What is dialysis?
Dialysis is one of the treatments that are available when kidneys have almost stopped working. Other options include kidney transplant and conservative management. Dialysis does not do everything that healthy kidneys normally do, but it cleans the blood and filters out harmful wastes and excess fluids. Most people who start dialysis remain on dialysis for the rest of their lives, or until they receive a kidney transplant.
What are the most common types of dialysis?
This website focuses on the two types of dialysis that are used by the majority of patients with kidney failure: in-center HD and PD. Since these treatments are very different, we want to help you understand how each might fit your preferences and lifestyle.
What is in-center hemodialysis (HD)?
Where is it done?
We focus on in-center HD that is done in a specialized clinic, called a dialysis center. In some cases, when a person is very ill, HD is done at the hospital. HD can also be done at home. For more information on home hemodialysis, see Home Hemodialysis.
Who is involved?
Dialysis nurses and patient care technicians (PCT) are responsible for performing dialysis treatment, following a doctor's prescription.
Suppose something goes wrong, or I don't do anything. I'm not an expert at doing dialysis. I get it at the center, where I know I'll get professional treatment. If anything goes wrong, they're there.
How is it done?
To take blood out of the body and put it back in, an access site to the blood stream is needed. There are two types of accesses:
HD treatment
Here is what you can expect from the in-center HD session:
What is peritoneal dialysis (PD)?
PD is usually done at home, but it can also be performed in other places (e.g. your workplace, in a hotel room).
I wanted to maintain my lifestyle as much as possible, and being on PD doesn't disrupt that too much. I know that I have to cycle for 10 hours at night, but then I can get up and go to work, and go about my normal routine.
If you choose PD, you will be responsible for performing your own treatment every day. Before starting PD you will receive extensive training until you are proficient with the entire treatment process. A member of your health care team will always be available by phone, and you will go to the clinic for appointments, usually once or twice a month.
How is PD done?
For the dialysate fluid to go in and out of the belly, a plastic tube ("PD catheter") is placed through surgery. One end of the catheter is inserted under the skin into the peritoneum, while the other end sticks out from the skin, usually below the belly button. Since the catheter is directly connected to the belly, there is a risk of getting very serious infections if the catheter is not properly cared for.
There are two types of PD: continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In CAPD, the catheter is connected to a bag of dialysate and a bag for drainage. In APD, a machine (called a cycler) is connected to the bags, fills the belly with dialysate, and then drains it out.
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Automated Peritoneal Dialysis (APD)
CAPD or APD may be better for a specific person, depending on physical condition and personal characteristics. If you choose PD, your doctor will indicate what modality is best for you.
PD treatment
Here is what you can expect from the PD treatment:
As with hemodialysis (HD), there isn't an exact timeline. Events may take place at different times for each person.
Here is a comparison of HD and PD:
In-center Hemodialysis (HD)
Peritoneal Dialysis (PD)
What is it?
Uses a machine to clean the blood
Uses the peritoneum to clean the blood
In a specialized dialysis center
At home or wherever the patient is (example: workplace, vacation)
Health care team does the treatment
Patient does the treatment
With a machine that pumps blood in and out of the body through an access site
With dialysate fluid that is put into and out of the belly through a tube
This website was developed by patients, family members, and professionals who are committed to empowering people just like you facing the decision of what type of dialysis to start. We are a group of people with a wide range of backgrounds. Some of us are patients, just like you, and some of us are social workers, researchers, and doctors representing Arbor Research Collaborative for Health; the University of Michigan; and Greenfield Health Systems, a division of the Henry Ford Health System.
As a team, we have gathered information from over 180 people who are currently living with chronic kidney disease (CKD) or who are on hemodialysis (HD) or peritoneal dialysis (PD). The people who took part in our research provided helpful information, like what it feels like to be on dialysis on a daily basis, concerns of being on dialysis, quality of life on dialysis, and things they wish they would have known before starting dialysis.
It is our goal to give you the information you need to make a decision, as well as to share other patients’ experiences, to help you make the choice that’s best for you. Your role in this decision is very important, and we want you to feel comfortable being involved in the decision as much as you want.
Advanced Kidney Disease: A term sometimes used to describe kidney failure.
Automated Peritoneal Dialysis (APD): Peritoneal dialysis that uses a machine, called a cycler, to fill the belly with dialysate, and then drains dialysate and wastes out of the belly. Catheter (Hemodialysis): A plastic tube that is placed in the neck and is inserted into a large vein to take blood in and out of the body.
Catheter (Hemodialysis): A plastic tube that is placed in the neck and is inserted into a large vein to take blood in and out of the body.
Catheter (Peritoneal Dialysis): A plastic tube that is used to put dialysate fluid into the belly and to take the fluid, along with wastes, out of the body. One end is inserted under the skin into the belly (peritoneum), while the other end sticks out from the skin, usually below the belly button.
Chronic Kidney Disease (CKD): A long-term condition when the kidneys do not work properly.
Conservative Management: Supportive care for advanced chronic kidney disease that includes medications and diet restrictions without dialysis.
Continuous Ambulatory Peritoneal Dialysis (CAPD): Peritoneal dialysis in which the patient connects to bags of dialysate fluid and uses only gravity, not a machine, to fill the belly (peritoneum) with dialysate fluid, and drain the fluid along with wastes.
Creatinine: A product of muscle metabolism that is normally eliminated by the kidneys. Creatinine levels in the blood are used to estimate kidney function.
Cycler: A machine used during Automated Peritoneal Dialysis (APD) to put dialysate into the belly and drain the fluid, along with wastes, out of the belly.
Dialysate: A fluid used in dialysis to draw fluids and toxins out of the bloodstream and supply electrolytes and other chemicals.
Dialysis: A treatment that can remove waste and excess fluid from the body.
Dialysis Nurse: A trained medical professional who will assist in your care and dialysis treatment.
End-stage renal disease (ESRD): A condition in which the kidneys have stopped working. Also called kidney failure.
Fistula: An access site to the bloodstream used in hemodialysis to take blood out and put it back into the body; usually placed in the arm.
Glomerular Filtration Rate: A test that measures the function of kidneys. This is based on creatinine levels, age, weight, and sex.
Graft: An access site to the bloodstream used in hemodialysis to take blood out and put it back into the body; usually placed in the arm.
Hemodialysis: A type of dialysis that uses a machine to take blood out of the body, filter it, and put it back in; it is usually done at a specialized center.
Home Hemodialysis: Hemodialysis that is done at home, in which the patient provides his/her own treatment.
In-Center HD: Hemodialysis that is done in a specialized clinic, called a dialysis center.
Kidneys: Internal organs that clean the blood and produce urine.
Kidney Disease: A condition when the kidneys do not work properly.
Kidney Failure: A condition in which the kidneys have stopped working. Also called renal failure.
Kidney Transplant: A surgical operation in which a healthy kidney donated by another person is placed into the body of person with kidney failure.
Nephrologist: A doctor who works with people with kidney problems
Patient Care Technician (PCT): A health care worker trained to give care during hemodialysis treatments.
PD Exchange: The process in which sterile fluid called dialysate is put into and removed from the belly.
Peer Mentor: A kidney patient who has been trained to support other patients.
Peritoneal Dialysis (PD): A type of dialysis that uses the membrane that lines the inside of the belly (peritoneum) to purify the blood from wastes; it is usually done at home. There are two types of PD: Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis (see definitions).
Peritoneum: Membrane that lines the inside of the belly.
Renal Failure: A condition in which the kidneys have stopped working. Also called kidney failure.
Social Worker: A trained professional who gives all levels of support, including educational and emotional, to patients before and after beginning dialysis.
Waste Products: Products of metabolism (urea, creatinine, uric acid), that are removed from the body by healthy kidneys.
Are you looking for more information about dialysis? You may want to visit these websites: