Choosing Between Dialysis and Kidney Transplant

Planning for a kidney transplant and "Kidney transplant").

Peritoneal dialysis " � Peritoneal dialysis is a procedure that people do at home every day. It involves piping a special fluid into the belly. This fluid collects waste and excess salt and water from the blood. Then, the used fluid drains out of the belly (figure 3). Before people can have peritoneal dialysis, they need surgery to have a tube put in their belly. The tube allows the fluid to get in and out of the belly.More information about peritoneal dialysis can be found in this article: (see "Peritoneal dialysis").

Hemodialysis " � Hemodialysis is a procedure in which a dialysis machine takes over the job of the kidneys. The machine pumps blood out of the body, filters it, and returns it to the body (figure 4). Before people can have hemodialysis, they need surgery to create an "access. " � An access is a way for the blood to leave and return to the body. People have hemodialysis at least 3 times a week. Most people can choose between having hemodialysis at a dialysis center (in a hospital or clinic) or at home. More information about hemodialysis can be found in these articles: (see "Preparing for hemodialysis" and "Hemodialysis").

What are the benefits and downsides of the different treatments? " � The following Table lists the benefits and downsides of a kidney transplant, peritoneal dialysis, and hemodialysis (table 1). � �
How do I choose between the different treatment options? " � You, your doctor, and your family will need to work together to find the treatment thats right for you. It will depend partly on your condition, overall health, and home situation. Your doctor can explain all of your options. � �
People usually benefit most from a kidney transplant. But a new kidney is not always available. Plus, not everyone who wants a kidney transplant can get 1. People need to meet certain conditions to be able to get a kidney transplant. � �
When thinking about your choices, you should also know that: � �

If you are on a list to get a kidney from a dead donor, you might need to wait a long time. You will most likely need to start peritoneal dialysis or hemodialysis while you wait.
If you start 1 type of dialysis and it doesn't work for you, you can switch to the other type of dialysis.

Can I choose not to have any of these treatments? " � Yes, you can choose not to have any renal replacement therapy. People usually live for days to weeks without treatment, depending on their kidneys, symptoms, and overall health. � �
If you don't have renal replacement therapy, waste will build up in your blood. This can make you feel tired, itchy, or sick to your stomach. Fluid will also build up in your body. This can cause swelling and trouble breathing. During this time, your doctor will give you medicines to treat your symptoms and make you more comfortable. � �
All topics are updated as new evidence becomes available and our peer review process is complete. � �
This topic retrieved from UpToDate on: Nov 04, 2014. � �
Topic 16438 Version 3.0 � �
Release: 22.8 - C22.208 � �
� � 2014 UpToDate, Inc. All rights reserved. � �

figure 1

Anatomy of the urinary tract

Urine is made by the kidneys. It passes from the kidneys into the bladder through two tubes called the ureters. Then it leaves the bladder through another tube, called the urethra.

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Anatomy of the urinary tract

Urine is made by the kidneys. It passes from the kidneys into the bladder through two tubes called the ureters. Then it leaves the bladder through another tube, called the urethra.

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figure 2

Kidney transplant

This drawing shows a person who has had a kidney transplant. The new kidney is put in the lower part of the belly. Its ureter (the tube that carries urine from the kidney to the bladder) is connected to the persons bladder. In many cases, the diseased kidneys are left in place.

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Kidney transplant

This drawing shows a person who has had a kidney transplant. The new kidney is put in the lower part of the belly. Its ureter (the tube that carries urine from the kidney to the bladder) is connected to the person's bladder. In many cases, the diseased kidneys are left in place.

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figure 3

Peritoneal dialysis

This drawing shows a person having peritoneal dialysis. The dialysis fluid (fresh dialysis solution) flows into the person's belly. It stays there for a certain amount of time, and then it drains out into the drain bag. The "transfer set" is the tubing that connects a thin tube (catheter) in the person's belly to the dialysis equipment.

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Peritoneal dialysis

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figure 4

Hemodialysis

This drawing shows a person getting hemodialysis. Two needles are put into an "access" in the person's arm. Blood flows from the body to the hemodialysis machine, where it is filtered. Then the blood is returned to the body. The whole process takes about 3 to 5 hours and must be repeated 3 to 7 times a week.

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Hemodialysis

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table 1The benefits and downsides of kidney transplant, peritoneal dialysis, and hemodialysisView Largetable 1The benefits and downsides of kidney transplant, peritoneal dialysis, and hemodialysis

Benefits

Downsides

Kidney transplant

People who get a kidney transplant usually live longer and have a better quality of life than people who are treated with dialysis

A kidney transplant is major surgery
It can be hard to find a donor kidney
People with certain medical conditions can't have a kidney transplant
After surgery, you need to take medicines every day for the rest of your life. These medicines could cause you to get severe infections or cancer.
After surgery, your body might "reject" your new kidney

Peritoneal dialysis

You can do it at home, which gives you more freedom and control over your life
It doesn't involve needles
You can do it overnight while you sleep
You don't need anyone to help you if you learn how to do it yourself
You don't need to limit your diet as much as with hemodialysis

It can be hard to learn how to do it
It increases the chance that you will get an infection in your belly

Hemodialysis

You usually have it in a dialysis center, where doctors and nurses can watch you closely
You don't have to learn to do it yourself
You do it fewer days each week than peritoneal dialysis

You need to travel to the center and back three times (or more) every week
You will have needles put in your arm each time
Your access can get infected or stop working
During dialysis, you might feel lightheaded or have trouble breathing

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