Choosing Between Haemodialysis, Peritoneal Dialysis & Home Options

1. What is dialysis, and will it cure chronic kidney failure?

Dialysis is a treatment that replaces some of the functions of the kidneys when they can no longer work properly. It removes waste products, excess fluid, and helps maintain the body’s chemical balance.

To begin dialysis, a patient usually requires either:

A vascular access for haemodialysis, such as an arteriovenous fistula (AV fistula) or graft, or
A peritoneal dialysis catheter inserted into the abdomen.

Dialysis does not cure kidney failure. It is a long-term treatment that supports patients with ESRF while they await a transplant or when transplantation is not possible.

Although dialysis can significantly improve survival and quality of life, patients require ongoing medical monitoring and medications. Dialysis access sites can also develop complications over time, including infection or blockage.

Studies comparing outcomes in haemodialysis and peritoneal dialysis patients are discussed by Vonesh et al. (2006) – Kidney International.

2. What are the main types of dialysis available?

Haemodialysis (HD)

Haemodialysis uses a machine and an artificial filter (dialyser) to clean the blood. Blood is removed from the body through ‘dialysis access’ – a arteriovenous fistula (AVF), graft (AVG) or line (catheter) – filtered, and then returned to the patient.

Peritoneal Dialysis (PD)

Peritoneal dialysis is usually performed at home. A sterile dialysis fluid is introduced into the abdomen through a permanent catheter. The lining of the abdomen (peritoneum) acts as a natural filter.

Home Haemodialysis (Home HD)

Home haemodialysis allows selected patients to perform treatment independently after specialist training.

3. How do I choose between haemodialysis and peritoneal dialysis?

The choice depends on several factors, including:

Overall health
Lifestyle preferences
Home environment
Ability to manage treatment independently
Medical suitability

Some patients prefer the flexibility of home therapies, while others feel more comfortable receiving treatment in a hospital or dialysis unit.

Not everyone is suitable for home dialysis. Patients are assessed for physical ability, understanding of treatment, and support available at home.

4. Where is the vascular ‘access’ site for haemodialysis located?

The most common long-term access for haemodialysis is an arteriovenous fistula (AV fistula), usually created in the lower forearm or upper arm.

A surgeon connects an artery to a vein beneath the skin, allowing the vein to become larger and stronger for repeated needle insertion during dialysis.

Temporary dialysis lines may also be placed in larger veins in the neck or chest when urgent dialysis is required.

More information about vascular access can be found from the National Kidney Foundation – Vascular Access.

5. How long is the wait to start haemodialysis?

The timing depends on kidney function and overall medical condition.

Some patients begin dialysis in a planned manner after months of preparation, while others may require urgent dialysis if kidney failure progresses rapidly.

Creating and maturing an arteriovenous fistula usually takes 6-8 weeks.

Information about UK dialysis outcomes and planning is discussed in the UK Renal Registry Annual Report – MacPhee et al. (2015).

6. How long does a standard haemodialysis session take?

A standard haemodialysis session usually lasts around 4 hours, commonly performed three times per week.

Including travel, preparation, and recovery time, patients may spend 6-8 hours away from home on treatment days.

Patients are usually assigned regular morning, afternoon, or evening treatment sessions.

Haemodialysis guidance is available from NHS – Haemodialysis.

7. Is haemodialysis always delivered in hospital?

While historically tied to a hospital-based renal unit, haemodialysis in the UK is increasingly delivered outside of the traditional hospital setting.

Many patients now receive their maintenance treatment in community-based satellite dialysis units, which are managed by NHS trusts or independent providers closer to patients’ homes.

The NHS actively encourages home haemodialysis for suitable candidates, providing specialized training and installing dedicated equipment directly into the patient’s residence.

Choosing home-based therapy under the care of a local renal team allows for more frequent or nocturnal sessions, significantly improving clinical outcomes and patient flexibility.

Ultimately, whether a patient receives dialysis in an acute hospital, a satellite unit, or at home depends on their medical stability, independence, and a shared decision-making with their multi-disciplinary team.

8. Can everyone choose peritoneal dialysis?

No. Some patients are not medically suitable for peritoneal dialysis.

Reasons may include:

Extensive abdominal scarring or adhesions
Certain bowel conditions
Recurrent abdominal infections
Inability to safely manage treatment at home

Older age alone does not automatically prevent someone from having peritoneal dialysis, but overall health and physical ability are important considerations.

Clinical comparisons between dialysis methods are reviewed by Vonesh et al. (2006).

9. How does peritoneal dialysis clear waste products?

In peritoneal dialysis (PD), dialysis fluid is placed into the abdomen through a catheter.

The peritoneal membrane acts as a filter, allowing waste products and excess fluid to move from blood vessels into the dialysis fluid. The used fluid is later drained and replaced with fresh fluid.

There are two main types of PD: CAPD and APD (see below).

Further patient guidance is available from NHS – Peritoneal Dialysis.

10. Differences Between CAPD and APD

There are two main types of Peritoneal Dialysis (PD):

Continuous Ambulatory Peritoneal Dialysis (CAPD)

CAPD is performed manually during the day without a machine.

Patients usually perform 3 to 5 fluid exchanges per day
Each exchange typically takes around 30 to 40 minutes
Dialysis fluid remains inside the abdomen between exchanges for several hours (known as the dwell time)
Exchanges are usually carried out at regular intervals throughout the day

CAPD offers flexibility and does not require overnight machinery, but patients must perform exchanges consistently every day.

Automated Peritoneal Dialysis (APD)

APD uses an automated machine called a cycler to perform dialysis exchanges overnight while the patient sleeps.

Patients are usually connected to the machine for around 8 to 10 hours overnight
The cycler automatically fills and drains dialysis fluid several times during the night
Most patients disconnect from the machine in the morning and continue normal daytime activities

APD is often preferred by people who work, study, or want fewer daytime interruptions.

11. Can dialysis be performed entirely at home?

Yes. Both peritoneal dialysis and home haemodialysis can be performed at home in suitable patients.

Home dialysis offers greater independence and flexibility, but patients must complete training and demonstrate that they can manage treatment safely.

Guidance on preparing patients for home haemodialysis is discussed in Harwood et al. (2005).

12. In terms of home dialysis training, how long will I be in hospital for?

Many patients do not require a long hospital stay for planned dialysis access procedures.

For home dialysis training:

Peritoneal dialysis training often takes about a week
Home haemodialysis training may take 4 weeks or more.

Emergency dialysis starts may require a longer admission depending on the patient’s condition.

13. Is adjusting to life on dialysis psychologically stressful?

Yes. Starting dialysis can be emotionally and physically challenging.

Common experiences include:

Anxiety
Fatigue
Uncertainty
Lifestyle disruption

Frequent clinic visits and treatment schedules may initially feel overwhelming. However, many patients gradually regain confidence and independence over time.

Psychological adjustment to chronic kidney disease and dialysis is discussed by Kidney Care UK.

14. What are the complications of chronic dialysis?

Possible complications include:

Infection
Blood clots
Low blood pressure
Muscle cramps
Fluid imbalance
Cardiovascular disease

Peritoneal dialysis may also cause peritonitis or catheter problems.

Comparative risk factors and mortality outcomes are analysed by Vonesh et al. (2006).

15. What is ‘dialysis access’ infection?

A dialysis access infection occurs when bacteria enter the access site, such as:

A haemodialysis catheter
An AV fistula needle site
A peritoneal dialysis catheter exit site

Symptoms may include:

Redness
Pain
Swelling
Fever
Drainage from the site

Most infections can be treated successfully if identified early.

Additional information is available from National Kidney Foundation – Dialysis Access Complications.

16. What drugs are needed alongside dialysis?

Many dialysis patients require medications such as:

Phosphate binders
Blood pressure medications
Iron supplements
Erythropoietin (EPO) injections
Vitamin D supplements
Medications to control potassium levels

Treatment plans vary between individuals depending on their medical needs.

17. How common is diabetes among dialysis patients?

Diabetes is one of the leading causes of kidney failure worldwide and is present in over 30% of dialysis patients.

Blood sugar control can become more difficult during dialysis treatment, particularly during peritoneal dialysis because dialysis fluids contain glucose.

More information is available from Diabetes UK – Kidney Disease and Diabetes.

18. Are there sexual problems on dialysis, and is it possible to have children?

Kidney failure and dialysis can affect:

Sexual health
Hormone levels
Fertility

Pregnancy is possible during dialysis but is considered high risk and requires specialist medical care.

Patients considering pregnancy should discuss this with their renal team.

Fertility and dialysis outcomes are discussed in Vonesh et al. (2006).

19. Are work and a normal life possible while on dialysis?

Yes. Many people continue to:

Work
Travel
Exercise
Maintain active social lives

Treatment schedules may require adjustments, especially in the early stages, but many patients establish stable routines over time.

Advice on living with dialysis is available from Kidney Care UK – Living on Dialysis.

20. Is it possible to switch dialysis methods if one fails? And what is survival like on dialysis?

Yes. Patients can often switch between haemodialysis and peritoneal dialysis if medically appropriate.

Reasons for changing treatment may include:

Access failure
Infection
Lifestyle changes
Inadequate dialysis clearance
Medical complications

A full medical assessment is usually required before changing treatment method.

The average survival for someone from the start of dialysis is approximately 5 years. But it very variable, being affected by age, medical conditions (especially diabetes and heart disease) and underlying cause of ESRF.

Long-term dialysis survival data are discussed in the UK Renal Registry Annual Report – MacPhee et al. (2015).

Choosing Between Haemodialysis, Peritoneal Dialysis & Home Options