Hemodialysis vs Peritoneal Dialysis NCLEX Review for Nurses
The kidneys are a pair of bean-shaped organs located below the rib cage. They are responsible for the removal of waste from the blood and excess fluids from the body in order to regulate blood pressure, electrolytes (such as sodium and potassium), and fluid balance.
They also produce erythropoietin, a hormone that promotes the formation of the red blood cells in the bone marrow. When the kidney stops functioning properly, the patient may require dialysis. There are two types of dialysis: hemodialysis and peritoneal dialysis.
In this study guide, we will discuss the differences between the two by looking at each of their defining characteristics.
Hemodialysis and peritoneal dialysis have one end-goal: to purify the blood once the kidneys stop working (also known as kidney failure).
However, they differ in terms of procedure. Hemodialysis uses a machine called dialyzer, which essentially becomes the patient’s artificial kidney.
The process starts by gaining a hemodialysis access, which includes creating an arteriovenous (AV) fistula, a connection between an artery and a vein. The access sites include the jugular veins, femoral veins, and brachial veins.
During the hemodialysis session, the dialysis nurse will insert two tubes to the access site, one for filtering blood by passing it into the cleansing fluid called dialysate, and another tube for return the filtered blood to the body.
Peritoneal Dialysis (PD)
Peritoneal Dialysis (PD) uses the tissues of the abdominal cavity of the patient to perform the purification process.
It makes use of a dialysis catheter and a dialysate to irrigate and cleanse the intestines, and then remove the contaminated fluid from the peritoneal cavity.
The peritoneal membrane acts as a filter between the solution and the bloodstream. The fluid usually contains an osmotic agent and electrolytes such as sodium, chloride, and hydrogen carbonate, in order to correct the electrolyte imbalance.
Frequency and Duration
Patients can have hemodialysis ideally three times a week, as an inpatient or an outpatient. A hemodialysis session lasts for 6 to 8 hours.
Patients on peritoneal dialysis can manage their own care at home. It requires about 4 to 6 exchanges a day, and the patient will have to spend about 1 to 2 hours to drain the dialysate out of the abdomen.
The rest of the day, the dialysate works in the abdominal cavity and the patient can get on with their day’s activities.
One of the main criteria for choosing between hemodialysis and peritoneal dialysis is the patient’s ability to manage their own care.
People who are independent and able to self-care at home are suitable for peritoneal dialysis as it will give them more freedom and time to get on with their lives while dialysis is ongoing in their body.
People who have had major abdominal surgeries are more suitable for hemodialysis. Patients with severe body weakness, complications, inflammatory bowel disease, diverticulitis, or unable to self-care are recommended to have hemodialysis.
People with blindness or arthritis may be able to do peritoneal dialysis at home using a machine-led type of PD known as automated peritoneal dialysis. The dialysis care team will frequently contact the PD patient to ensure that the procedure is being done properly and to assess the patient’s well being.
Studies show that hemodialysis and peritoneal dialysis have almost equal benefits to patients with renal failure. Therefore, the eligibility and risks of an individual patient are both important factors to choosing the most suitable treatment option.
Peritoneal dialysis may put the patient at risk for infection of the peritoneum known as peritonitis, Therefore, the dialysis catheter must always be free from any signs of infection by managing it properly, and the patient needs to be adequately trained to do his or her own PD at home.
Abdominal muscles may be strained due to holding in a large amount of liquid over long periods of time, and may eventually result to hernia.
The patient on PD may experience high blood sugar (hyperglycemia) due to the dextrose in the dialysate. Also, they may have nausea, abdominal cramping and pain.
Peritoneal dialysis may be ineffective after several years. At that point, the doctor will recommend switching from PD to hemodialysis.
Patients on hemodialysis are at risk for low blood pressure (hypotension), which is common.
The dialysis nurse will frequently check the blood pressure during hemodialysis.
The patient may also have abdominal cramping, shortness of breath, nausea, or muscle cramping. To manage the symptoms, the hemodialysis prescription may be changed by the doctor, such as adjusting the amount of potassium and sodium.
Hypertension may result from too much salt and/or fluid intake, so hemodialysis patients are put on a fluid restriction and low sodium diet.
The access sites of the patient may also become blocked or suffer from aneurysm (narrowing or ballooning) of the blood vessel.
The patient is also at risk for bloodstream infection (bacteremia) if the access site gets infected. Methicillin-resistant Staphyloccocus aureus (MRSA) is one of the most common cause of bacteremia in hemodialysis patients.
In summary, below is a comparison chart that shows the differences between hemodialysis and peritoneal dialysis.
|Procedure||Uses a machine called dialyzer and a dialysate||Uses the peritoneal membrane and a dialysate|
|Access Site||jugular veins, femoral veins, and brachial veins and creating an AV fistula||Abdominal cavity using a dialysis catheter|
|Frequency||2 to 3 times a week||daily|
|Duration||6 to 8 hours||4 to 6 exchanges a day/ 1 to 2 hours for drainage|
|Eligibility||Patients who need professional care and assistance Patients with severe complications, inflammatory bowel disease, diverticulitis, and/or have had several abdominal surgeries||Patients who are able to self-care at home|
|Risks||Bloodstream infection Access site blockage or aneurysm Hypotension (common) Hypertension (if with high sodium or fluid intake) Weight gain abdominal cramping, shortness of breath, nausea, or muscle cramping||Peritonitis Hernia May become ineffective after a few years Weight gain, hyperglycemia, nausea and abdominal cramping and pain|