Is Peritoneal Dialysis Superior to Traditional Hemodialysis for People with Chronic Kidney Disease?

Kidney diseases because of several causes such as age, family history, diabetes, high blood pressure levels, and more, have been increasingly becoming common. The treatment options vary for every patient depending on the stage of their disease, the condition, lifestyle, age, and more.

Patients who suffer from kidney failure could be prescribed to undergo dialysis or a transplant. Dialysis is a procedure that is used in order to filter out harmful substances, waste products, and excess fluids from the patient’s bloodstream.

As per the experts, there are three kinds of dialysis, two of the most common ones being: Hemodialysis and Peritoneal dialysis.

Before understanding which dialysis is the best option for your treatment, it is imperative that you understand what they are and how they differ from each other.

Peritoneal Dialysis

This is a kind of dialysis that works towards the removal of waste products and excessive fluids from your bloodstream when your kidneys fail to function properly. During this dialysis, the dialysate goes through the catheter into a portion of the abdomen. The inner lining of your abdomen, the peritoneum, acts as a filter that naturally removes the excess fluid and waste products from your bloodstream.

The fluid which contains the filtered wastes flows through the catheter in order to get discarded safely after some dwell time. There are two kinds of peritoneal dialysis, namely, automated peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). This dialysis type is good for patients who meet a few health-related requirements and desire a lesser number of restrictions than they would have in case they opt for hemodialysis.

What is Hemodialysis

This is a type of dialysis in which a machine, also known as an artificial dialyzer or kidney, which has a special filter cleanses the bloodstream. During this dialysis, the blood of the patient flows from the access point of the dialysis (generally in the arm) into the artificial kidney or dialyzer which filters out the blood through a membrane. The excessive waste products present in the bloodstream are passed through the membrane. After this, they have washed away by using dialysate which is a fluid. The wastes are discarded and the cleaned blood is then brought back to the body.

Patients who are getting hemodialysis done generally require the treatments at least three times per week and every treatment takes about four hours. This could get inconvenient for certain patients, especially for those who have to commit to long-term hemodialysis. Hence, they are provided with an alternative to home hemodialysis as prescribed by their respective doctor.

Opting for either hemodialysis or peritoneal dialysis can be financially draining. Hence, it is advisable to get comprehensive health insurance from an insurance provider with an average incurred claim ratio ranging between 50% to 100%. A comprehensive health insurance policy will provide you with financial coverage against the above-mentioned treatment expenses.

Hemodialysis Vs Peritoneal Dialysis

The major difference between peritoneal dialysis and hemodialysis is that the latter requires a kidney machine which is artificial in order to filter out the blood whereas the former does not. Instead, the former utilizes the lining on the belly’s internal part as a natural filter for the blood.

Here’s the detailed difference between peritoneal dialysis and hemodialysis:

Category

• Hemodialysis
• Peritoneal Dialysis

Where is it done

• At a hospital or at home
• At home

Frequency of the treatment

• Three to five times every week
• Four to six times a day, or at night

Complexity

The dialyzer needs vascular access through which the blood is pulled out of the body into the machine and filtered and then cycled back to the bloodstream through special filters. The access is gained by the placement of a temporary catheter present in the central neck initially and then surgery is done in order to form a fistula in the arm.

A peritoneal catheter gets inserted into the peritoneum through laparoscopic surgery. This offers access to the abdomen after two weeks. The abdominal cavity must be filled with a special fluid every day through this point of access. The blood is then cleaned by the fluid through the peritoneum and then collected in a bag which must be emptied out regularly.

Ability to work

• The patient cannot perform any other activities during the total period of the dialysis procedure.
• The patient will be able to work during the day if the dialysis is done at night.

Side effects

• Low blood pressure, fatigue
• Membrane function can get limited and the catheter abdomen can get infected.

Diet restrictions

• Restricted water and salt intake, along with food with high phosphorus and potassium concentration.
• Few restrictions with respect to hemodialysis.

Peritoneal or Hemodialysis ─ Which is Better?

Indians are generally scared of getting affected by diseases that may prove to be fatal. The population facilitates the risks of the extra burden of End-Stage Renal Disease (ESRD) which is caused because of Chronic Kidney Disease (CKD).

Since it is an emerging public health issue on a global basis, it can result in end-stage renal disease or even kidney failure, which can prove to be fatal if it is not treated at the right time. Health has become a key priority of the Indian government, and hence, it has given priority to making dialysis accessible for the treatment of end-stage renal disease, as stated by Dr. Dinesh Khullar, who is a nephrologist at the Max Hospital in New Delhi.

CKD has become the major reason of death across the world, and the experts state that peritoneal dialysis (PD) proves to be a blessing for patients. Being a home-based dialysis treatment option, PD offers a lower infection risk which the patients can manage after the necessary training is provided to them or through an automatic dialyzer. The therapy is very convenient and easily manageable for the patients at the comfort of their homes. It does not result in any infections and keeps up the ability of the patients to stay active in physical activities, traveling, or daily work.

Following are a few advantages of PD:

• Convenient and hassle-free
• More cost-effective than hemodialysis
• Makes the function of the residual kidney better
• Patient can travel
• Visiting the hospital is not mandatory
• Beneficial for bed-ridden as well as non-ambulatory patients

Peritoneal dialysis is a better option for patients with cardiovascular ailments since it does not result in any kind of further heart-related stress. For patients who have failed vascular accesses, peritoneal dialysis can be performed safely since it doesn’t need any vascular access.

PD is more useful for CKD patients with liver failure issues, proper economical background, and continuous care providers.

Malnourished or weak patients often find it difficult to perform PD at their homes. The risk of infection increases if the PD is not performed in sterile or clean surroundings, which may even result in serious complications. Getting an isolated environment for performing PD may not always be feasible and the PD fluid supply may get tough in remote towns.

Conclusion

During the lockdown period of COVID-19, peritoneal dialysis proved to be a blessing in disguise for the patients who were already undergoing hemodialysis in their respective centers. Several patients could not go to their centers for their hemodialysis because of which they had to stay back and that’s when PD came to their rescue.

This is because it could be performed in the comfort of their own home. PD has fewer side effects according to Dr. Kullar and hence, does not leave its patients feeling nauseous, sick, or exhausted after the end of the treatment sessions. Hence, it can be considered a more effective method of dialysis for CKD patients as compared to traditional hemodialysis.