Which should I choose, hemodialysis or peritoneal dialysis?

There has always been a "competition" between hemodialysis and peritoneal dialysis since their emergence, and it is also one of the most frequently asked questions by patients who are about to enter dialysis.

Patients are the main body receiving treatment. Should they do hemodialysis or peritoneal dialysis? In the decision-making process, patients should be equally important decision-makers as doctors. Therefore, in addition to the doctor's advice, patients with uremia should fully consider their own condition, family environment, lifestyle, economic conditions, etc. to make a choice between hemodialysis and peritoneal dialysis. Figuratively speaking, it is like choosing clothes to go out today. You should choose clothes that suit you according to the weather, personal preferences, and event occasions. At the same time, if the weather changes or an accident occurs during the trip, we can also change clothes at any time.

0 1 Personal illness

For most patients, the initial dialysis can be either peritoneal dialysis or hemodialysis. When encountering the following special circumstances, careful consideration should be given.

( 1 ) Who is not suitable for hemodialysis ?

① Patients with unstable cardiovascular and cerebrovascular systems. Hemodialysis requires the drainage of about 150-200 mL of blood outside the body. Some patients have cardiovascular diseases such as severe heart failure, ischemic cardiomyopathy, severe arrhythmia, and severe hypotension. After the blood is drained outside the body, the blood pressure will further decrease, or more serious complications may occur. Such patients should be prohibited from or carefully choose hemodialysis.

② Patients who cannot establish vascular access (i.e., the access for drawing blood out of the body and returning it to the body). For hemodialysis, whether it is cannulation or arteriovenous fistula, the vascular conditions must be relatively good to establish vascular access. If the vascular conditions are particularly poor, such as patients with severe stenosis, occlusion, or thrombosis of the superior and inferior vena cava, vascular access cannot be established to draw blood out, and hemodialysis cannot be performed.

③ Patients with coagulation disorders. We all have this experience. If there is bleeding from an injury, the body's own coagulation mechanism will quickly stop the bleeding. When doing hemodialysis, a large amount of blood is drawn out of the body, and it lasts for 4 hours at a time. If the patient has a coagulation disorder, hemodialysis is not suitable.

④ Patients who cannot cooperate, such as those with mental illness, may engage in behaviors that endanger their personal safety, such as pulling out needles, during treatment and are not suitable for hemodialysis.

( 2 ) Which patients are not suitable for peritoneal dialysis ?

① Patients with surgical incisions, skin diseases or severe burns on the abdomen, that is, patients without intact skin on the abdomen, are not suitable for peritoneal dialysis. This is because peritoneal dialysis uses the capillaries on the peritoneum for exchange. If most of the peritoneum is removed during surgery or there is adhesion or fibrosis in the peritoneum, and the peritoneum cannot function normally, then peritoneal dialysis cannot be chosen.

② If the patient has severe chronic obstructive pulmonary disease and poor lung function, once 2000mL of peritoneal dialysis fluid is filled into the abdominal cavity, the diaphragm separating the abdominal cavity and the thoracic cavity will rise and compress the lungs, which may cause obvious dyspnea. In this case, peritoneal dialysis cannot be chosen.

③ If the patient has polycystic kidney disease, pregnancy, a huge intra-abdominal tumor, etc., the abdominal cavity volume is significantly reduced and peritoneal dialysis is not suitable.

④ Patients with intestinal obstruction, abdominal hernia or fistula, severe lumbar disc herniation, when peritoneal dialysis fluid is instilled into the abdominal cavity, these symptoms will be aggravated, and peritoneal dialysis is not suitable.

⑤ Elderly people with poor vision or blindness, poor precision, dementia, mental illness, hemiplegia, etc., should not use peritoneal dialysis without the continuous help of family members. Whether it is hemodialysis or peritoneal dialysis, the ideal treatment state is to have no uremic symptoms (such as nausea, vomiting, chest tightness, fatigue, etc.), good blood pressure, good eating and sleeping, and be able to perform daily life and relatively easy work.

Both dialysis methods have certain scope of application, and they can complement and replace each other. When one dialysis method is limited, the other method can be used.

0 2 Family environment

If the patient prefers home treatment, or needs to go to work or school during the day, or lives in a rural or remote area with inconvenient transportation, peritoneal dialysis can be given priority. Peritoneal dialysis itself is a type of home dialysis, which does not require repeated commuting between the hospital and home.

0 3 Lifestyle and attitude

Hemodialysis patients generally need to go to the hospital 2-3 times a week, especially for elderly patients, which increases their chances of social contact and going out, and is conducive to the recovery of patients' social activities. However, it is indeed inconvenient to go to the hospital on time for dialysis regardless of wind, rain or snow, and whether there are personal matters.

Whether it is hemodialysis or peritoneal dialysis, patients can move freely during the treatment period. Appropriate work, study, and social activities can help improve the quality of life of patients. If you need to travel for work or personal reasons, you should contact the local dialysis center in advance to arrange the dialysis time.

A good dialysis state requires an optimistic and self-disciplined attitude towards life, which is the key to determining the dialysis effect.

0 4 Economic conditions

Economically, peritoneal dialysis costs less, but both dialysis methods can be reimbursed in most parts of the country. Some regions have different medical insurance policies for hemodialysis and peritoneal dialysis, and the reimbursement ratios are also different. Patients can make a reasonable choice based on local policies and personal economic conditions.

Regarding peritoneal dialysis and hemodialysis, patients do not need to "hold hands with their loved ones and grow old together". "Assessing the situation and acting accordingly" is a wise choice.