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Compare treatments for kidney disease

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What are my options for kidney disease treatment? What are the pros and cons of each option? Are the patients currently doing the treatment satisfied? What would my doctor choose for himself? How much time will I have to commit to dialysis? How will I feel after dialysis?

This tool can help you answer these and some of your other questions about the different treatments for kidney disease. This tool is not medical advice and provides general information and publicly available facts on each treatment. You should discuss your treatment options with your doctor, other members of your kidney team and your family and friends to determine the best therapy for your health and lifestyle.

We recommend you print this tool, circle or highlight the things that are important to you and have it with you when you talk to your doctor and kidney team. Make sure you discuss the things that are important to you. And remember, dialysis isn’t an end. It’s just another chapter in a life well lived.

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Number of people on therapy in the U.S. as of December, 2008
Transplant	Peritoneal Dialysis (PD)	Home Hemodialysis (HHD)†	In-center Hemodialysis (ICHD)

Preferred treatment	Most utilized home therapy	Most flexible Hemodialysis	Currently most utilized treatment for kidney disease in the U.S.

A donated kidney is surgically placed in your body.	Dialysis is done by you at home using a special solution that goes into your abdomen through a tube called a catheter. Waste products and extra fluid are removed when you drain the solution from your body.	Dialysis is done by you and a trained partner at home. Blood is removed from the body, usually through an access point in your arm. The blood is cleaned by a home dialysis machine with a special filter, before being returned to your body.	Dialysis is done by nurses and technicians in a clinic. Blood is removed from the body, usually by an access point in your arm. The blood is cleaned by a machine with a special filter before being returned to your body.

No longer need dialysis You have a functioning kidney again You have more energy and feel better than compared to dialysis Requires anti-rejection medications which may be costly and have side effects Requires surgery May have to wait for a kidney	Can help you preserve any remaining kidney function^1,2 Preserves access to veins Flexible dialysis schedule Have more energy and feel better than compared to In-center Hemodialysis³ Less fatigue and fewer daily peaks and valleys with how you feel compared to In-center Hemodialysis³ Must keep dialysis supplies and equipment at your home Have a catheter (tube) in your abdomen	Fewer fluid and dietary restrictions^4,5 Fewer blood pressure and phosphorus medications^4,5 Strengthens your heart and makes your heart better able to manage excess fluid^4,5,6 Have more energy and feel better than compared to In-center Hemodialysis³ Fewer daily peaks and valleys with how you feel than compared to In-center Hemodialysis³ Must keep dialysis supplies and equipment at your home Must have a trained partner May require modifications to your home You or your partner must perform needlestick Exchange of blood occurs in your home	Have four days off from dialysis No dialysis supplies in your home Interact with other dialysis patients Many restrictions on fluid and diet compared to all other treatments Limited flexibility and control over dialysis schedule and amount of dialysis May feel bad and tired between and following dialysis treatments

United States Renal Data System (USRDS) American Association of Kidney Patients (AAKP) Patient Survey American Journal of Kidney Disease	United States Renal Data System (USRDS) American Association of Kidney Patients (AAKP) Patient Survey American Journal of Kidney Disease Nephrology News & Issues	United States Renal Data System (USRDS) American Association of Kidney Patients (AAKP) Patient Survey American Journal of Kidney Disease Nephrology News & Issues	United States Renal Data System (USRDS) American Association of Kidney Patients (AAKP) Patient Survey American Journal of Kidney Disease Nephrology News & Issues

165,639⁷	28,291⁸	4,141⁸	339,483⁸

% of patients "satisfied" with their treatment
Transplant - 87%⁹	PD - 75%⁹	HHD - 85%⁹	ICHD - 52%⁹
Survival rate after 1 year
92.4%^{10 ††}	87.3%¹⁰	U.S. survival data is not currently available	79%¹⁰
Survival rate after 5 years
71.2%^{10 ††}	36.9%¹⁰	U.S. survival data is not currently available	35%¹⁰
% of waste and excess fluids removed from body - goal is 100%
15% - 100% (depending on the function of the transplanted kidney)	15%¹¹**	15%¹²**	19%¹³**
% of patients requiring hospital stay due to serious infection (bacteremia/septicemia) or peritonitis (exit-site infection)
3.3%¹⁴	6% - sepsis¹⁴ 18.6% - peritonitis¹⁴	U.S. data is not currently available	10.5%¹⁴

% receiving a transplant within 2 years (Data from 2003-2005)
Not Applicable	9.3%¹⁵	2.5%¹⁵	2.9%¹⁵
% of nephrologists who would choose this dialysis while waiting for transplant
Preferred treatment	43%¹⁶	50%¹⁶	5%¹⁶

Time spent connected to dialysis equipment
No dialysis needed	CAPD: 30-40 minutes per day, four times per day APD: 8-10 hours per night	Short daily: 2-3 hours a day, 4-6 days a week Nighttime: 8-10 hours a day, 5-7 days a week	3-5 hours a day, 3 days a week
Days per week waste and fluids are removed from the body
7 days	7 days	Short daily: 4-6 days Nocturnal: 5-7 days	3 days
Recovery time after each dialysis treatment
Not Applicable	Typically no recovery time	Short daily: 16-67 minutes³; Nocturnal: 2-20 minutes³	397-460 minutes (7 hours)³
Average monthly time in clinic + travel time to clinic (does not include time dialyzing at home)***
Frequent visits post-transplant for first year Annual visit every year thereafter	3 hours per month¹⁴	3 hours per month¹⁴	60 hours per month^3,18

% of patients employed 90 days after starting of dialysis ^*
Not applicable	32.4%¹⁷	Not applicable	16.2%¹⁷

Learn more
Renalinfo.com or kidney.org	Discover PD	Discover HHD	Renalinfo.com or kidney.org
Where to find
USAtransplant.org - click on Find A Transplant Center or call: (800) 830-9664	Dialysis Facility Compare at www.medicare.gov > Resources > Dialysis Facilities	Dialysis Facility Compare at www.medicare.gov > Resources > Dialysis Facilities	Dialysis Facility Compare at www.medicare.gov > Resources > Dialysis Facilities

Is home dialysis right for you?

While home dialysis has many advantages and is a viable option for most people, there are some exceptions. You must be healthy enough to provide care for yourself. In some cases, you may need to have a caregiver. You will also need to have a home or place suitable for home dialysis. If you've had previous abdominal surgeries or the presence of intestinal diseases, such as inflammatory bowel disease or diverticulitis, your doctor might not prescribe home dialysis. Home dialysis may also not be an option if you've had a recent history of seizures or memory difficulties. In addition, there are sanitary precautions that must be taken before, during and after dialysis, and you must be prepared for occasions or incidents that, if not recognized and responded to promptly, may be hazardous to your health. Remember, every patient is different so it is important to talk to your doctor, nurse and/or social worker to determine if there are other reasons home dialysis may not be right for you.

† Information is for short-daily and nocturnal/nighttime HHD

††Deceased donor survival data

* For patients who were working up to a year prior to starting dialysis, the following are the percentage of patients that remained employed four months after starting dialysis: PD = 61%, HD = 29%¹⁴

** Normal kidneys have a standard weekly Kt/V of 12.965, Peritoneal dialysis has a standard Kt/V of about 2.05 So 2/12.96 = 15%, Short daily HD has a weekly standard Kt/V of 2.0-2.2 6 So 2.1/12.96 = 16%, In-center HD has a standard Kt/V of 2.497 So 2.49/12.96 = 19%

*** PD 30 minutes travel to and from clinic, 1-2 hours for monthly clinic visit. Total of 3 hours per month, HHD - 30 minutes travel to and from clinic, 1-2 hours for monthly clinic visit. Total of 3 hours per month, ICHD - 30 minutes travel to and from clinic 3 times per week = 3 hours, 4 hours for treatment in clinic, 3 times a week = 12 hours. Total of 15 hours per week, 4 weeks a month = 60 hours

^1. Misra M, Vonesh E, Van Stone JC, Moore HL, Prowant B, Nolph KD. Effect of cause and time of dropout on the residual GFR: a comparative analysis of the decline of GFR on dialysis. Kidney Int. 2001;59:754-763.

^2. Jansen MA, Hart AA, Korevaar JC, Dekker FW, Boeschoten EW, Krediet RT. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int. 2002;62:1046-1053.

^3. Heidenheim AP, Muirhead N, Moist L, et al. Patient Quality of Life on Quotidian Hemodialysis. Am J Kidney Dis. 2003 Jul; 42(1 Suppl):36-41

^4. Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis versus conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA. 2007; 298:1291-1299.

^5. Ayus JC, Mizani MR, Achinger SG, et al. Effects of short-daily versus conventional hemodialysis on left ventricular hypertrophy and inflammatory markers: a prospective controlled study. JASN. 2005; 16:2778-2788.

^6. Hiroaki Lo, Yuuki Ro, Yoshimi Sekiguchi et al. Cardiac structure and function in longitudinal analysis of echocardiography in peritoneal dialysis patients. Perit Dial Int. 2010; 30 (3):353-361.

^7. United States Renal Data System – 2010 Annual Data Report – Treatment Modalities. Available at: www.usrds.org. Accessed October 20, 2010.

^8. ESRD Network 2009 Annual Reports Table 3 & 4. Accessed October 20, 2010.

^9. Fadem S, Walker D, Abbott G, et al. Satisfaction with Renal Replacement Therapy and Education: The American Association of Kidney Patients Survey. CJASN. 2011; 6:605-612

^10. United States Renal Data System – 2009 Annual Data Report – Patient Survival. Available at: www.usrds.org. Accessed October 20, 2010.

^11. Gotch FA. The Current Place of Urea Kinetic Modeling with Respect to Different Dialysis Modalities. Nephrol Dial Transplant. 1998;13(Suppl 6):10-14.

^12. Jaber B, Lee Y, Collins A, et al. Effect of Daily Hemodialysis on Depressive Symptoms and Postdialysis Recovery Time: Interim Report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis. 2010;56(3):531-539.

^13. Chertow GM, Levin N, Beck G, et al. In-Center Hemodialysis Six Times per Week versus Three Times per Week. New England J Med. November 20, 2010. 10.1056/NEJMOA1001593.

^14. United States Renal Data System – 2009 Annual Data Report – Morbidity & Hospitalization. Available at: www.usrds.org. Accessed October 20, 2010.

^15. United States Renal Data System – 2009 Annual Data Report – Treatment Modalities. Available at: www.usrds.org. Accessed October 20, 2010.

^16. Schiller B, Neltzer A, Doss S. Perceptions about Renal Replacement Therapy among Nephrology Professionals. Neph News & Issues. September 2010:36-44.

^17. Mehrotra R, Kermah D, Fried L, et. al. Chronic Peritoneal Dialysis in the United States: Declining Utilization Despite Improving Outcomes. JASN. 2007; 18: 2781-2788.

^18. Moist L, Bragg-Gresham J, Pisoni R, et al. Travel Time to Dialysis as a Predictor of Health-Related Quality of Life, Adherence, and Mortality: The Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2008;51(4):641-650.

^19. Kutner N, Zhang R, Huang Y, et. al. Depressed Mood, Usual Activity Level, and Continued Employment after Starting Dialysis. CJASN. 2010; 5: 2040-2045.

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Compare treatments for kidney disease

Transplant

Peritoneal Dialysis (PD)

Home Hemodialysis (HHD)†

In-center Hemodialysis (ICHD)

Is home dialysis right for you?