Choosing Between Hemodialysis and Peritoneal Dialysis: What to Consider

It is common to see discussions about whether dialysis is necessary when kidney function declines to a certain level, and which dialysis method to choose. In fact, when to start dialysis and how to choose between hemodialysis and peritoneal dialysis can often cause uncertainty. Understanding the differences between these two methods and knowing when each is appropriate not only helps in receiving the most suitable treatment but also ensures that quality of life is maintained.

When Do You Need Dialysis?

The kidneys are responsible for removing waste and excess fluids from the body, as well as maintaining the balance of electrolytes. When kidney function drops significantly by more than 90%, the body can no longer eliminate toxins efficiently. At this stage, dialysis or a kidney transplant is required to sustain life.

6 Key Signs You May Need Dialysis

When kidney function is severely impaired, the body cannot eliminate toxins and excess fluids, which accumulate and may lead to the following symptoms:

• Chronic Fatigue: The buildup of waste can cause ongoing fatigue and exhaustion that interferes with daily activities.
• Shortness of Breath: Excess fluid may accumulate in the lungs, leading to difficulty breathing, shortness of breath, or feelings of chest tightness.
• Swelling (Edema): Fluid retention can cause swelling in the hands, feet, ankles, and face.
• Nausea/Vomiting: The accumulation of toxins in the body can cause gastrointestinal discomfort, leading to nausea, vomiting, and loss of appetite.
• Decreased Urine Output: As the kidneys fail to produce sufficient urine to eliminate waste, some patients may experience significantly reduced urine output, or even no urine at all.
• Increased Blood Pressure: The kidneys help regulate fluid and salt levels; when they fail, fluid retention increases blood pressure. Damaged kidneys also disrupt hormone regulation, worsening hypertension.

How to Choose the Right Dialysis Method?

There are two main types of dialysis: Hemodialysis and Peritoneal Dialysis, each with its own pros and cons. The choice depends on your doctor’s recommendations, along with considerations of your lifestyle, health condition, and personal preferences. Here’s a comparison of the two methods:

Hemodialysis (Blood Dialysis)

In hemodialysis, a machine called a dialyzer functions as an artificial kidney to filter the blood. The patient’s blood is directed into the dialyzer, where toxins and excess fluid are removed. The clean blood is then returned to the body.

Frequency: Typically 3 times a week, with each session lasting 3-5 hours

Advantages:

• Performed in a dialysis centre or hospital under professional supervision, ensuring immediate medical assistance if complications arise

Disadvantages:

• Requires frequent visits to a dialysis centre
• Involves needle insertion 
• Higher risk of blood infections
• Possible side effects such as blood pressure fluctuations and nausea
• Requires strict dietary restrictions, limiting protein, potassium, phosphorus, salt, and fluid intake

Peritoneal Dialysis (Belly Dialysis)

In peritoneal dialysis, the patient's peritoneum (the lining of the abdominal cavity) acts as a natural filter. A dialysis solution is introduced into the abdomen, where it absorbs waste and excess fluid. The solution is then drained from the body.

Frequency: 4-5 times per day, with each session lasting about 30 minutes

Advantages:

• Can be done at home, offering more flexibility and control over treatment times
• No needles required.
• Fewer side effects
• Fewer dietary restrictions, allowing for moderate fluid and protein intake, with no potassium restrictions (though phosphorus intake must still be monitored)
• Helps preserve residual kidney function for a longer time

Disadvantages:

• Patients must learn how to perform the procedure themselves or have a caregiver assist
• Higher risk of peritonitis if proper hygiene is not maintained

Prevention Is Better Than Cure

By getting early screenings and actively managing risk factors for kidney disease, such as high blood pressure, diabetes, and chronic kidney disease, you can slow down or even prevent kidney function from deteriorating to the point of needing dialysis. Adopting healthy lifestyle habits like balanced eating, regular exercise, quitting smoking and drinking, and getting regular health check-ups are essential steps to protecting your kidneys. Keeping your kidneys healthy is the easiest way to maintain a better quality of life!