What to expect for each kind of dialysis

The information on this page is intended to help you better understand what to expect for each type of dialysis. It reviews the benefits and the points to consider for each option.

PD

PD is a treatment that you can do at home. Doing your own treatment allows you some control over your kidney disease.
PD can be done in two ways: Continuous Ambulatory Peritoneal Dialysis (CAPD) or Automated Peritoneal Dialysis (APD).

CAPD means that you “exchange” old solution for new solution about four times every day, about 30 minutes each time. Dialysis is happening continuously. CAPD is done by gravity. There are three steps to do an exchange:

  • Drain:
    Connected to the PD catheter, the used and old dialysis solution inside the abdomen is drained. This dialysis solution contains waste and excess fluid.
  • Fill:
    After the abdomen is completely drained of the old solution, new dialysis solution is placed into the abdomen.
  • Dwell:
    When the new solution has been placed, the tubing and bags are removed. You wear only a short tubing set covered with a sterile cap.
    During the dwell is when the dialysis occurs in the forms of osmosis and diffusion. During this time, the dialysis solution collects waste and excess fluid from your body while you are disconnected from the dialysis supplies and doing your daily activities.

Dialysis

APD is an automated form of PD. APD completes PD exchanges (drain, fill, dwell) with a machine while you sleep at night. During the day, you are free to go anywhere and be involved in your normal activities. If you require an additional exchange during the day, your nurse will advise you.

PD is easy to learn. You do not need to insert needles for the delivery of peritoneal dialysis.

In most cases, you can learn it in a week or two. Your healthcare team will schedule training for you and it includes:

  • Setting up an exchange room
  • Hand washing
  • Catheter and exit site care
  • Doing an exchange
  • Choosing which solution to use
  • Storing and ordering supplies
  • Keeping treatment logs
  • Taking your blood pressure, pulse, temperature and weight
  • Diet and fluid limits
  • Recognizing and reporting problems

Osmosis and diffusion in PD treatment happens continuously. PD solution dwells in your abdomen, continuously collecting waste from your body, while you continue your daily activities. When starting treatment, you may feel full or stretched when you put fluid in. Your body will get used to this over the first few weeks. You may show a slightly larger waistline due to carrying fluids.

PD may help you keep your remaining kidney function longer than in-centre hemodialysis.7 Recent studies have also suggested that PD can offer improved early survival (within the first two years) compared to hemodialysis.8 However, it is important to do PD as you are taught to avoid infections. Since PD is done at home, it allows you to schedule treatment around your lifestyle and have more flexibility for your daily activities. PD is portable, so you can still travel and perform your treatment elsewhere. Talk to the manufacturer of your PD products for travel arrangement.

PD is performed daily by yourself at home or with the help of your family member. A PD nurse is on-call 24 hours a day if you need any help. You will not do exchanges alone until both you and your nurse are confident in your training that you can do all the steps safely. You will still have appointments with your nephrologist. And if you have questions, or need help with your equipment and supplies, your social worker, nurse, dietitian and technical support will always be just a phone call away.

For CAPD, you do not need a dialysis machine and only require storage space at home for solution and ancillaries supplies. The manufacturer of PD supplies will deliver boxes of dialysis solutions to your home every month. The number of boxes could be about 30 boxes per month. If you are on APD (performing PD overnight), you will also need a space to keep and set up your dialysis equipment for daily treatment.

REFERENCES:

  1. Yeates, K et al. Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada. Nephrol Dial Transplant. 2012 Sep;27(9):3568–3575.
  2. Adapted from Schatell, Dori MS, and Agar, John MD. Help, I Need Dialysis! How to have a good future with kidney disease. Madison, WI: Medical Education Institute, Inc.; 2012. P. 64.

ICHD

In-centre hemodialysis (ICHD): Conventional ICHD is always an option and is a backup for other types of treatment. You have to go to your clinic at a scheduled time for ICHD treatment.

If you are on ICHD, arrive early for your treatment time, wear comfortable clothes and bring something to pass the time. A physical assessment is performed and your weight is measured before the treatment to assess how much water to remove during the HD treatment. Connecting to the dialysis machine requires your access site to be cleaned, needles inserted and/or tubing connected. After your prescribed treatment, you are disconnected from the machine and, once your blood pressure meets clinic standards, you can go.

You do not need to be trained for ICHD as medical staff are present and will connect you to the machine. In some clinics, you may be able to do some of the tasks yourself. You also do not need to store any treatment supplies at home as dialysis is done in the hospital. However, ICHD requires a large time commitment. Treatment happens 3 times a week and 3–5 hours are needed for each treatment. With travel time and preparation, this may take much longer. Feeling in control of your treatment can be difficult with ICHD when you are dependent on others or if life changes limit your choices.

You may feel tired or experience discomfort such as nausea, leg cramps, etc. during or after the treatment. Be sure to talk to your medical staff about these symptoms.


HHD

HHD is completed the same way as in-centre HD, only you do it yourself, at home. You will be trained to set up your dialysis machine and equipment, insert needles and complete your dialysis treatment.

Because HHD is done at home, you can adjust your treatment schedules with short daily or nocturnal HD (overnight HD). Short, daily HD can be done 5–6 times a week over a shorter time period (2.5–4 hours) letting you fit treatment around your schedule. Nocturnal HD (overnight HD) completes treatment while you sleep over 8 hours. Monthly visits to a clinic are required.

It has been shown that the clinical benefits increase the more dialysis is done.9 Symptoms after HHD are less severe than in-centre HD due to less fluid being removed with each treatment.

Completing treatment at home gives you more time to carry on with your life. You may be able to travel for a longer duration, but it depends on the availability of a dialysis centre close to your destination. You would need to book appointment at the dialysis unit/clinic.

Home hemodialysis does, however, require space for hemo and water reverse osmosis machines, as well as your dialysis supplies. Plumbing and electrical adjustment may be required. In addition, you need to insert needles by yourself or with the support of your family member to deliver dialysis. The training time for home hemodialysis is longer; it usually requires a minimum of 4–6 weeks.

REFERENCES:

  1. Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs. conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA. 2007;298:1291–1299.