Differences between haemodialysis and peritoneal dialysis, which one is best for me?

To learn about these two options for patients with Chronic Kidney Disease (CKD), we spoke with Mauricio Sanabria, nephrologist at Baxter



What is it?

This is a therapy to replace kidney function. The hemodialysis procedure involves accessing the patient's circulation through a vein or an arterio-venous fistula (which is the junction of an artery-to-vein). so that the blood is driven toward the dialysis filter where the process of eliminating
products of the patient's metabolism that cannot be eliminated by the kidneys due to chronic kidney disease is performed.

Where is it done?
Typically performed in dialysis units or centers; the hemodialysis session usually lasts 4 hours and is often three times a week.

What is peritoneal dialysis?
It is a therapy in which the peritoneal membrane is used, which is the membrane that covers all the organs of the abdominal cavity. A catheter is placed in that space and through its peritoneal dialysis fluids are infused using the membrane to extract substances from the patient's blood into that cavity. A drain is then done to a pouch connected to a pouch that connects to the peritoneal dialysis catheter. This procedure removes toxic substances from the body, where these toxic substances are released that the kidney cannot eliminate.

Where is the peritoneal dialysis procedure performed and how long does it last?
It can be done at home.

How long does it last?
This type of dialysis is performed at the patient's home; the full cycle of
dialysis fluid infusion, permanence in the peritoneal cavity and drainage lasts about 4 hours, although it can last up to six hours. In manual peritoneal dialysis, it is usual for 4 replacements of this type to be performed during the 24 hours. There is a second option that is Automated Peritoneal Dialysis, where the patient is connected to a machine (while at home) and it performs the Peritoneal Dialysis procedures, usually during the night this technology makes between 3 and 5 refills. One modality of automated peritoneal dialysis is
to add remote monitoring, where the machine transmits information to a platform in the renal clinic where nurses and doctors can monitor important aspects of the way therapy is being conducted.


Which type of dialysis is best for me?
To choose a type of dialysis, it is worth asking each patient what conditions are most functional for them. As Dr. Sanabria comments, "very young patients, working or academically active patients, or patients of advanced ages, who due to their conditions prefer not to attend the renal clinic frequently or do not have someone to take them, it may be more convenient for them peritoneal dialysis". However, there are also patients who feel more comfortable and confident attending the renal unit. “There are patients who say, ‘Look, I don’t really feel good doing the procedure at home, I prefer to have it done in the renal unit’; these patients could do better with hemodialysis.

Now, there are some conditions that make it indicated
to perform a therapy. For example, patients who have abdominal pathology, some previous surgery, very marked obesity, abdominal wall problems, large hernias, etc. Such patients would be contraindicated for peritoneal dialysis, due to difficulties that exist within the peritoneal cavity or in the peritoneal wall, in the muscular part of the abdomen, for example
patients with intra-abdominal pathologies, previous large abdominal surgeries hernias or abdominal wall pathologies. they would be contraindicated for peritoneal dialysis.”

Dialysis and quality of life.

 Although these procedures may seem somewhat complicated in principle, the fact is that the vast majority of patients are very well on their dialytic therapy, with a near normal life, and with a very acceptable quality of life. Many patients are also elderly, so they have age-specific limitations. In general, the prognosis of patients on chronic dialysis has been improving substantially and allows them to reintegrate into their family, social and cultural environment to continue with their life projects.