Kidney failure: What type of dialysis should I have?

1. Get the Facts

Your options

Have hemodialysis.
Have peritoneal dialysis.

Key points to remember

There are two types of dialysis: hemodialysis (say "HEE-moh-dy-AL-uh-sus") and peritoneal dialysis (say "pair-uh-tuh-NEE-uhl dy-AL-uh-sus"). Each type 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 keep doing it to stay as healthy as possible.
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.
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.
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 that you are making the best decisions.

FAQs

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. See a picture of hemodialysis .
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. See a picture of peritoneal dialysis .

Why might your doctor recommend one type of dialysis over another?

Your doctor may recommend peritoneal dialysis if you don't have good dialysis access for hemodialysis.
Your doctor may recommend hemodialysis if you have belly problems, such as a hernia or adhesions, or active inflammatory bowel disease (Crohn's disease, ulcerative colitis).

2. Compare Options

	Reasons to choose hemodialysis	Reasons to choose peritoneal dialysis
What is usually involved?	Before hemodialysis treatments can begin, your doctor will need to create a site where blood can flow in and out of your body. 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. You will probably go to a hospital or dialysis center on a fairly set schedule. Hemodialysis usually is done 3 days a week and takes 3 to 5 hours a day. In some cases, hemodialysis can be done at home. These sessions happen more often but for shorter periods of time than hemodialysis done at a hospital or center.	You will have a catheter placed in your belly (dialysis access) before you begin dialysis. Peritoneal dialysis uses the lining of your belly, which is called the peritoneal membrane, to filter your blood. The process of doing peritoneal dialysis is called an exchange. You will usually complete 4 to 6 exchanges every day. You will be taught how to do your treatment at home, on your own schedule.
What are the benefits?	It is most often done by trained health professionals who can watch for any problems. It allows you to be in contact with other people having dialysis, which may give you emotional support. You don't have to do it yourself, as you do with peritoneal dialysis. You do it for a shorter amount of time and on fewer days each week than peritoneal dialysis.	It gives you more freedom than hemodialysis. 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. It doesn't require as many food and fluid restrictions as hemodialysis, and it does not use needles. It doesn't 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.
What are the risks and side effects?	It causes you to feel tired on the day of the treatments. It can cause problems such as low blood pressure and blood clots in the dialysis access. It increases your risk of bloodstream infections. It requires the use of blood thinners during the procedure, so it may not be the best choice if you have bleeding problems or take medicines that interfere with blood clotting.	The procedure may be hard for some people to do. It increases your risk for an infection of the lining of the belly, called peritonitis.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see:

Personal stories about choosing a type of dialysis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

" I have had kidney problems ever since I was born. So really, I have grown up knowing how to do peritoneal dialysis. I like it because I can do most of my exchanges overnight and go to college during the day. "

— Kristeen, age 26

"I never really considered hemodialysis. It just wouldn't work for me. I live way out—it's an hour's drive to the nearest clinic—and I can't spend all that time on the road and away. I've got a farm to run. Oh, at first I was a little bit dazed by what you have to do with peritoneal dialysis—putting on the gloves and the mask, dealing with the catheter, all that. But you get used to it, and then it's pretty easy. "

— Saul, age 69

"I am on the waiting list for a kidney transplant. In the meantime, I chose peritoneal dialysis so I could be home with my kids as much as possible. I like taking care of the treatments myself. It makes me feel less like a patient all the time. "

— Georgia, age 34

" I have been on hemodialysis for about 3 years now. I've gotten used to the schedule, and in fact, I have some friends who are at the center at the same time. The people who work there are really nice and helpful, and I feel I'm getting the best care out there. "

— Ed, age 58

" I haven't worked a regular job in a long time, but I am able to use my time at the dialysis center to piece quilts that my daughter puts together and sells for me. Another woman who comes there knits, so we sit and chat while we have our dialysis. "

— Marita, age 76

" Besides having kidney failure, I have inflammatory bowel disease, so peritoneal dialysis wasn't an option for me. I am lucky to have a wife who got trained in hemodialysis, so she does my treatments. I like the freedom it gives me to have my treatments in the comfort of my own home. "

— Luis, age 45

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose hemodialysis

Reasons to choose peritoneal dialysis

I feel more comfortable having professionals handle the procedure.

I am confident that I can do the procedure myself.

More important

Equally important

More important

I don't want to have dialysis every day.

I don't mind having dialysis every day.

More important

Equally important

More important

I live near a dialysis center or am able to get to a dialysis center.

I live far from a dialysis center or have trouble getting around.

More important

Equally important

More important

I prefer to be around others who are also getting dialysis.

I like the independence of doing the dialysis myself.

More important

Equally important

More important

I don't mind people sticking needles in me.

I hate having needles stuck in me.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Hemodialysis

Peritoneal dialysis

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. No matter what kind of dialysis I choose, it won't cure my kidney failure. I will need to keep getting dialysis to stay as healthy as I can.

True
False
I'm not sure

That's right. 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 keep doing it to stay as healthy as possible.

2. With hemodialysis, I will be connected to a machine called a dialyzer to clean my blood.

True
False
I'm not sure

That's right. During hemodialysis, tubes connect your blood vessels to a man-made membrane called a dialyzer, which cleans your blood.

3. With peritoneal dialysis, my blood is filtered through the lining in my belly.

True
False
I'm not sure

That's right. Peritoneal dialysis uses the lining of your belly, called the peritoneal membrane, to filter your blood. You or a caregiver will be taught to do peritoneal dialysis at home.

Decide what's next.

1. Do you understand the options available to you?

Yes
No

2. Are you clear about which benefits and side effects matter most to you?

Yes
No

3. Do you have enough support and advice from others to make a choice?

Yes
No

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.