Switching Dialysis Treatment

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.

There are two main types of dialysis: peritoneal dialysis and hemodialysis (in-center and home hemodialysis). Some people who are on one type of dialysis treatment wonder whether another type of dialysis treatment would be more comfortable, result in better outcomes or better fit their lifestyle. For others, a switch in dialysis treatment may be needed because of their medical condition. With input from your doctor and healthcare team, you can decide whether switching dialysis treatments is the right decision for you.

Reasons to switch

For many patients with end stage renal disease (ESRD), switching from one kind of dialysis to another is a lifestyle choice. Some patients prefer to treat themselves at home, which is where peritoneal dialysis (PD) or home hemodialysis (HHD) is done; while others would rather have professionals treat them at a hemodialysis center. Many patients find that shorter daily PD treatments are preferable; others prefer the every-other-day schedule at the hemodialysis center, even if it means longer treatment sessions.

Some patients consider switching to a different dialysis treatment for medical reasons. Your doctor may recommend switching if your current treatment is not cleaning your blood adequately. Your doctor will check how effective your treatment is by looking at your blood work as well as your urea reduction ratio (URR) and Kt/V level. URR and Kt/V are used to measure dialysis adequacy, or how effective dialysis is in removing wastes. National guidelines recommend a URR of at least 65 percent and a Kt/V of at least 1.2 for hemodialysis patients who dialyze three times per week and a Kt/V 1.7 for peritoneal dialysis treatments. In other circumstances, people who have difficulty maintaining a functional dialysis access (such as an AV fistula, graft or PD catheter) may need to consider changing to a different type of therapy.

Your medical history and health conditions may also be reasons to switch. If you have diabetes or high blood pressure or find yourself cutting time short because you're feeling bad, another dialysis treatment option may be better for you.

Dialysis options

If you are happy with your current type of treatment, there are options that may make it even better for you. For example, if you want to stay on hemodialysis, but would rather not go to a dialysis center for treatments, HHD may be an option for you. Or perhaps you need your days free but would like to continue in-center hemodialysis, nocturnal dialysis may be available at a center near you. Or if you want to do dialysis at home but without using needles, you could look into peritoneal dialysis. Talk to your doctor about the different choices you have.

Hemodialysis can be done at a dialysis center or at your home. At a dialysis center, you will be surrounded by healthcare professionals trained to watch over you while you are being treated. Traditional in-center hemodialysis treatments last about three to four hours and are generally scheduled three times a week. Some patients use this time to sleep, catch up on work, read or relax. In-center hemodialysis patients also have the option of performing their own treatment (called in-center self care) under the direction of a registered nurse.

Home hemodialysis is just that: hemodialysis that can be done in the comfort of your home. A hemodialysis machine will be set up for you in your home to perform your treatments. You and your care partner will be trained on how to use and monitor the machine, as well as the sanitary practices that must be followed to prevent infections. Many patients enjoy taking an active part in their treatment as well as the convenience of home hemodialysis.

Peritoneal dialysis is the most popular home dialysis option and can either be automated or manual. PD uses the thin membrane that lines your abdomen to perform dialysis treatments. The abdomen is filled with dialysate through a permanent catheter that is surgically placed in the abdomen. After a few hours, the dialysate is drained and fresh dialysate is put in. PD patients also have the option of having these exchanges automated. Automated peritoneal dialysis (APD) uses a machine called a cycler that automatically fills and empties the dialysate from the peritoneal cavity while the patient is asleep. This helps free up the day for other activities when this option is used. Other patients may choose to perform manual exchanges of dialysis fluid without the use of a machine. This is called continuous ambulatory peritoneal dialysis (CAPD), with exchanges usually done four to five times a day.

Can you switch?

Your doctor will determine if you need to switch treatment programs for medical reasons. If you would like to switch because of other reasons, use DaVita's online Treatment Evaluator tool. This short quiz will show you which treatment fits your lifestyle best according to your answers. You can talk to your doctor or healthcare team about these results and also about which treatment interests you most.

Your doctor will review your medical history and consider your current health. By eating right, taking your medicines, not missing dialysis treatments and following your doctor’s advice, you can make your current treatment program more effective and prepare yourself for a successful transition.

Making the switch

Switching from one type of dialysis treatment to another can be challenging, but for some it is worth the wait. If you are on PD and wish to move to hemodialysis, you will need surgery to create a vascular access. If you choose an arteriovenous (AV) fistula, which is considered the gold-standard access, it can take several months for it to heal and grow strong for hemodialysis. Some doctors advise that even PD patients who don't use an AV fistula have the surgery to place one in case they ever need to switch to hemodialysis. An arteriovenous (AV) graft is another vascular access option that takes only a few weeks to heal. Until the access is ready for hemodialysis, the patient can still use PD. If a person is no longer able to use PD, a temporary central venous catheter (CVC) can be placed for immediate use for hemodialysis.

Patients who switch from hemodialysis to PD will need to have a PD catheter placed. This is usually done as an outpatient procedure and requires two or more weeks healing time before it can be used. Some patients may stay on hemodialysis until the catheter is ready and he or she has been trained on how to do PD.

Learning new methods for your treatment (particularly if you opt for at-home treatment) will take training. Your home training nurses will be with you every step of the way. Talk to your doctor and healthcare team about any concerns you may have.

When switching is not possible

For some patients, switching from one type of dialysis treatment to another is not possible. Medical reasons and your lifestyle may not make you a good candidate for some other treatments. If you wish to switch but discover you cannot, discuss your concerns about your current treatment with your doctor and DaVita care team. Your doctor may be able to make adjustments to your current dialysis treatment so that you can have a more comfortable experience and feel better, and your care team can provide additional resources to help you manage your physical and emotional needs.

Improving your quality of life

Switching dialysis treatments may help you improve your quality of life as well as your health. Whichever dialysis treatment you choose, you will still need to follow the advice of your doctor and healthcare team to make any switch successful.

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