Dialysis: Hemodialysis vs Peritoneal

Creator: Progress Note
Published: 2026-08-29
Keywords: dialysis, hemodialysis vs peritoneal dialysis, dialysis indications, AEIOU dialysis, renal replacement therapy, dialysis complications

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check_circleDialysis removes wastes and excess fluid when kidney function is inadequate.
check_circleHemodialysis filters blood through an external machine, usually via an AV fistula.
check_circlePeritoneal dialysis uses the peritoneal membrane and dialysate in the abdomen.
check_circleUrgent indications are recalled by AEIOU: Acidosis, Electrolytes, Intoxication, Overload, Uremia.
check_circleEach modality has characteristic complications, such as access infection.

How Dialysis Works

Dialysis substitutes for the kidney's clearance function using the principles of diffusion (solutes move across a semipermeable membrane down their concentration gradient into dialysate) and ultrafiltration (a pressure gradient removes excess water). It corrects the accumulation of nitrogenous wastes, potassium, and acid, and removes fluid, but it does not replace the kidney's hormonal functions, which are managed separately.

Hemodialysis

Hemodialysis pumps the patient's blood through an external dialyzer where it is cleaned against dialysate, then returns it. It requires reliable vascular access — an arteriovenous fistula is preferred for durability and lower infection risk over a graft or a central catheter — and is typically performed several times a week at a center. It provides efficient clearance but causes larger fluid and solute shifts between sessions.

Peritoneal Dialysis

Peritoneal dialysis uses the patient's own peritoneal membrane as the filter: dialysate is instilled into the abdominal cavity through a catheter, allowed to dwell while solutes and water move across the peritoneum, and then drained. It can be done at home, offers more independence and gentler, continuous clearance, but requires the patient to manage exchanges and carries a risk of peritonitis.

Indications and Complications

Dialysis is started for end-stage kidney disease and for urgent indications summarized by AEIOU: severe metabolic Acidosis, refractory Electrolyte abnormalities (especially hyperkalemia), certain Intoxications, fluid Overload unresponsive to diuretics, and symptomatic Uremia (such as encephalopathy or pericarditis). Complications include hypotension and access problems in hemodialysis and peritonitis and catheter issues in peritoneal dialysis.

Frequently asked questions

What is the difference between hemodialysis and peritoneal dialysis?expand_more

Hemodialysis filters the blood through an external machine, usually via an arteriovenous fistula, several times a week at a center. Peritoneal dialysis uses the body's own peritoneal membrane, instilling dialysate into the abdomen through a catheter, and can be done at home with more independence but a risk of peritonitis.

When is dialysis indicated?expand_more

Dialysis is used for end-stage kidney disease and for urgent problems recalled by AEIOU: severe Acidosis, refractory Electrolyte abnormalities (especially hyperkalemia), certain Intoxications, fluid Overload unresponsive to diuretics, and symptomatic Uremia such as encephalopathy or pericarditis.

What are the complications of dialysis?expand_more

Hemodialysis can cause hypotension during sessions and vascular access complications such as infection or clotting. Peritoneal dialysis can cause peritonitis and catheter-related problems. Both require ongoing management of fluid balance and the underlying kidney disease.

What is the preferred access for hemodialysis?expand_more

An arteriovenous (AV) fistula is the preferred access for hemodialysis because it is durable and has the lowest infection risk. Arteriovenous grafts and tunneled central venous catheters are alternatives but carry higher rates of complications.

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