Benefits and challenges of PD

Benefits:

• Less travel expenses than in-center treatments
• Potential for higher care satisfaction compared to in-center treatments¹
• Choosing PD more closely mimics the natural action of your kidneys and is done more consistently than hemodialysis, which can lead to better health outcomes²
• Increased flexibility since treatments are either done as you sleep or can be completed at work and at your convenience
• Less dietary restrictions than hemodialysis
• You don’t need a needle to engage in treatment
• Being at home means that you don’t need to be around other patients that could be sick
• More flexibility to travel as compared to in-center dialysis
• Your blood stays in your body and does not go through a machine
• Works for patients that are not strong candidates for a fistula or an arterio-venous graft

Drawbacks:

• You do need substantial space to perform exchanges and to store supplies
• Catheters run a higher risk of infection (peritonitis), especially if they are not well maintained³
• Unless precautions are made, you can’t take a bath above your waste or swim
• More control over the therapy does mean you are more involved and there are no full off-days
• Depending on the type of treatment, you might have to dwell during the day and this can make you feel bloated or impact your appearance
• The dialysate solution contains sugar, which can lead to weight gain if not closely monitored
• Due to dextrose used in the dialysate, diabetic patients might have trouble managing their disease. However, new substances are being used that have little impact on blood sugar levels⁴
• Some patients also will need a dedicated caregiver or partner to help in exchanges or supply management
• Risk of changes to the peritoneum may cause patients to need to switch to hemodialysis
• Risk of back strain, hernias and muscle injuries caused by extra abdominal weight and pressure⁵
• Potential for a decrease in lean body mass and protein loss during treatments.⁶

1.       Rubin Haya R., Fink Nancy E., Plantigna Laura C., et al. Patient Ratings of Dialysis Care with Peritoneal Dialysis vs Hemodialysis. Journal of the American Medical Association. 2004; 291(6): 697-703. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=198181#qundefined [1].

2.       Chertow GM., Levin NW., Beck GJ., et al. In-Center hemodialysis six times per week versus three times per week. New England Journal of Medicine. 2011 Jan 6;364(1):93. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21091062 [2].

3.       Lafrance Jean-Philippe, Rahme Elham, Iqbal Sameena, et al. Association of Dialsis Modality with Risk for Infection-Related Hospitalization: A propensity Score-Matched Cohort Analysis. Clinical Journal of the American Society of Nephrology. 2012. Published online at http://cjasn.asnjournals.org/content/early/2012/08/15/CJN.00440112.full [3].

4.       Dasgupta Mrinal K., Management of Patients with Type 2 Diabetes on Peritoneal Dialysis. Advances in Peritoneal Dialysis. 2005 Vol 21. Retrieved from http://www.advancesinpd.com/adv05/Adv20053d-1.pdf [4].

5.       Mahale AS., Katyal A., Khanna R., Complication of peritoneal dialysis related to increased intra-abdominal pressure. Advances in Peritoneal Dialysis. 2003; 19:130-5. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14763049 [5].

6.       Stenvinkel Peter, Lindholm Bengt, Lonnqvist Fredrik., Increases in serum leptin levels during peritoneal dialysis are associated with inflammation and a decrease in lean body mass. Journal of the American Society of Nephrology. 2000 Vol 11:7 1303-1309. Retrieved from http://jasn.asnjournals.org/content/11/7/1303.full [6].