Which is better - Hemodialysis or Peritoneal Dialysis?

Before we get to answer that question, I'd like to digress a bit and ask you another question. Which is better - Vanilla Ice Cream or Strawberry Ice Cream? Your answer might be 'Depends' or 'Varies from person to person'. 

That is exactly my answer to the question we are discussing on whether Hemodialysis (HD) is better or Peritoneal Dialysis (PD) is better? 'Depends' and 'Varies from Person to Person'.

Both are different modalities for dialysis. Different people will like different modalities. There is no standard answer for everyone. There are, however, some aspects about each modality that we should consider to decide which modality we might like more. Let us look at those aspects.

(I am assuming you know the basics of both the modalities. If you don't, then I suggest reading up on this first. This might be a good place to start.)

PD works best if you do it on your own. While there are people who have a caregiver do it for them, the real power of PD lies in the independence that you gain by doing it on your own. If you are proactive about your health, take precautions when instructed to and have basic dexterity levels (like you can put a cap on a pen yourself), then you may be suited to PD.

If you are scared to take the responsibility of your health in your own hands, then HD may be the better option. HD may also work better if you are unable to do your basic daily tasks yourself. 

People keep saying you need to be careful of infections while on PD. True. Equally true, however, is that the technicians need to be careful of infections in HD. So the burden of that responsibility lies on the patient in PD and the dialysis unit staff in HD. In PD, bacterial infections are more common. In HD, you can get both bacterial and viral infections.

Cost considerations are an important factor in deciding on the treatment modality in India. PD costs tend to be constant across the country changing only from manufacturer to manufacturer. HD costs vary widely depending on the location, type of unit, type of HD, whether you reuse the dialyser or not, and so on. Charity and Government-run centres can offer it free of cost or at a very minimal cost. Other centres charge between Rs. 1,000 to Rs. 4,000 depending on the centre.

Access type may also be a factor for some people. In PD, you will have a catheter placed in your stomach, one end of which will come out of your stomach and be placed in a pouch that is tied around your waist. In HD, your access may be under the skin and invisible to the outside world unless an aneurysm forms, which is not uncommon, in which case there could be a bulge under the skin which could be visible. Some patients also have a catheter in the neck, which has one end coming out and may be visible from outside.

There are several factors that should be considered while deciding between the two. I know of people who swear by HD and I know of people who would never give up PD. Personally, I would prefer PD. I can't go back to PD, though, for clinical reasons.

It is important for you to discuss the modality with your nephrologist and family and jointly arrive at the decision. Do not let anyone else decide for you. You know your body and mind the best. It is only fair that you have the primary right to make this decision.


Comments

Aakash Patel said…
Thanks for guiding us sir,PD is better then Hd.
Kamal D Shah said…
Glad you liked the post, Aakash. Thanks!
Parth Wankhede said…
Almost a decade back I had sought your advice over email on this same topic for my late father's treatment. I still remember the good guidance I received from you based on which we could discuss with the nephrologist and the marketing team that were pushing us towards a particular brand of PD solution. Your blog reminded me of those tense days, after all these years.

Thanks once again for sharing your knowledge.
Dr Krishnan said…
Well written balanced view about the two modalities.PD acceptance is v poor from both sides- patients and Nephrologists.Fear,inertia and lack of will- apart from individual bias - all these account for a v poor percentage of patients accepting PD.Maybe if the Govt can subsidise the cost, PD can be taken up in several centres even by primarycare physicians.
Dr S Krishnan
Kamal D Shah said…
Thanks Parth for your comment.

Thanks Dr. Krishnan for your appreciation. Agree with your point. Government subsidy will help a great deal in improving the uptake of PD. For many patients, the government subsidy on HD makes it the only choice.
Unknown said…
Kamal Ji following you from kwf group. You are an inspiration for every young youth. Thank you for sharing this information both pd and hemo has its pros and cons.
Kamal D Shah said…
Thanks for your kind words!