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Medical Author:

Pranay Kathuria, MD, FACP, FASN, FNKF

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Hemodialysis

Hemodialysis involves circulation of blood through a filter or dialyzer on a dialysis machine.

• The dialyzer has two fluid compartments and is configured with bundles of hollow fiber capillary tubes.
• Blood in the first compartment is pumped along one side of a semipermeable membrane, while dialysate (the fluid that is used to cleanse the blood) is pumped along the other side, in a separate compartment, in the opposite direction.
• Concentration gradients of substances between blood and dialysate lead to desired changes in the blood composition, such as a reduction in waste products (urea nitrogen and creatinine); a correction of acid levels; and equilibration of various mineral levels.
• Excess water is also removed.
• The blood is then returned to the body.

Hemodialysis may be done in a dialysis center or at home. In-center hemodialysis typically takes 3 to 5 hours and is performed three times a week. The patient will need to travel to a dialysis center for in-center hemodialysis.

Some centers may offer the option of nocturnal (night-time) hemodialysis wherein the therapy is delivered while the patient sleeps. Long nocturnal dialysis offers patients a better survival and an improvement in their quality of life.

Home hemodialysis is possible in some situations. A care partner is needed to assist the patient with the dialysis treatments. A family member or close friends are the usual options, though occasionally people may hire a professional to assist with dialysis. Home hemodialysis may be performed as traditional three times a week treatments, long nocturnal (overnight) hemodialysis, or short daily hemodialysis. Daily hemodialysis and long nocturnal hemodialysis offer advantages in quality of life and better control of high blood pressure, anemia, and bone disease.

Peritoneal dialysis

Peritoneal dialysis utilizes the lining membrane (peritoneum) of the abdomen as a filter to clean blood and remove excess fluid. Peritoneal dialysis may be performed manually (continuous ambulatory peritoneal dialysis) or by using a machine to perform the dialysis at night (automated peritoneal dialysis).

• About 2 to 3 liters of dialysis fluid are infused into the abdominal cavity through the access catheter. This fluid contains substances that pull wastes and excess water out of neighboring tissues.
• The fluid is allowed to dwell for 2 to several hours before being drained, taking the unwanted wastes and water with it.
• The fluid typically needs to be exchanged four to five times a day.
• Peritoneal dialysis offers much more freedom compared to hemodialysis since patients do not need to come to a dialysis center for their treatment. The patient can carry out many of their usual activities while undergoing this treatment. This may be the preferable therapy for children.

Most patients are candidates for both hemodialysis and peritoneal dialysis. There are little differences in outcomes between the two procedures. The physician may recommend one kind of dialysis over the other based on the patient's medical and surgical history. It is best to choose one's modality of dialysis after understanding both procedures and matching them to one's lifestyle, daily activities, schedule, distance from the dialysis unit, support system, and personal preference.

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