unlike hemodialysis that cleans the blood outside your body; peritoneal dialysis helps filter the blood in the body itself. This is done by allowing cleansing fluid to flow into the abdomen via a tube. The lining of the abdomen extracts the waste from the blood, and then, the fluid along with the wastes is drained out of the body.

Peritoneal Dialysis Vs Hemodialysis - What's the difference between them and which one is right for You?

The biggest difference in Hemodialysis vs Peritoneal Dialysis is that Hemodialysis requires an artificial kidney machine to filter blood while peritoneal dialysis does not. Instead of a machine, peritoneal dialysis uses the lining on the inside of the belly as a natural filter for blood.

Although both types of dialysis can effectively filter your blood, the benefits of peritoneal dialysis include greater lifestyle flexibility and independence especially if you work, travel or live far from a hemodialysis center.

Peritoneal dialysis offers continuous filtration and does not require as much disruption to your daily activities. However, hemodialysis is ideal for patients with less kidney function. Peritoneal dialysis is not a good option for obese patients or people who have abdominal scarring.

Peritoneal dialysis is done more continuously than hemodialysis, resulting in less accumulation of potassium, sodium and fluid which allows you a more flexible diet than you could have on hemodialysis. People who use peritoneal dialysis might retain kidney function slightly longer than people who use hemodialysis.

What factors should be considered?

A person whose kidney function has declined considerably needs hemodialysis. This happens when only 10% to 15% of the kidney function is left. This condition is known as kidney failure or end-stage renal disease

Peritoneal dialysis can be the better option if you cannot tolerate the rapid changes of fluid balance associated with hemodialysis or you want to minimize the disruption of your daily activities.

Peritoneal dialysis might not work if you have extensive surgical scars in your abdomen, a large area of weakened abdominal muscle (hernia) or limited ability to care for yourself. People using peritoneal dialysis will eventually have a decline in kidney function that requires hemodialysis or a kidney transplant.

Risks & Complications

In hemodialysis some people have problems with the AV fistula or graft. You may develop an infection, poor blood flow or a blockage from scar tissue or a blood clot.

In Peritoneal dialysis some people develop skin infections around the catheter. You’re also at risk for peritonitis, an infection that occurs when bacteria gets inside the abdomen through the catheter.

*Study: Peritoneal dialysis offers better outcomes vs in-center hemodialysis

A Canadian study that compared patients who started on peritoneal dialysis vs. in-center hemodialysis found PD offered lower costs and better quality of life.

The study used a baseline model that looked at outcomes during a 10-year period. The results showed patients who started on PD “generally lived longer than people who started on in-center hemodialysis and so they received higher quality-adjusted life-years,” Paul Komenda, MD, MHA, a study co-author, told Healio Nephrology.

“Then, we calculated costs and we found out that if you started on PD, over a lifetime spent on dialysis vs. starting on in-center hemodialysis, you get more life years and it costs less,” the author stated.

Conclusion

Many people on dialysis continue to live active lives, working, raising families and traveling. Studies reveal that it’s possible to live 10 to 20 years on dialysis.

Talk with your doctor about which type of dialysis might be best for you. Factors to consider include kidney function, overall health, personal preferences, home situation, etc.

Both the options have its respective advantages & disadvantages. It’s important to remember that even once you choose a type of dialysis, you always have the option to change. Be sure to speak to your healthcare professional to find out what is right for you.

References: https://www.healio.com/news/nephrology/20210112/study-peritoneal-dialysis-offers-better-outcomes-lower-costs-vs-incenter-hemodialysis