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Dialysis - Advantages and disadvantages of the different types of dialysis

NHS Choices Medical Reference

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If dialysis is recommended for you, you will need to decide whether you want to have

haemodialysis or peritoneal dialysis.

Both methods of dialysis are equally effective, so it is usually a case of personal preference.

However, there may be some situations where a particular type of dialysis is recommended. For example, peritoneal dialysis is usually recommended as the first form of treatment for:

  • children aged two or over 
  • people who still have some limited kidney function
  • adults who do not have other serious health conditions, such as heart disease or cancer

Haemodialysis is usually recommended for people who are unable to carry out peritoneal dialysis, such as those who:

If you decide to have haemodialysis, you will then need to decide whether you want to receive treatment at home or visit a local hospital or dialysis unit for treatment.

If you choose to have peritoneal dialysis, you will have to decide whether you want to have continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD).

Any decision you make about which treatment method to have will not be final and it is possible to move from one treatment option to another. Also, depending on your health, you may have to have haemodialysis at some point in the future because peritoneal dialysis may no longer be a safe or suitable treatment for you.

Haemodialysis

The main advantage of haemodialysis is that you have four dialysis-free days a week.

Haemodialysis usually involves using the dialysis machine three times a week, with each dialysis session usually lasting about four hours. Therefore, you will have to plan your life around your dialysis sessions.

If you travel to another country, you will have to pre-arrange access to dialysis facilities. If you are planning to travel, you should inform the staff at your dialysis centre well in advance as they may be able to arrange for you to be referred to a dialysis unit at your destination.

The Global Dialysis website has a database of dialysis units across the world. However, many of these units may charge a fee.

Another disadvantage of haemodialysis is that your diet and the amount of fluid you drink needs to be restricted. For example, many people receiving haemodialysis have to avoid foods that are high in potassium, such as bananas, chocolate and crisps, and they are usually advised not to drink more than a couple of cups of fluid a day.

Read about how dialysis is performed for more information and advice about diet and fluid intake.

Peritoneal dialysis

Unlike haemodialysis, the obvious advantage of peritoneal dialysis is that regular visits to a dialysis unit are not required and, in the case of home haemodialysis, there is no need to have a bulky machine installed in your house.

As the equipment used for peritoneal dialysis is portable, you have more freedom to travel compared with haemodialysis patients.

CAPD equipment is roughly the size of a hat stand on wheels. The equipment used for APD is the size and weight of a small suitcase.

Another advantage of peritoneal dialysis is there are fewer restrictions on diet and fluid intake compared with haemodialysis where there are strict limits on the amount of fluids that you can drink.

One of the main disadvantages of peritoneal dialysis is that it needs to be carried out every day, whereas haemodialysis is usually only carried out three days a week.

Another major disadvantage of peritoneal dialysis is that your risk of developing peritonitis (infection of the peritoneum) is increased.

Repeated episodes of peritonitis can damage your peritoneum (the thin membrane that surrounds your abdomen) and surgery may be required to repair it.

Another drawback of peritoneal dialysis is that the dialysis fluid used can cause a reduction in protein levels, which can lead to a lack of energy and, in some cases, malnutrition.

Weight gain is another possible side effect of peritoneal dialysis.

Continuous and automated peritoneal dialysis

The two types of peritoneal dialysis are continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD).

CAPD does not involve using a machine. Instead, portable equipment is used, which includes a dialysis bag that contains fluid and a number of tubes.

With CAPD, regular dialysis sessions are carried out during the day. The sessions are known as exchanges because clean fluid is exchanged with fluid containing waste products. Most people using CAPD have four exchanges a day, with each exchange lasting 30-40 minutes.

In APD, a dialysis machine is used, although it is much smaller than the one used in haemodialysis. Dialysis is carried out during the night as you sleep, with a session lasting 8-10 hours.

The main advantage of CAPD is that the equipment is portable. This gives you more freedom to travel away from your house. For example, you may be able to take your CAPD equipment to your workplace. However, you will need to spend at least two hours a day performing dialysis.

The main advantage of using APD is that your days are dialysis-free. However, you need to keep and maintain a dialysis machine (and the associated equipment) in your house, which does not suit some people. 

Medical Review: September 29, 2013
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