What is the difference between peritoneal dialysis (PD) and hemodialysis (HD) for patients with end-stage renal disease (ESRD)?

From the Guidelines

Peritoneal dialysis (PD) is generally preferred over hemodialysis (HD) for patients with end-stage renal disease (ESRD) who have severe cardiac disease or cannot tolerate HD, due to its ability to provide better hemodynamic control and avoid acute changes in solute transport and volume shifts 1.

Key Differences Between PD and HD

• PD uses the patient's peritoneal membrane as a filter, allowing for continuous gentle filtration and better preservation of residual kidney function, whereas HD removes blood from the body and filters it through an external artificial kidney machine 1.
• PD offers greater independence, fewer dietary restrictions, and can be performed at home without complex equipment, but requires a motivated patient capable of self-care and carries risks of peritonitis 1.
• HD provides more efficient clearance of certain toxins, requires less patient involvement, and may be better for patients with certain conditions like inflammatory bowel disease or recent abdominal surgery 1.

Considerations for Choosing Between PD and HD

• Patient lifestyle, medical conditions, support system, and personal preferences should be taken into account when deciding between PD and HD 1.
• Patients may transition between modalities during their treatment journey, and it is common for ESRD patients to change renal replacement therapy modalities due to complications, inability to perform the therapy, or patient request/lifestyle issues 1.

Recommendations

• PD should be considered as a first-line treatment option for patients with severe cardiac disease or those who cannot tolerate HD, due to its ability to provide better hemodynamic control and avoid acute changes in solute transport and volume shifts 1.
• The choice between PD and HD should be individualized based on the patient's unique needs and circumstances, with consideration of the potential benefits and risks of each modality 1.

From the Research

Overview of Peritoneal Dialysis (PD) and Hemodialysis (HD)

• Peritoneal dialysis (PD) and hemodialysis (HD) are two dialysis options for patients with end-stage renal disease (ESRD) 2.
• The selection of PD or HD is based on patient motivation, desire, geographic distance from an HD unit, physician and/or nurse bias, and patient education 2.

Comparison of PD and HD

• Most studies show that the relative risk of death in patients on in-center HD versus PD changes over time, with a lower risk on PD, especially in the first 3 months of dialysis 2.
• The survival advantage of PD continues for 1.5-2 years, but over time, the risk of death with PD equals or becomes greater than with in-center HD, depending on patient factors 2.
• PD offers patient survival comparable to or better than in-center HD, while preserving residual kidney function, empowering patient autonomy, and reducing financial burden to payors 3.
• PD is of particular benefit in patients with cardiorenal syndrome and uncontrolled fluid status, decreasing hospitalization rates and duration 3.

Benefits and Drawbacks of PD

• The better preservation of residual renal function associated with PD is emphasized, along with its potential cardiovascular benefits 4.
• PD has a superior patient survival rate compared to HD during the first 2 years on dialysis 4.
• The relatively high technique failure rate on PD leads to an increasing need for HD 4.
• PD preserves renal function better than HD and is useful while awaiting renal transplantation, with faster postoperative restoration of diuresis 5.

Quality of Life and Cost-Effectiveness

• Patient satisfaction may be higher with PD, and PD costs are significantly lower than HD costs 2.
• The quality of life with PD as home treatment is usually better than with HD 5.
• The lower cost of PD, in association with its clinical advantages, makes it more cost-effective in the early years on dialysis 4.