If you or someone you care for has been told that the kidneys are no longer filtering blood the way they should, you are likely facing a lot of new information at once. One of the first and most important decisions is which form of dialysis to use. The good news is that there is no single right answer — there are several effective options, and the best one depends on your health, your lifestyle, and your personal preferences.
In this guide, you will learn what dialysis does, the two main categories of treatment, how each type is performed, what is involved in getting started, and the practical factors that help people and their care teams choose wisely. This is general information, not personal medical advice, so plan to discuss your specific situation with your kidney care team.
What Dialysis Does and When It Becomes Necessary
Healthy kidneys perform several essential jobs. They filter waste products from the blood, balance fluids and electrolytes, help regulate blood pressure, and support the production of red blood cells and vitamin D. When kidney function falls to a very low level — often described as kidney failure or end-stage kidney disease — the body can no longer clear waste and extra fluid on its own.
Dialysis is a treatment that performs part of that filtering work. It does not cure kidney disease, but it can replace enough kidney function to help you feel better and stay healthier. In some cases, dialysis is a long-term treatment. In others, it is a bridge until a kidney transplant becomes available. Dialysis may also be needed suddenly and temporarily after an acute injury or illness.
Most people begin dialysis when kidney function drops to roughly 10 to 15 percent of normal, or sooner if symptoms such as severe fatigue, nausea, swelling, or shortness of breath become difficult to manage.
The Two Main Categories of Dialysis
All dialysis works on the same basic principle: blood or body fluid passes across a filter, and waste products and extra fluid move out of the body. There are two broad ways to accomplish this.
- Hemodialysis — blood is filtered outside the body using a machine.
- Peritoneal dialysis — a sterile fluid is used inside the abdomen, and the body’s own peritoneal lining acts as the filter.
Hemodialysis: Filtering Blood Outside the Body
During hemodialysis, blood is drawn out through a vascular access point, circulated through a dialyzer that removes waste and excess fluid, and then returned to the body. Treatments usually last a few hours and are performed several times each week.
In-Center Hemodialysis
This is the most familiar form of dialysis. Patients travel to a dialysis center, typically three times per week, for sessions lasting about three to four hours. The advantages include:
- Care provided and monitored by trained clinical staff
- A predictable, structured schedule
- No need to store equipment or supplies at home
- Quick access to medical help if problems arise
The trade-offs are the time commitment, travel to and from the center, and less flexibility in daily routines.
Home Hemodialysis
With proper training, some patients perform hemodialysis at home, either with a partner or independently. Home schedules vary widely. Some people dialyze more often but for shorter sessions, while others dialyze overnight while sleeping.
- Greater control over when treatment happens
- More frequent treatment, which some patients tolerate better
- Fewer dietary and fluid restrictions for some people
- Requires reliable water and electrical setup, storage space, and training
Peritoneal Dialysis: Using the Lining of the Abdomen
Peritoneal dialysis uses the peritoneum — the thin membrane lining the abdominal cavity — as a natural filter. A sterile solution is instilled into the abdomen through a soft catheter, waste products and extra fluid pass into the solution over a period of hours, and then the fluid is drained out.
Continuous Ambulatory Peritoneal Dialysis (CAPD)
This form is done by hand, usually four times a day. Each exchange takes about 30 to 40 minutes, and the fluid dwells in the abdomen between exchanges. No machine is required, making it portable and travel-friendly.
Automated Peritoneal Dialysis (APD)
With APD, a machine called a cycler performs several exchanges overnight while you sleep. The abdomen is often left empty during the day, which may feel more comfortable for some people and can free up daytime hours for work, school, or caregiving.
Peritoneal dialysis generally offers more scheduling freedom and often allows a less restrictive diet, but it requires commitment to sterile technique, dedicated storage space, and careful monitoring for infection.
How the Options Compare at a Glance
Access Points: How Treatment Reaches the Bloodstream or Abdomen
A safe, well-functioning access point is essential for successful dialysis.
Vascular Access for Hemodialysis
- Arteriovenous fistula — a surgically created connection between an artery and a vein, usually in the arm. It is often preferred because it lasts longer and has fewer infections, but it needs several weeks to mature before use.
- Arteriovenous graft — a synthetic tube connecting an artery and vein, used when vessels are not suitable for a fistula. It can be used sooner but may clot or become infected more often.
- Central venous catheter — a tube placed in a large vein, often used for urgent or short-term treatment. It carries a higher risk of infection and is generally not intended for long-term use.
Abdominal Catheter for Peritoneal Dialysis
A soft, flexible tube is surgically placed into the abdomen. After a healing period of a few weeks, it can be used for exchanges. Keeping the exit site clean and dry is a central part of preventing infection.
Factors That Help Shape the Choice
There is no universally better option. Kidney care teams consider many elements when helping patients decide, including:
- Overall health, including heart and blood vessel condition
- Previous abdominal surgeries or hernias
- Whether a suitable vascular access can be created
- Support available at home from family or caregivers
- Work, school, travel, and caregiving responsibilities
- Vision, dexterity, and the ability to follow detailed steps
- Comfort with needles and with medical equipment
- Personal preference and quality-of-life priorities
Preferences can also change over time. Many patients start with one method and switch later if circumstances shift.
Diet, Fluids, and Medications on Dialysis
Dialysis works best alongside a plan designed by your care team. Common recommendations include:
- Limiting sodium to help control blood pressure and thirst
- Watching potassium and phosphorus, which can build up when kidneys fail
- Managing fluid intake to prevent swelling and shortness of breath
- Eating enough protein, which dialysis can remove from the body
- Taking phosphate binders with meals, as prescribed
- Using vitamin supplements and medications that support red blood cell production or iron levels, when recommended
A registered dietitian who specializes in kidney care can tailor these guidelines to your treatment type, lab results, and food preferences.
Possible Side Effects and How They Are Managed
Dialysis is well tolerated by many people, but side effects can occur. Common ones include low blood pressure during treatment, muscle cramps, fatigue after sessions, itching, and dry skin. Peritoneal dialysis carries a risk of infection in the abdominal cavity, while hemodialysis access points can clot or become infected.
Most of these issues can be managed by adjusting treatment time, fluid removal goals, medications, or technique. Report new or worsening symptoms — especially fever, redness or swelling at an access site, cloudy dialysis fluid, or persistent dizziness — to your care team promptly.
Dialysis and Kidney Transplant
For many people with kidney failure, a kidney transplant offers the possibility of longer survival and a less treatment-intensive daily life. Dialysis often serves as a bridge while waiting for a donor organ, and it can keep you healthy enough to remain a good transplant candidate. Ask your team about evaluation, waitlist options, and living donation if transplant interests you.
Living Well While on Dialysis
Dialysis is a treatment, not a pause on life. Many people continue working, traveling, and enjoying time with family. Helpful habits include keeping every appointment, following your fluid and diet plan, staying as active as your team approves, keeping vaccinations current, protecting your access site, and asking for emotional support when you need it. Connecting with others who are on dialysis can also make a meaningful difference.
Key Takeaways
- Dialysis replaces part of the filtering work kidneys can no longer perform.
- The two main categories are hemodialysis, done outside the body, and peritoneal dialysis, done inside the abdomen.
- Each category includes in-center, home, manual, and machine-assisted variations.
- Vascular or abdominal access is essential, and each type has its own benefits and risks.
- Health status, home support, schedule, and personal preference all influence the choice.
- Diet, fluids, medications, and regular follow-up care are part of every dialysis plan.
Choosing a dialysis option is a decision you make with your care team, not on your own. Ask questions, share what matters most to you, and revisit the plan as your needs change. If you would like to learn more about kidney health, related conditions, and supportive treatments, explore the other guides and resources available on our site.