As the dialysis treatments has two main types: hemodialysis and peritoneal dialysis, you need to select one of them. So, what is the best treatment between hemodialysis vs peritoneal dialysis?

Why do you need dialysis?

In the latter stage of Chronic Kidney disease (CKD), you need to have Renal Replacement Therapy (RRT). RRT includes either transplantation of a kidney or regular dialysis treatment. 

Dialysis is a process of clearing out the unnecessary components of the body. This process includes some toxic elements, excretory products, drugs, etc. 

There are two main types of dialysis;

1. hemodialysis
2. peritoneal dialysis

Although hemodialysis and peritoneal dialysis function differently, the ultimate goal is the same. That is the replacement of the kidney functions of the body. 

What is hemodialysis?

Hemodialysis is a process of purification of blood. This process uses an external machine called the dialysis machine. The blood is taken out of the body. Then the blood is going through a dialyzer.  

When you undergo hemodialysis, you need to have vascular access to train the blood out of the body. You can have an AV Fistula, AV Graft, or some other type of access for this. 

Disadvantages of hemodialysis

Usually, the hemodialysis is done in a hemodialysis center or home. You need to undergo around three hemodialysis for a week. Also, it takes about three to five hours to complete. Therefore you need to adhere to a tight schedule to continue your regular hemodialysis. Also, you cant have long travel distances from your dialysis center. 

Complications of hemodialysis

It has some complications too. The dialysis-related hypotension, dialysis disequilibrium syndrome, Hypoglycemia, etc. are some of them. 

Advantages of hemodialysis

However, the hemodialysis is more effective in clearing out particles than the peritoneal dialysis. Usually, hemodialysis is beneficial in the latter part of the disease. Also, the risk of infection is very low. You do not feel much discomfort to have an AV fistula. 

What is peritoneal dialysis?

In peritoneal dialysis, we use the abdominal cavity to have dialysis. The peritoneal dialysis solution is inserted into the peritoneal cavity. Then we have to wait for 30 – 40 minutes for the dialysis process. Usually, we have to do it 3 to 5 times a day. 

Disadvantages of peritoneal dialysis

When you undergo peritoneal dialysis, you have to have proper training. Also, it would help if you had an aseptic area. It would also be best if you had adequate time to have peritoneal dialysis several times a day. 

Complications of peritoneal dialysis

Also, peritoneal dialysis associate with peritoneal infections. Peritonitis is quite a lethal condition. Therefore you need proper handling during the procedure. But according to some researches, both hemodialysis and peritoneal dialysis have the same morbidity rates. 

Advantages of peritoneal dialysis

However, peritoneal dialysis is cheap compared to haemodialysis. You do not need to travel to a dialysis center for your peritoneal dialysis. You can freely continue your day to day activities and travel. Additionally, the newel methods like Continuous Ambulatory Peritoneal Dialysis (CAPD) have created fewer complications. 

 

What is the better option between hemodialysis vs peritoneal dialysis?

When you ask to start dialysis treatments, your nephrologist will discuss the method of renal replacement. If you are not undergoing a kidney transplant, you will offer another type of RRT. This option is either hemodialysis or peritoneal dialysis. 

But some people can’t undergo hemodialysis effectively, while others can’t have peritoneal dialysis. It would help if you discussed this with your nephrologist. He will explain you cons and pros of hemodialysis vs Peritoneal dialysis. 

Factors contributing to the selection of dialysis method

Usually, if your eGFR falls less than 15, you need dialysis treatments. But you need to select a better dialysis method for you. When you decide the better one between hemodialysis vs peritoneal dialysis, use the following factors. 

1. Your preference between hemodialysis and peritoneal dialysis
2. Distance to nearest hemodialysis center
3. Affordability of dialysis treatment methods
4. Possibility of insurance coverage of your treatment method
5. Plan for transplants
6. Level of education

So, now you would understand the decision between hemodialysis vs peritoneal dialysis is affected by a lot of factors. You need to consider all of them before the selection of one of them. 

Referance:

1. Hemodialysis : https://en.wikipedia.org/wiki/Hemodialysis

Why do we do dialysis in patients?

Your kidney have very important set of functions to maintain balance between lots of body functions. This includes excretion of waste products, removal of excess water from the body, maintain electrolyte balance, maintain acid base balance and etc.
If someone fail to maintain these kidney functions, they will be facing lot of problems
Eg:

• Accumulation of water in the lungs (Pleural effusion)
• Accumulation of water in abdomen (Ascites)
• Excess Potassium in the serum (Hyperkalemia)
• Reduced pH in the blood (Acidosis)

As most of above issues are life threatening timely dialysis is very important.

How need hemodialysis?

As mentioned, there are two groups of patients who need dialysis.

1. Patients with Chronic Kidney Diseases (CKD)
2. Acutely ill patient with Acute kidney injury (AKI)

Dialysis of CKD patients

Hemodialysis is one of the very important option in management of CKD patients. It will help to maintain most of the kidney functions.
This will ensure;

• Removal of excess fluid from the body
• Remove excess Potassium from the plasma
• Maintain acid base balance

Dialysis of AKI patients

There are patients who get Acute Kidney Injuries (AKI) following different incidents. Viper bites, Sepsis, Leptospirosis are some of them. In such situations some patients undergo urgent haemodialysis.

How to dialysis a patient?

When we say dialysis most of the time it represents hemodialysis than the peritoneal dialysis.
When we do haemodialysis, the basic of this process is to take blood out of the body, purify it and re transfuse into the body. But this is very complicated process than this.

Steps of hemodialysis

1. Prepare the dialysis machine
2. Heparinize the vascular set properly
3. Connect the patient through Vascular access to the dialysis machine
4. Adjust all parameters of dialysis including UF, BFR, Heparin dose and etc
5. Let blood go through the semipermeable membrane of the dialyzer
6. Re transfuse blood to the patient
7. Reinfuse the blood after completion of procedure
8. Disconnect the Vascular line
9. Await for hemostasis

Important parts of Dialysis procedure

What is dialyzer?

As I mentioned, dialysis is an artificial process. So to give you kidney functions artificially, there should be an artificial kidney. Dialyzer is the one doing the function of an artificial kidney in the dialysis machine.

The dialyzers are made of synthetic semi permeable membranes. These membranes are capable of providing selective permeability to some of the molecules while others do not get it.
So dialyzer is the most important part of the haemodialysis machine.

Vascular access

When you want to undergo haemodialysis, you need to have an access point. This may be a AV Fistula, AV Graft, Perm Cath or Temporary Catheter. So each have different abilities. You should select your vascular access depending on your future dialyzing plan, vascular structure and lots of other factors.

However if you are undergoing an urgent haemodialysis, you have to use a temporary femoral or neck vascular catheter.

The vascular access will ensure the adequate blood supply to the dialysis machine. Also it will return all the purified blood to body.

Water supply

In a dialysis we are doing an invasive procedure to ensure the renal functions of the patient. However if we do not use proper water for this process, patients ended up with lot of complications. Sepsis is one of them.

Therefore we use a water plant with reverse osmotic systems.
This includes both filtering capacity of unnecessary particles and germs.

Complications of Haemodialysis

Although haemodialysis is a very important and effective treatment method, it may have lot of complications.

1. Dialysis Disequilibrium Syndrome
2. Hypotention during dialysis
3. Hypoglycaemia
4. Headache
5. Fever
6. Infections
7. Bleeding from vascular access

Reference

https://www.ajkd.org/article/S0272-6386(05)00436-1/fulltext