Introduction

Kidney failure is where your kidneys do not work properly, leading to toxins and harmful substances building up in the blood and making you unwell. Dialysis is used to treat kidney failure by acting as a filter, removing the harmful toxins, excess fluid and waste products from the blood. Dialysis can be long-term, but for most people, it is used as a short-term treatment until your kidneys recover or a suitable donor kidney becomes available for transplant. There are two main types of dialysis that are commonly used to treat kidney failure; peritoneal dialysis and haemodialysis.

In haemodialysis, the blood is pumped through a dialysis machine, where it is cleansed and filtered around 3 times a week. In peritoneal dialysis, the peritoneum (lining of the abdomen) is used as a natural filter to clean the blood, using dialysis fluid and a catheter. 

Although they both do the same job, peritoneal dialysis and haemodialysis work in different ways. They are done at different times of day, take different lengths of time, use different equipment and have different impacts on the patient lifestyle.

Haemodialysis

How haemodialysis works

In haemodialysis, blood is taken from the body, usually through a fistula in the arm, then filtered through a dialysis machine and returned back. A fistula is an artificial connection between blood vessels, which is created during a quick surgical procedure and used for vascular access during dialysis. Catheters in the neck can also be used. After the blood has left the body, it goes to a special dialysis machine, where it is cleaned by a dialyser (filter). Once the blood has been thoroughly cleaned, it is returned to the body. This process helps to keep the blood clean and free from toxins and also helps to remove excess water and salts from the blood. 

Usually, haemodialysis is carried out 3 times per week in a hospital dialysis unit. Each session tends to last around 3-4 hours. Haemodialysis can also be carried out at home, which is called ‘Home haemodialysis’. This is becoming increasingly popular, as patients then have the choice to dialyse overnight or do dialysis sessions at home 3 times a week, as they would in a normal hospital unit.

Benefits of haemodialysis

Effective treatment

Haemodialysis is a very effective treatment for kidney failure, as it is efficient at removing waste, toxins and excess fluids from the body. It helps to keep patients alive when their kidneys have stopped working, and it also helps to relieve any symptoms they may experience. Haemodialysis helps patients to feel better in themselves and live longer with kidney failure.

Schedule and routine

Patients usually have 3 haemodialysis sessions at the same time each week, and this schedule provides a sense of routine. Having weekly routines helps give patients a sense of control, and it allows them to make the most of their free time when they are not having dialysis. This consistency can also improve their mental health and wellbeing, and relieve anxiety.

Haemodialysis at home

Patients can also be trained to do haemodialysis at home, which would give them more freedom. They would be able to dialyse when it is convenient for them, allowing them more free time away from dialysis and the hospital. Dialysing at home also empowers patients to take control of their healthcare and care for themselves.

Negatives of haemodialysis

Although haemodialysis has many benefits andis able to help keep patients alive when their kidneys have failed, it also comes with many negatives. 

Time-consuming

Haemodialysis is very time-consuming; patients will spend around 12 hours a week in a dialysis unit, not including the time needed to travel to the dialysis unit or any other appointments they may have to attend. This schedule can be very restrictive for patients.

Renal diet

Whilst on haemodialysis, patients must also adhere to a very strict ‘renal diet’, which limits what types of food they can eat and how much they can drink. For example, patients should ensure they eat high-quality protein, including non-processed meats, fish, eggs and poultry. It is also important that patients limit the amount of electrolytes (potassium, phosphorus, sodium) in their diet. Patients on renal diets must closely watch how much they have to drink. These dietary restrictions are very strict, so your doctor may recommend a supplement prescribed specifically to patients with kidney failure to prevent malnutrition. However, every patient is different and your doctor and healthcare team will advise on the specific dietary changes needed for you and your particular condition.

Side effects of haemodialysis

Haemodialysis can also be very physically demanding, as it puts a huge strain on your body. This can lead to certain unpleasant side effects, including fatigue, dizziness, infections and muscle cramps. These side effects can have a massive impact on your day-to-day life, as it may affect your ability to work and do other ‘normal’ activities alongside dialysis. 

Haemodialysis does have many drawbacks and negatives, but it is important to remember that it is life-saving and, for most people, it is only temporary until a suitable donor kidney is found for a transplant or until your kidneys have recovered. 

Peritoneal dialysis

Understanding peritoneal dialysis

The peritoneum is the lining of the abdomen, and it is used in peritoneal dialysis as a natural filter to remove toxins and clean the blood when the kidneys do not work properly. There are two different types of peritoneal dialysis - continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) - although they are both very similar. In CAPD, a bag of dialysate (cleansing fluid) enters the abdomen through a small, thin tube called a catheter, which is permanently in place in the abdomen. After the dialysis session is finished, the fluid can then be drained out of the abdomen. Each fluid exchange can take 30-40 minutes, and it is normally carried out 3-5 times per day. APD is very similar to CAPD, except the fluid is delivered and removed via a machine, called a cycler. APD is usually carried out overnight, rather than throughout the day.

Benefits of peritoneal dialysis

Flexibility and independence

Peritoneal dialysis is usually performed overnight and at home, which reduces the number of hospital trips and allows for more flexibility. Patients have more time to do activities they enjoy, including going to school and work regularly- they are much less restricted by their dialysis schedule. The increased flexibility also means that patients can travel more easily on peritoneal dialysis.

Dietary freedom

The recommended diet for patients on peritoneal dialysis is less restrictive than those on haemodialysis - this is because peritoneal dialysis is carried out daily, so build-up of fluid, waste and electrolytes (salts) is less of a concern. Patients are again recommended to eat high-quality meat, poultry, fish and eggs to ensure they get enough protein. Your doctor may still prescribe a renal multivitamin to prevent malnutrition and nutritional deficiencies.

Less physical strain

Peritoneal dialysis is generally less physically straining and demanding than haemodialysis, so patients tend to be less fatigued and are able to go to work, school, and go about their daily lives. Continuous, daily dialysis improves patient’s wellbeing and helps them feel better whilst they are on treatment.

Negatives of peritoneal dialysis

Infection risk

The main risk associated with peritoneal dialysis is infection and peritonitis. Peritonitis is the infection and inflammation of the peritoneum, and symptoms include abdominal pain/tenderness, bloating, nausea, vomiting, fever, and cloudy dialysis fluid. Peritonitis can be extremely serious, as it can lead to other complications such as sepsis. However, it can be prevented through good hygiene - for example, washing your hands before dialysis treatments, applying an antibiotic cream around the catheter and wearing a mask or face covering. 

Carrying out dialysis at home

Patients must also receive training before they can have peritoneal dialysis at home, to ensure that they can dialyse safely and effectively. Although some patients find this empowering, others may find it stressful, and they may be anxious about doing the dialysis treatment themselves. Patients also need to have space available at home to store dialysis equipment, including the cycler (if on APD), dialysate fluids and catheter supplies. This can take up a lot of space, and some patients may not have the space at home to accommodate the necessary equipment.

Summary: making the right choice for you

Both haemodialysis and peritoneal dialysis come with their benefits and drawbacks. Peritoneal dialysis may suit someone who wants a more flexible life, but it may not work for someone who doesn’t want to do dialysis at home. Haemodialysis may fit well with some people’s lifestyles, but others might struggle with the dietary restrictions, physical demands and fatigue. Your medical needs must also be considered, as not everyone is a suitable candidate for both types of dialysis.

There are a number of factors to consider when choosing between haemodialysis and peritoneal dialysis, including lifestyle, medical needs and personal preferences. Patients should take the time to consider which type of dialysis is best for them and discuss their feelings and concerns with their healthcare team, who will further support and advise on the best next steps to take.