Ethan Rhodes
Dialysis is a treatment that filters waste and excess fluid from the blood when the kidneys stop working properly. It is often done when someone is experiencing kidney failure or end-stage kidney disease (ESKD). Dialysis can be carried out in a hospital, a dialysis centre, or at home. The type of dialysis and location will be decided by a doctor, based on the patient's medical condition and their wishes. The two main types of dialysis are haemodialysis and peritoneal dialysis. Haemodialysis is the most common type of dialysis and usually takes place in a hospital or dialysis centre, although it can also be done at home. Peritoneal dialysis can be done at home or in a dialysis centre.
| Characteristics | Values |
|---|---|
| Dialysis treatment | Filters waste and fluid from blood when kidneys are failing |
| Who needs it | People with late-stage kidney disease, end-stage kidney disease (ESKD), or kidney failure |
| Dialysis types | Hemodialysis, peritoneal dialysis, in-center dialysis, at-home dialysis |
| Hemodialysis | Requires needles and tubes to divert blood to an external machine; performed at a dialysis center or hospital |
| Peritoneal dialysis | Blood is filtered inside the body without a machine; can be done at home or while travelling with a portable machine |
| In-center dialysis | Performed at a dialysis center or hospital; offers fixed time slots and professional support |
| At-home dialysis | Can be done at home or while travelling; offers flexibility but requires a suitable home dialysis machine |
| Treatment frequency | Hemodialysis: 3-4 hours, 3 times/week; Peritoneal dialysis: 40 minutes, 3-5 times/day |
| Side effects | Hemodialysis: itchy skin, muscle cramps; Peritoneal dialysis: risk of peritonitis (abdominal infection) |
| Limitations | Requires adjustments to diet and fluid intake; may require rest after treatment |
| Emergencies | Power outages or travel disruptions may hinder access to dialysis centers or hospitals |
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What You'll Learn
Haemodialysis vs. peritoneal dialysis
Dialysis is a treatment that filters waste and excess fluid from the blood when the kidneys are failing. It is often required in cases of kidney failure or end-stage kidney disease (ESKD). It can be done in a hospital, a dialysis centre, or at home, depending on the patient's medical condition and personal wishes.
There are two main types of dialysis: haemodialysis and peritoneal dialysis. Haemodialysis is the most common type and involves a machine with a special filter, known as an artificial kidney or dialyzer, to clean the blood. A tube is attached to a needle in the patient's arm, and the blood passes along the tube into the machine, which filters it before returning it to the arm. Haemodialysis usually takes place three times a week, with each session lasting around three to four hours.
Peritoneal dialysis, on the other hand, uses the lining of the patient's abdomen or belly area (peritoneum) as a natural filter for the blood. Before starting this type of dialysis, a minor surgery is required to place a catheter (soft tube) in the abdomen. During treatment, the belly area is slowly filled with dialysate (a cleansing fluid) through the catheter. As blood flows naturally through the area, extra fluid and waste are pulled out of the blood vessels and into the belly, where they are then drained out. Peritoneal dialysis can be done at home or anywhere the patient has access to the required supplies. It is typically done three to five times a day, with each session lasting about 40 minutes.
The choice between haemodialysis and peritoneal dialysis depends on various factors, including the patient's health, lifestyle, and personal preferences. Haemodialysis may be preferred for patients with less kidney function, while peritoneal dialysis offers more flexibility and less disruption to daily activities. However, peritoneal dialysis may not be suitable for obese patients or those with abdominal scarring, and it carries a risk of peritonitis (inflammation of the peritoneum). Haemodialysis, on the other hand, may lead to poor blood flow or blockages and requires regular visits to a dialysis centre or hospital.
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Dialysis at home
Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys are not functioning properly. It often involves diverting blood to a machine to be cleaned. Dialysis can be done in a hospital, a dialysis centre, or at home.
Home Haemodialysis
Haemodialysis is the most common type of dialysis. During the procedure, a tube is attached to a needle in the patient's arm. Blood passes along the tube and into an external machine that filters it, before it is passed back into the arm along another tube. Haemodialysis can be done at a dialysis centre or at home. At a dialysis centre, haemodialysis is usually carried out three days a week, with each session lasting around four hours.
Home haemodialysis is the modality of haemodialysis done in the home. During home haemodialysis, blood flows from the patient's vascular access through a dialysis machine. The dialysis machine cleanses the blood of extra waste and fluids and sends the clean blood back into the body.
There are three types of haemodialysis that can be performed at home:
- Conventional home haemodialysis: This is done three times a week for three to four hours or longer each time.
- Short daily home haemodialysis: This is usually done five to seven times a week using new machines designed for short daily home treatment. Treatments usually last about two hours each.
- Nocturnal home haemodialysis: Long, slow treatments done at night while the patient sleeps. This is done six nights a week or every other night, depending on what the doctor prescribes. Treatments usually last about six to eight hours.
Home Peritoneal Dialysis
Peritoneal dialysis is a type of dialysis where the blood is filtered inside the patient's own body instead of using a dialyzer machine. For this type of dialysis, the lining of the abdomen or belly area (also called the peritoneum) is used as a filter. Peritoneal dialysis can be done quite easily at home and can sometimes be done while the patient sleeps, but it needs to be done every day.
There are two types of peritoneal dialysis:
- Continuous ambulatory peritoneal dialysis (CAPD): This does not use a machine for treatment and can be done during the day, but it must be done daily. It works by using gravity to help do exchanges by hand. Most people do four exchanges a day. Each exchange takes about 30 to 40 minutes to drain and refill the belly with the dialysate.
- Automated peritoneal dialysis (CCPD): This uses a machine called a cycler to do the exchanges, and it is needle-free. CCPD is usually done at night while the patient sleeps, but it must be done every night. The cycler usually does three to five exchanges each night and takes about nine hours.
Benefits of Dialysis at Home
Dialysing at home offers many benefits. Home dialysis allows patients to receive treatments from the comfort of their own home, and it provides them with less food restriction and better health outcomes. Patients who dialyse at home have the ability to achieve improved clinical outcomes. Home dialysis also gives patients more flexibility to do the activities they enjoy, including travelling.
Drawbacks of Dialysis at Home
Dialysing at home may present a few drawbacks that may or may not impact the patient's lifestyle.
Training for Home Dialysis
Before starting home dialysis, patients and their care partners will go through a comprehensive safety and training program at a local dialysis centre. During the training program, they will learn everything they need to know about performing dialysis treatments safely and effectively in their homes. Training usually takes from four to eight weeks and is conducted individually by a home training nurse.
Costs of Home Dialysis
Medicare pays for part of the cost and training for home dialysis. If the patient is 65 or older or disabled, they should already have Medicare. Patients can also get Medicare at any age if they have kidney failure and they or their spouse or parent worked long enough to qualify for Social Security. There are other sources that help pay for dialysis. Check with your social worker.
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Dialysis at a centre
Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys stop functioning properly. It is often required in cases of kidney failure or end-stage kidney disease. There are two main types of dialysis: haemodialysis and peritoneal dialysis.
Haemodialysis involves diverting blood to an external machine to be cleaned and filtered. A minor surgery is required to create a vascular access site, typically in the arm, to facilitate the process. Each haemodialysis session at a dialysis centre lasts around three to four hours and is usually done three times a week. During this time, a team of healthcare professionals, including nurses and technicians, will assist you.
Peritoneal dialysis, on the other hand, filters blood within the body. This type of dialysis uses the peritoneum, the lining of the abdomen, as a natural filter. Before beginning peritoneal dialysis, minor surgery is needed to place a catheter, a soft tube, in the abdomen. The belly area is then filled with dialysate, a cleansing fluid. After a few hours, the fluid, along with the waste products, is drained from the body using the catheter. Peritoneal dialysis can be done at home or while travelling with the necessary supplies.
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Dialysis in hospital
Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys are not functioning properly. It is often necessary when an individual is suffering from kidney failure or end-stage kidney disease. Dialysis can be performed in a hospital, a dialysis centre, or at home, depending on the patient's medical condition and preferences.
In-centre haemodialysis is typically performed three times a week, with each session lasting around three to four hours. During this procedure, a tube is attached to a needle in the patient's arm, and their blood is pumped through an external machine that filters it before returning it to the body. This type of dialysis usually requires patients to visit a hospital or dialysis centre, although it can also be done at home with proper training. Haemodialysis can cause side effects such as itchy skin and muscle cramps.
Peritoneal dialysis, on the other hand, can be performed at home or even while travelling with the necessary equipment. It involves minor surgery to place a catheter (soft tube) in the abdomen, which is then filled with dialysate (a cleansing fluid) to filter the blood. This type of dialysis can be done daily, with sessions lasting 40 minutes to 8-12 hours, depending on the specific method. Peritoneal dialysis may require limiting certain physical activities and can increase the risk of developing peritonitis, an abdominal infection.
The choice between haemodialysis and peritoneal dialysis depends on various factors, including the patient's lifestyle, medical condition, and personal preferences. It is important to discuss the pros and cons of each option with a healthcare provider to determine the most suitable treatment plan.
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Dialysis during an emergency
Dialysis is a treatment that filters waste and fluid from the blood when the kidneys are failing. It is often done by diverting blood to a machine to be cleaned. There are two main types of dialysis: haemodialysis and peritoneal dialysis. Haemodialysis involves a dialyser (filtering machine) that filters waste and extra fluid from the blood and then returns the filtered blood to the body. Peritoneal dialysis uses the inner lining of the abdomen (peritoneum) to filter blood.
During an emergency, getting kidney dialysis may not be possible. Power outages, closed roads, and other disruptions can prevent access to dialysis centres or hospitals. If you have a home dialysis machine, you may be able to perform manual exchanges until the power is restored. Alternatively, consider purchasing a small backup generator to ensure a continuous power supply.
If you are unable to access your usual dialysis centre, it is important to take several proactive steps to safeguard your health:
- Prepare an emergency kit with contact numbers for your doctor, your regular dialysis centre, and another nearby dialysis centre. Include a list of your medications and a 3-day supply of each.
- Follow the 3-Day Emergency Diet, which could help save your life.
- If you need to go to a shelter, inform someone in charge about your medical needs.
- Ensure your dialysis centre has your current phone number and address so they can contact you if needed.
- Register with your water and power companies in advance to request priority in restoring your service during an emergency.
- Contact the National Kidney Foundation (NKF) helpline or the Kidney Community Emergency Response (KCER) hotline for additional information and resources.
In the case of an emergency hospital admission, dialysis support is provided in intensive care units (ICUs) for patients with acute or chronic renal failure. This includes the use of continuous renal replacement therapy, optimising fluid, electrolyte, and toxin balance in critically ill patients. Hospitals also have acute dialysis units that provide standard haemodialysis care for inpatients with acute kidney injury or end-stage renal disease.
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