Hemodialysis Compared to Peritoneal Dialysis

Hemodialysis and peritoneal dialysis are both used to treat kidney failure. Hemodialysis uses a man-made
membrane (dialyzer) to filter wastes and remove extra fluid from the blood. Peritoneal dialysis uses the
lining of the abdominal cavity (peritoneal membrane) and a solution (dialysate) to remove wastes and
extra fluid from the body.
Each form of dialysis has its advantages and disadvantages.
Comparison of dialysis methods
Hemodialysis Peritoneal dialysis
Advantages It is most often done by trained
health professionals who can
watch for any problems.
It allows you to be in contact
with other people having
dialysis, which may give you
emotional support.
You don't have to do it yourself,
as you do with peritoneal
dialysis.
You do it for a shorter amount
of time and on fewer days each
week than peritoneal dialysis.
It gives you more freedom than hemodialysis. It
can be done at home or in any clean place. You
can do it when you travel. You may be able to
do it while you sleep. You can do it by yourself.
It doesn't require as many food and fluid
restrictions as hemodialysis, and it does not use
needles.
Disadvantages It causes you to feel tired on the
day of the treatments.
It can cause problems such
as low blood pressure and blood
clots in the dialysis access.
It increases your risk of
bloodstream infections.
The procedure may be hard for some people to
do.
It increases your risk for an infection of the
lining of the belly, called peritonitis

Dialysis Diet Differences: Hemodialysis and Peritoneal Dialysis
Similarities and differences
Although many components of a dialysis diet (also called a kidney diet) are the same for people on
hemodialysis and peritoneal dialysis (PD), there are also differences. To some extent, your diet guidelines
are determined by the kind of dialysis you choose.
Calories
Hemodialysis and PD each require adequate calories for your body to function and not become
malnourished.
But there is a difference between these treatment types: some of the calories for PD patients come
from the dialysate solution, the cleansing fluid placed in the abdomen that pulls waste and extra fluid out
of the blood. It contains dextrose, a form of sugar, providing calories and decreasing the need for as many
calories from food. Thats why PD patients may eat fewer carbohydrates than hemodialysis patients do,
yet have the same overall calorie intake.
People with diabetes should be especially mindful of the added sugars and consider this for their overall
treatment plan. Use of higher concentrations of dextrose2.5 percent (yellow bags), or especially 4.25
percent (red bags)will result in larger amounts of carbohydrate absorption and may make blood sugar
levels harder to control. Your healthcare team can help you manage this issue more effectively.
Protein
Protein needs are higher in people undergoing dialysis. This may be for several reasons.
Hemodialysis patients can lose 10-12 grams of amino acids, the building blocks of protein, per
treatment.
PD patients may lose 5-15 grams of protein per treatment.
Infection, inflammation, sores, anemia, some thyroid issues, metabolic acidosis (common with
diabetes) and other medical conditions call for a higher protein intake.
People who perform daily treatment are able to consume more protein in their diet.
Protein lost during dialysis can be replaced by eating high-quality meat, poultry, fish and eggs. You may
require three or more servings each day to meet your protein needs, depending on your kidney diet
prescription. In some cases a protein supplement may be included to help meet the increased protein
requirements.
Sodium
Hemodialysis and PD patients should limit their sodium intake to 2,000 mg or less daily. The normal
healthy American's diet probably already has more than 2,000 mg, so you should avoid adding salt to
food. Because youre unable to get rid of sodium on your own, large amounts can lead to increased thirst,
swelling, shortness of breath, high blood pressure andheart failure. High amounts of sodium are found in
pre-packaged, processed, frozen, canned, restaurant and fast foods. A dietitian can help you identify
hidden sources of sodium, and determine lower-sodium substitutions.
Potassium
High potassium levels are more common in people on hemodialysis. For people in this category, the
recommendation is usually 2,000 mg each day. Some people may safely consume more depending on
whether they still make urine, how frequently they dialyze and other individual needs.
Potassium removal is more efficient on PD because the treatment occurs daily, so PD patients can eat
more potassium-rich foods than hemodialysis patients can. A typical daily goal for PD patients is 3,000-
4,000 mg of potassium. Some PD patients may need to add extra high-potassium foods or potassium
supplements if their levels are too low.
People on short daily HHD may have less restriction on potassium because they dialyze almost every day,
or five to six times per week.
Phosphorus
Excess phosphorus is excreted by heathly kidneys. Phosphorus is found in colas, milk, cheese, processed
meats, fish, poultry, chocolate, whole grains and nuts. When the kidneys fail, phosphorus builds up in the
blood, which can cause severe bone and heart problems, tissue calcification and itching. Thats why the
recommended amount is 800-1,000 mg per day.
Most dialysis patients take phosphate binders with their meals. These medications bind up the phosphorus
so it can be excreted in the stool instead of being absorbed.
Calcium
No matter which dialysis treatment youre on, intake of calcium should be no more than 2,000 mg daily,
including the calcium from your prescribed calcium-based phosphate binders and other medications. If
your calcium or vitamin D level is low, calcium is pulled out of the bones causing them to become weak
and brittle. Calcium can also bind with excess phosphorus, depositing in the soft tissue, such as your
heart, arteries, skin or lungs. This leads to serious health issues. Do not take calcium supplements without
first speaking with your healthcare team.
Fluid balance
Hemodialysis patients may feel the negative effects of fluid imbalance more than PD patients or those on
short daily HHD. While this does not mean PD and HHD patients can drink unlimited amounts, their fluid
allowance is usually more generous than for those on in-center hemodialysis. However, if PD patients
consume too much fluid, they may have to use a more concentrated glucose dialysis solution to remove it.
High fluid intake can cause swelling, increased blood pressure and shortness of breath. If you gain too
much fluid, , your blood pressure may drop and cause you to feel nauseous, dizzy and weak during your
dialysis treatment. Muscle cramps are common in people who take in too much fluid. Too much fluid
weight gain may require longer dialysis treatment times and sometimes more frequent dialysis.
It is recommended that people on dialysis who dont make urine consume less than 4 cups (32 ounces) of
fluid each day. This includes foods, such as soup, ice pops, gelatin, gravy and ice that are liquid at room
temperature. If you still urinate, the general rule is you may consume 4 cups plus the equivalent amount
of urine you make daily. For example, if you urinate 1 1/2 cups, then your fluid limit would be5 1/2 cups
daily. It is important that patients speak with their physician or dietitian for individual guidance.
Fiber
Whether youre on hemodialysis or PD, its recommended that you consume 20-25 grams offiber per day.
By consuming a diet rich in kidney-friendly fruits and vegetables along with some lower-phosphorus
grain products, you should be able to meet your fiber needs.
High-fiber diets help lower cholesterol levels, which can reduce your risk for a heart attack or other
cardiovascular events.
Many patients on dialysis, especially those on PD, complain of gastrointestinal (GI) symptoms, such as
constipation or diarrhea. These may be a side effect of various medications. Fiber can help to reduce
symptoms. It also can help with weight control and regulate blood sugar levels. Your dietitian can help
you find ways to gradually include fiber into your diet.
Summary
There are some differences between the hemodialysis and PD diets. But once you determine the modality
thats right for your lifestyle, you will be educated on how to adjust your diet to meet your
individual needs. Your healthcare team will help you along the way.