Introduction
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
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:
Your Information
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
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.
