Comparing Hemodialysis and Peritoneal Dialysis: A Comprehensive Guide

Dialysis is an incredible medical intervention that helps people with impaired kidney function. As the kidneys play a pivotal role in filtering waste and excess fluids from the blood, any dysfunction can lead to a buildup of toxins, posing a serious threat to overall health. Dialysis, a process replicating the kidney’s essential functions, becomes imperative in cases of renal failure. When the kidneys fail, dialysis is used to eliminate waste and extra fluid from the blood. Blood passes through a filtration machine in this process.

Why Does One Need Dialysis?

A dialysis is needed when your kidneys fail to function properly, leading to an inability to effectively clear toxins from your blood. This can occur in advanced stages of chronic kidney disease, also known as kidney failure. Kidney failure is caused by chronic diseases, namely diabetes and hypertension, acute diseases, and injuries. When the kidneys are no longer able to effectively remove waste and extra fluid from the body, toxin accumulation results in different complications. Some symptoms of kidney failure include fatigue, swelling, breathing issues, and urine output abnormalities. When the kidney functions deteriorate significantly, dialysis becomes a critical intervention. The purpose of dialysis is to eliminate all the waste, salt, and the extra amount of water from the body preserving a stasis which the kidneys fail to accomplish anymore. Furthermore, dialysis can help regulate blood pressure and electrolyte levels despite compromised renal function. Since dialysis is an alternative to renal filtration, it is also called renal replacement treatment (RRT).

Types of Dialysis

Peritoneal Dialysis and hemodialysis are the two main types of dialysis:

Hemodialysis (HD)

Hemodialysis is the most common form of dialysis, often conducted in a medical facility known as a dialysis centre or clinic. During hemodialysis, your blood is filtered using a dialyzer (a device that removes waste and excess fluid), and the purified blood is then put back into your body. A little surgery is required to make a vascular access site—a hole into one of your blood vessels—usually in your arm, before you can begin hemodialysis. Vascular access is a critical aspect of hemodialysis. A surgeon creates an access point, either through an arteriovenous (AV) fistula, AV graft, or central venous catheter, to ensure a continuous and reliable flow of blood to the dialyzer. The majority of hemodialysis treatments are initially carried out in a dialysis facility, hospital, or doctor’s office. The process typically lasts for about four hours and is usually performed three times a week.  Your body’s size, the quantity of waste it contains, and your present state of health can all affect how long the therapy takes. After undergoing hemodialysis for a significant period, you may become prepared to do your dialysis treatments at home. This is a common choice for those requiring ongoing care.  While HD is efficient and provides rapid removal of toxins, patients must adhere to a strict schedule and may experience fluctuations in blood pressure during the procedure.

Peritoneal Dialysis (PD)

Peritoneal Dialysis offers a more flexible and home-based alternative to hemodialysis. During peritoneal dialysis, your blood is filtered inside rather than by a dialyzer equipment. The lining of your stomach or abdomen, often known as the peritoneum, serves as a filter for this kind of dialysis. In this method, the peritoneum, a membrane lining the abdominal cavity, acts as the natural filter. A cleansing fluid, known as dialysate, is introduced into the peritoneal cavity through a catheter. The dialysate absorbs waste products and excess fluids from the blood through the peritoneum, after which it is drained out, taking the impurities with it. The catheter is implanted surgically by a doctor. A dialysis nurse will usually train you for a few weeks before beginning dialysis so you can learn how to execute the exchanges and take care of the catheter site. Peritoneal dialysis allows for more frequent treatments, enhancing the removal of waste products and providing a gentler approach to dialysis. This modality is particularly suitable for individuals who prefer a more independent lifestyle. However, it requires strict adherence to hygiene practices to prevent infections associated with the catheter site. You should continue this process three to five times a day, which might take many hours. But this exchange of fluids may occur both when you’re asleep and when you’re awake—even when you go about your regular business. Among the types of peritoneal dialysis are:

• Continuous ambulatory peritoneal dialysis (CAPD): Your stomach is repeatedly filled and emptied throughout the day. This technique has to be used when awake and doesn’t require a machine.
• Continuous cycling peritoneal dialysis (CCPD): The fluid is cycled in and out of your abdomen by CCPD using a machine. Usually, you do it while you’re sleeping at night.
• Intermittent peritoneal dialysis (IPD): Although you may do it at home, this therapy is often administered at a hospital. Although the procedure takes longer, it makes use of the same equipment as CCPD.

Risks Associated with Dialysis

Despite its life-saving benefits, dialysis carries certain risks. It is important for patients as well as doctors to be aware of these potential consequences.

Risks Associated with Hemodialysis (HD)

Some risks associated with hemodialysis include: 

• Hypotension: A common side effect during HD is a sudden drop in blood pressure. This can lead to dizziness, nausea, and, in severe cases, fainting.
• Anaemia: Over time, repeated HD sessions can contribute to anaemia, as red blood cells may be lost during the process.
• Muscle Cramps: The rapid removal of fluid during HD may trigger muscle cramps, causing discomfort for some patients.
• Itching: Many hemodialysis patients have itchy skin, which may worsen during or just after the treatment.
• Infection: Vascular access points, such as catheters or fistulas, can become sites for infections. Strict hygiene measures are essential to mitigate this risk.
• Problems with sleep: Hemodialysis patients frequently have difficulty falling asleep, perhaps due to breathing pauses during the night or to painful, unpleasant, or restless legs.
• Blood Clotting: The blood’s contact with the dialysis machine and tubing may activate clotting factors, posing a risk of clot formation and subsequent complications.
• High blood pressure (hypertension): Your high blood pressure is likely to worsen and cause heart issues or strokes if you eat too much salt or drink too much fluid.
• Inflammation of the membrane surrounding the heart (pericarditis).:  The membrane that surrounds your heart may become inflamed as a result of inadequate hemodialysis, which may impair your heart’s capacity to pump blood throughout your body.

Risks Associated with Peritoneal Dialysis (PD)

Your risk of infections, such as peritonitis, in or near the catheter site may rise if you are receiving peritoneal dialysis. Other risks include:

• Infection: The insertion of a catheter into the abdominal cavity creates a potential route for infection. Peritonitis, inflammation of the peritoneum, is a serious complication that requires immediate attention.
• Weight Gain: Dextrose is a kind of sugar found in dialysate. You might gain weight if your body takes in hundreds of more calories each day as a result of absorbing part of this fluid.
• Exit Site Infection: The area where the catheter exits the body is susceptible to infection, emphasising the importance of proper hygiene.
• Hernias: Increased abdominal pressure from the dialysate can contribute to the development of hernias in some peritoneal dialysis patients.
• Reduced efficacy of treatment:  After a few years, peritoneal dialysis may no longer be effective. You might have to switch to hemodialysis.
• Fluid Overload: A buildup of fluid from inadequate dialysate drainage can cause problems, including edema and dyspnea.

Conclusion

Dialysis is a potentially life-saving treatment that can take over the role of failing kidneys. It helps restore electrolyte and fluid balance by purifying your blood. The choice between Hemodialysis and Peritoneal Dialysis often depends on individual circumstances, lifestyle preferences, and medical considerations. In addition, there are issues with treatment access as well as hazards and consequences to take into account. Discuss the benefits and drawbacks of dialysis with a doctor and find out which kind could be most appropriate for your circumstances. Omni Hospitals, a leading healthcare institution committed to excellence, understands the complexities of renal care. With state-of-the-art facilities and a compassionate healthcare team, Omni Hospitals strives to provide comprehensive dialysis services tailored to individual needs.