Understanding Kidney Dialysis: A Look at Its Function
When the kidneys fail to maintain the body's balance of fluids, electrolytes, and waste products, dialysis becomes necessary. This article will help you understand the key factors to consider when choosing between two main types of dialysis: hemodialysis (HD) and peritoneal dialysis (PD).
Patient's Clinical Condition and Hemodynamic Stability
HD is preferred for rapid fluid removal, especially in acute volume overload settings. However, it can cause blood pressure fluctuations and intradialytic hypotension, which may be risky for patients with heart disease or vascular instability. PD offers continuous and gradual fluid removal, better preserving hemodynamic stability, making it potentially advantageous for patients prone to cardiovascular instability.
Availability and Vascular Access Considerations
HD requires reliable vascular access for blood filtration outside the body, while PD uses the peritoneal cavity inside the abdomen and does not require vascular access. For acute kidney injury (AKI) in adults, PD is generally not recommended when vascular access for HD is available, due to lower clearance efficiency. PD is considered mainly when vascular access is not possible, especially in resource-limited settings.
Patient Lifestyle and Treatment Setting
HD is traditionally conducted in a dialysis center multiple times weekly, requiring travel and time commitments. PD can often be performed at home, offering greater flexibility and independence, which can improve quality of life for some patients.
Risk of Complications
HD may lead to complications such as hypotension, arrhythmias, or vascular access issues, but generally facilitates more rapid waste removal. PD carries risks of peritonitis (infection of the abdominal lining) and issues with dialysate flow, requiring patient education and monitoring.
Healthcare Resource Availability
In resource-constrained areas or during healthcare crises, PD may be favored due to simpler requirements and avoidance of vascular access complications. In well-resourced settings, HD remains the dominant modality for acute management due to faster clearance and more intensive fluid management options.
Specific Patient Factors
Pediatric patients may be more suitable for PD in certain situations unless life-threatening electrolyte imbalances or digestive lesions are present. Patients with acute coronary syndromes complicated by fluid overload may benefit from PD to reduce sudden blood pressure changes.
Navigating the Dialysis Journey
Joining a support group, utilizing educational resources, and maintaining open communication with healthcare providers can help patients navigate the dialysis journey more effectively. Understanding the side effects of dialysis, such as fatigue, muscle cramps, and low blood pressure, can help in managing them effectively.
In summary, the choice between HD and PD depends on the patient's medical status, vascular access availability, lifestyle preferences, risk profile, and healthcare context, balancing HD's rapid clearance and PD's hemodynamic stability and flexibility. Whether you choose HD or PD, remember that dialysis plays a crucial role in maintaining electrolyte balance in the body, preventing dangerous imbalances that can lead to complications.
[1] Foley RN, Ikizler TA. Hemodialysis and peritoneal dialysis. In: UpToDate. 2021. [Accessed 2022 Feb 21]. [2] Nissenson AR. Peritoneal dialysis in acute kidney injury. In: UpToDate. 2021. [Accessed 2022 Feb 21]. [3] Mehrotra A, Nissenson AR. Peritoneal dialysis in chronic kidney disease. In: UpToDate. 2021. [Accessed 2022 Feb 21]. [4] Nissenson AR. Home peritoneal dialysis. In: UpToDate. 2021. [Accessed 2022 Feb 21]. [5] Mehrotra A, Nissenson AR. Complications of peritoneal dialysis. In: UpToDate. 2021. [Accessed 2022 Feb 21].
- For patients with heart disease or vascular instability, medical-conditions that may exacerbate intradialytic hypotension, choosing peritoneal dialysis (PD) over hemodialysis (HD) could be advantageous due to its gradual fluid removal, which better maintains hemodynamic stability.
- When considering the health-and-wellness aspects for individuals undergoing dialysis, taking into account the side effects such as fatigue, muscle cramps, and low blood pressure, and engaging with support groups, educational resources, and healthcare providers can help improve the quality of life and effectively navigate the dialysis journey.
