What is the difference between peritoneal dialysis (PD) and hemodialysis (HD)?

From the Guidelines

Peritoneal dialysis is recommended over hemodialysis for patients with severe cardiac disease or those who cannot tolerate hemodialysis due to its better hemodynamic control and fewer acute changes in solute transport and volume shifts. When considering the choice between peritoneal dialysis (PD) and hemodialysis (HD) for patients with end-stage renal disease, several factors come into play, including lifestyle preferences, medical conditions, and the ability to manage the treatment at home. According to the guidelines outlined in the study by 1, PD is indicated for patients who prefer it, cannot tolerate HD, or have conditions such as congestive or ischemic heart disease where the rapid changes associated with HD could be detrimental.

The advantages of PD, as noted in the study 1, include better hemodynamic control, less risk of acute hypokalemia or other electrolyte shifts that could lead to arrhythmias, and better control of anemia, which is particularly important for patients with coronary artery disease. While there isn't a direct comparison of PD to HD specifically for patients with severe heart failure in the provided evidence, reports suggest that PD can be successfully performed in these patients with satisfactory tolerance, fluid management, prevention of arrhythmias, and patient survival.

Key considerations for choosing between PD and HD include:

• Patient preference and ability to perform the dialysis at home
• Presence of severe cardiac disease or other conditions where PD might offer better management
• The need for more efficient filtration, which might favor HD for larger patients
• The risk of peritonitis with PD versus the need for regular travel to a dialysis center for HD
• The preservation of remaining kidney function, which PD may facilitate longer than HD

Ultimately, the decision between peritoneal dialysis and hemodialysis should be tailored to the individual patient's needs, medical conditions, and lifestyle, considering the benefits and drawbacks of each modality as outlined in the most recent and relevant clinical guidelines, such as those referenced in 1.

From the Research

Peritoneal Dialysis vs Hemodialysis

• Peritoneal dialysis (PD) has been shown to be superior to conventional hemodialysis (HD) in preserving residual renal function for a longer period 2.
• A combination of PD and home hemodialysis (HHD) may be a new and effective method for patients receiving dialysis therapy, as it allows for the preservation of residual renal function and improves patient outcomes 2, 3.
• PD has been found to be an ideal bridge from conservative therapy to kidney transplant, due to its favorable profile towards preservation of residual renal function, patient survival, and lower overall burden on cardiovascular morbidity and infection risks 4.
• The selection of the initial dialysis modality is crucial in the treatment of end-stage renal disease (ESRD) patients, and PD has shown a survival advantage over HD in some studies, especially in non-diabetic patients and in young patients with diabetes 5, 6.
• PD is a viable and less expensive renal replacement therapy option, which may provide a survival advantage over HD in the first 2-4 years of treatment, although this advantage may be lost in long-term PD due to changes in the peritoneal membrane 6.

Key Findings

• PD preserves residual renal function for a longer period compared to conventional HD 2.
• Combination therapy with PD and HHD preserves residual renal function and serum albumin 3.
• PD is an ideal bridge from conservative therapy to kidney transplant due to its favorable profile towards preservation of residual renal function and patient survival 4.
• PD has a survival advantage over HD in some patient populations, such as non-diabetic patients and young patients with diabetes 5, 6.

Patient Outcomes

• Patients who start with PD and transition to HHD have been found to have improved health status and are able to lead a nearly normal social life 2.
• PD patients have been found to have better preserved residual renal function and serum albumin compared to HD patients 3.
• PD patients have been found to have lower overall burden on cardiovascular morbidity and infection risks compared to HD patients 4.