If PD Fails, Think About Home HD

Some people do peritoneal dialysis (PD) and feel great for 10 or 15 or 20 years. But many who choose PD stop after just 2–3 years. 1 The peritoneum can fail. Or they may have "buyer's remorse" if PD does not fit their lives the way they hoped it would.

If this happens to you and you don't have a kidney transplant donor, you'll need to switch to a form of hemodialysis (HD). Why not home HD?

Quality of life on PD vs. HD

Rick by the Pool

When making a switch from PD to HD, it makes sense to think about how your quality of life will look.

Standard in-center HD (three times a week for 3–4 hours) is the "default" treatment. Some end up with it and don't know there are other options. 2 But PD is always a conscious choice. A study of why people choose PD found these reasons: 3

Quotes from people who do PD bear out these key points:

"[In-center] HD wore me out, to where I couldn't do much other than go to treatments and sleep. Then I found PD, which no one had ever talked with me about before—and after a little research, I made the switch. It was the BEST choice I ever made. I now use a cycler at night, and work during the day."

"I had a terrible time on [in-center] HD. I was scared at first because I wasn't sure if I could be in charge of my own care. But the difference is night and day for me. I have taken charge, and not only do I feel better physically but emotionally and spiritually too."

"Personally, I prefer PD to even the thought of HD. PD does not interfere with my lifestyle as much as HD would. I am very busy and tell people that I do not have time to sit on a machine for 4–5 hours 3 days a week. I do PD at night on a cycler and am dry during the day so can forget about dialysis during the day. I am able to continue all my activities and work. If I were on [in-center] HD I would have to quit work and would be unable to be as active as I am."

One study looked at quality of life in 60 people on PD and 60 on HD. 4 Those on PD had a much better quality of life in terms of:

And, on a scale of 1-10 (10 was the best), people on PD had a satisfaction rating 8.02. Those on standard in-center HD rated theirs at 7.25—significantly lower. 5 Why choose a treatment that people are less satisfied with?

Survival on PD vs. in-center HD

Elderly Mother and Her Daughter A look at nine large studies of survival with PD vs. standard in-center HD found that they tend to be about the same. Younger people and those who do not have diabetes tend to live longer with PD than with standard HD. 6

While those on PD don't seem to fare any worse after switching to in-center HD, 7 why not aim for better ?

Types of home HD

small home hd machine

Medicare requires clinics to tell you about ALL of the treatments for kidney failure—and where you can get them. 8 But we suspect this is not yet done across the US. If you need to make a change, learn your options. You'll be better able to choose a treatment that will fit your life:

Standard home HD
A nurse trains you and a partner to do HD treatments on a standard HD machine at home 3x/week.
  • You will have ups and downs in how you feel, and may not feel well for a few hours after each treatment.
  • Just 3 treatments means more fluid and diet limits and meds to take.
  • With only 3 treatments, you have a much higher risk of sudden cardiac death on the day after the 2-day no-treatment weekend. 9
  • You can schedule treatments when you want, though, and be at home.
Short daily home HD
A nurse trains you and a partner to use a small machine (see below) to do 2.5–4 hour treatments 5–6 days a week. dialysis machine in bedroom
  • You won't have ups and downs, 10,11
  • Eat and drink more of what you like.
  • You won't need as many blood pressure pills 12 or binders.
  • You may feel well half an hour or so after each treatment. 13
  • Survival is much better than standard HD or PD—in fact, it's about the same as deceased donor transplant! 14,15
Extended home HD
HD treatments are done for 6–8 hours, most often at night while you sleep, 3–6 times/week. This option (which may be called "nocturnal") is closest to PD in terms of lifestyle.
  • Slow, gentle treatments are easy on the heart.
  • No special diet or fluid limits may be needed. 16,17
  • Extended HD removes much more phosphorus so you won't need binders. 18
  • Blood pressure pills can be stopped. 19
  • People who do extended HD say it is no more of a burden than PD was. 20
  • People feel well just 10 minutes after the long treatments. 13
  • Studies find that people live about as long as if they had a deceased donor transplant. 21,22

Home HD: Things to Think About

Dialysis Needles

If you switch from PD to HD, there will be needles. Some programs will let you do home HD with a catheter. HD catheters at home are safer than in-center. 23 Learning to put in your own needles if you have a fistula or graft puts control in YOUR hands and removes a lot of the pain and fear.

If you have to have needles for HD, you might as well reap the benefits of better treatment!

Needing a Partner

Most programs require a partner for home HD. It’s best to do as much of your treatment as you can—whether or not you have a partner. If you live alone:

Finding a Home HD Program

Not knowing where to find home HD can also stop you. Look at the Find a clinic database on Home Dialysis Central to search by type of treatment and zip code.

Both PD and home HD have been growing. 26 There are more than 5,000 dialysis clinics in the US. About 45% have some type of PD. Growth has been much higher in home HD, but only about 15% of clinics offer some type of home HD.


You may or may not want to switch from PD to some form of HD. But if you need to for some reason, it's good to know that there are home HD treatment options that can help you keep the freedom, flexibility, and control of PD.


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  2. USRDS 1997 Annual Data Report, USRDS Dialysis Morbidity and Mortality (Wave 2), p. 53
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  16. Geary DF, Piva E, Tyrrell J, Gajaria MJ, Piccone G, Keating LE, Harvey EA. Home nocturnal hemodialysis in children. J Pediatr. 2005 Sep;147(3):383-7
  17. Warady BA, Fischbach M, Geary D, Goldstein SL. Frequent hemodialysis in children. Adv Chronic Kidney Dis. 2007 Jul;14(3):297-303
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  19. Nesrallah G, Suri R, Moist L, Kortas C, Lindsay RM. Volume control and blood pressure management in patients undergoing quotidian hemodialysis. Am J Kidney Dis. 2003 Jul;42(1 Suppl):13-7
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  24. Dialysis Needle Fear
  25. Self-Cannulation
  26. Copland M, Murphy-Burke D, Levin A, Singh RS, Taylor P, Er L. Implementing a home haemodialysis programme without adversely affecting a peritoneal dialysis programme. Nephrol Dial Transplant. 2009 Aug;24(8):2546-50