What do I need to know when choosing between haemodialysis and peritoneal dialysis?

Doctor's Answer

Hi,

Choosing between peritoneal dialysis and haemodialysis can be a difficult decision because there are many factors to consider and it is a significant event in patient’s life.

There are patients who have medical contraindications for one therapy or for the other and therefore they do not have much choice, or patients that have certain medical conditions for which the doctors would recommend one therapy over the other one. Said that, most patients do have a choice.

Overall, I advise my patients to choose the therapy they feel more comfortable with and which blends better with their lifestyle and personality or affects their lifestyle to a lesser degree. Just try to visualise how your personal, family, social, sports and work life will be affected after one or the other therapy. Then, the doctor can tune up your decision or reaffirm it. But do not forget that if you are eligible for kidney transplantation, probably you should consider it over any type of dialysis. I expand on the benefits of kidney transplantation in another question in this series.

Please see below a table comparing some characteristics of peritoneal dialysis and haemodialysis, which can help you to take a more informed decision. But please check all your queries with your kidney doctor, as he can personalise his advice to your needs.

HAEMODIALYSIS

PERITONEAL DIALYSIS

CLEANING OF BLOOD

Sufficient

Sufficient

INDEPENDENCE

Three times a week only

Do it at home by yourself

DEPENDENCE

Three times a week, on and on, need to plan your life around this schedule

Do it at home every day

CONFIDENCE

Done by professionals

Done by empowered patients

PEER EFFECT vs FAMILY LIFE

Benefit of dialysing together with peers suffering the same struggles

More permissive of family life, more able to take care of duties and shores at home

FLUID RESTRICTION

Needed and stringent

Needed, less restriction

DIET RESTRICTION

Needed and stringent

Needed, less restriction

TRANSPORT

Needed

Not needed

DEXTERITY & VISION

Not needed

Needed (except if a caregiver helps)

PATIENT ECONOMY

More expensive

Cheaper

HEALTHCARE ECONOMY

More expensive

Cheaper

WORKLIFE

Part-time or flexibility required

Full-time (while on breaks/night-time)

SPORTS

More permissive but case to case basis

Case to case basis but swimming and contact sports are cumbersome

TRAVEL

More difficult -Need to find a dialysis centre overseas

More permissive -Solutions can be supplied overseas

AESTHETICS

Arm bumps

Tube in tummy (need to cover for showering)

COMPLICATIONS

Infections, blockage, hypotension, messy blood pressure

Infections, blockage, hernias, weight gain

COMPATIBILITY WITH DIABETES

Some fluctuations

Usually worsens it

DURATION

More long-lasting

Peritoneal membrane can thicken with time, especially if developing infections

HOUSE RE-ARRANGEMENTS

Not needed

Need space for machine and fluids

In regards to sports, that is a tough question. There are doctors who are more conservative. I do not practice sports and I know how important is to continue doing them, and one of the aims of dialysis and transplantation is to allow as much as possible a close to normal life. But it depends on the type of sport, its intensity and its competitivity.

For instance, rugby will be difficult if you have a kidney transplant, which can be at risk of injury, or for peritoneal dialysis, as the catheter can be pulled accidentally by the opponent. The same might apply for soccer and basketball, although the contact is not a heavy as rugby, but also depends how intensive or competitive you are and who you played with or against it.

If just for leisure, no harm in kicking the ball around after the surgical wounds have recovered. Swimming will be difficult in you have a peritoneal dialysis catheter. Noncontact sports will be simpler like badminton or running or cycling, etc. Patients with haemodialysis on a fistula could do those sports, but ideal they rest well after a dialysis session and ideal to do sport with risks of fall or heavy contact in the hours after dialysis as they receive blood thinners in the dialysis treatment, etc.

There are so many sports and exercise types and permutations trying to match them with the different therapies for kidney failure, that my best practical advice is to discuss this further with your kidney doctor, as he/she can advise you more specifically and accurately, as he/she knows your condition better, based on your priorities and preferences, too.

Dr Francisco, wishing you the best possible health and that hopefully you can continue doing all their sports you like, but indeed you might need to modify the intensity or the setting in which you will practice it.

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