Answer: There are a few advantages and disadvantages of peritoneal dialysis over hemodialysis. The advantages are: No need for vascular access: This is a major advantage especially for people for whom the creation or maintenance of a well functioning vascular access is difficult. Vascular access related complications are the most common cause of hospitalization in hemodialysis patients. Multiple access failure, either due to thrombosis or narrowing of blood vessels, is the major reason hemodialysis patients are switched to peritoneal dialysis. Less dietary and fluid restriction: Peritoneal dialysis is a continuous process of removing excess fluid and toxic material from the body, mimicking the work of native kidneys. This property of peritoneal dialysis allows patients to be less restricted in their food and fluid intake. Better blood pressure control and less cardiovascular stress: Fluid overload is the major cause of congestive heart failure and uncontrolled blood pressure in hemodialysis patients. The ups and downs of fluid accumulation and the removal of fluid by hemodialysis are also stressful to the heart. In peritoneal dialysis, there is less fluid accumulation and the removal of fluid is slow and continuous. Thus, the stress on the heart is less and blood pressure is better controlled. Increased mobility: As peritoneal dialysis is a self-administered mode of therapy, patients can adjust their treatment according to their own schedule. They do not have to go to the center; they can do their dialysis almost anywhere (car, office, home etc). The disadvantages are: Infection: Peritonitis, exit site infection and tunnel infection are the major complications of peritoneal dialysis. Serious and frequent peritonitis, either due to fungal or bacterial infection, is the main reason to discontinue peritoneal dialysis and switch to hemodialysis. Nutritional complications: The combination of daily loss of protein in the peritoneal dialysate and decreased capacity to intake food due to increased intra-abdominal pressure, protein energy malnutrition has been observed in some peritoneal dialysis patients. Hyperlipidemia (increased cholesterol and triglyceride levels) has also been observed in these patients, especially during the initial period of treatment, and is due to high peritoneal glucose load. This high glucose load also causes excessive weight gain in these patients. Chronic back pain and hernia: Increased intra-abdominal pressure secondary to peritoneal fluid can cause chronic back pain and/or abdominal hernia in some patients. Question answered by Yalem Woredekal, MD. Dr. Woredekal is an Assistant Professor of Medicine and a Medical Director for the King County Ambulatory Hemodialysis Unit. She has also been a dialysis patient for the past 17 years and is currently on daily dialysis. The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted. This article originally appeared in the March 2002 issue of aakpRENALIFE, Vol. 17, No. 5.
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