Dialysis is a critical, life-saving treatment for people with severe kidney failure, especially for those with stage 5 chronic kidney disease (CKD). No single type of dialysis is best for everyone, however, and the choice between different options depends on individual medical conditions, lifestyle, and personal preferences. Here, Brigitte Chiomba, Director of Dialysis Services at Trilogy Health Services in Indiana, explains the pros and cons of different dialysis methods, and shares strategies for optimizing your dialysis experience.* 

Dialysis Basics

Dialysis is a repeated procedure for people whose kidneys can no longer filter toxins, wastes, and excess fluids from the bloodstream. It replaces the lost kidney function and is necessary when patients reach stage 5 CKD. 

There are two primary types of dialysis: 

• Hemodialysis (HD) typically takes place in a clinic, where blood is filtered through an artificial kidney and returned to your body. 
• Peritoneal dialysis (PD) is generally performed at home, and involves filtering wastes inside the body by introducing a special cleansing fluid into your abdomen.  

Each method carries pros and cons, and it’s essential for you and your doctor to thoroughly explore each option and choose the right fit for you, Chiomba says. “Everybody’s care is personalized.” 

Pros and Cons of Dialysis Types

Clinic-Based HD

Clinic-based hemodialysis has been the most common choice for people in end-stage renal disease with kidney failure. Benefits of clinic-based HD include:

• Professional staff to monitor treatments, 
• No need for home equipment, and 
• Full care team support (dieticians, social workers, nephrologists).

Essentially, Chiomba says, “You walk in, sit down, and everything is done for you.” 

Potential drawbacks, however, include:

• Having to travel to the dialysis center 
• Infection risk, 
• Needle insertion, which can make some people uneasy, and 
• Occasional blood loss. 

Scheduling constraints and fatigue after sessions are common.

Home-Based HD and PD

While clinic-based HD is still the most common choice in the U.S., home-based dialysis of both types has been growing in popularity, and it comes with its own benefits, such as:

• Greater flexibility and privacy, 
• No travel requirement, and 
• More frequent sessions, mimicking natural kidney function.

With home-based dialysis, Chiomba explains, “You can revolve your treatments around your daily activities.”

Potential drawbacks of home-based dialysis can include: 

• Space and storage needed for equipment and supplies, 
• Required training and the absence of a professional team during sessions, and
• The need for a care partner. 

Infection risks, along with the stress of self-management, can be challenging. 

Optimizing Your Dialysis Experience

To improve the dialysis experience, Chiomba advises following key guidelines. First, she says, it’s essential to “commit to a full dialysis session each time” to avoid leaving behind toxins that could accumulate and worsen the illness. 

She also emphasizes the importance of taking your medications as directed and following the food recommendations of your renal dietitian. Many people with advanced CKD need to adjust their fluid and protein intake, and reduce foods high in potassium, phosphorus, and sodium, to avoid complications. 

“Dialysis is a lifestyle change,” Chiomba says. In addition to sticking to your session, medication, and diet regimens, she encourages people on dialysis to:

• Keep their access site well-maintained and clean to prevent infections, and 
• Stay informed about their lab results and treatment numbers. 

Knowing your own numbers, Chiomba adds, empowers you to better manage your care.

Coping with Dialysis

It’s important to remember that dialysis is not solely a physical event. Your mental and emotional health also need to be addressed, Chiomba says, and sharing your feelings and concerns with family, friends, and care team is essential for your well-being. Social workers, key members of the dialysis team, are trained to provide emotional support and identify resources, from counseling to financial assistance.

Exercise can also play a vital role in coping with the demands of dialysis. Chiomba suggests engaging in regular exercise, “even if it’s just chair exercises or yoga,” to improve circulation and maintain strength. It can also help boost your mood.

Lastly, she encourages a proactive approach to educating yourself and working closely with your care team. Understanding your condition, options, and treatment empowers you to navigate the process more effectively and confidently.

“You,” Chiomba insists, “are in control of your dialysis.”

*Chiomba, B. (2024, October 16). Dialysis Demystified: Take Control of Your Treatment [Video file]. Retrieved from https://www.youtube.com/watch?v=SoX_wRi4tpE