Chart — Renal
Dialysis Comparison Chart
Hemodialysis vs peritoneal dialysis — mechanism, access, frequency, advantages, limitations, and nursing considerations side-by-side for nursing students and NCLEX preparation.
Source: National Kidney Foundation KDOQI Guidelines; KDIGO 2022 CKD Guidelines; clinical nephrology references. Reflects standard practice — protocols vary by institution.
Educational use only. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Key teaching point: Neither hemodialysis nor peritoneal dialysis is universally superior — the choice depends on patient preference, cardiovascular stability, lifestyle, surgical history, and residual kidney function. Transplant remains the optimal treatment for ESRD when eligible.
Hemodialysis (HD)
Extracorporeal · 3× weekly · Vascular access required
Peritoneal Dialysis (PD)
Home-based · Continuous/overnight · Peritoneal catheter
| Feature | Hemodialysis | Peritoneal Dialysis |
|---|---|---|
| Mechanism | Extracorporeal circuit — blood removed from body, filtered by artificial kidney (dialyzer/hemofilter), returned to patient | Blood stays in the body — dialysate instilled into peritoneal cavity; peritoneum serves as natural semipermeable membrane |
| Primary principle | Diffusion (concentration gradient) + ultrafiltration (hydrostatic pressure) across synthetic membrane | Diffusion + osmosis (dextrose in dialysate creates osmotic gradient to remove fluid) across peritoneal membrane |
| Vascular access | Required: AV fistula (preferred), AV graft, tunneled CVC, or temporary CVC | Peritoneal catheter (Tenckhoff catheter) inserted into peritoneal cavity — exits through abdominal wall |
| Setting | Outpatient dialysis center (most common) or in-hospital. In-center or home hemodialysis programs. | Home-based primarily — CAPD (continuous) or APD (automated, overnight cycler). Hospital-based for acutely ill patients. |
| Frequency / schedule | Conventional: 3 sessions/week × 3–5 hours each. Home HD: may be daily or more frequent. | CAPD: 3–5 exchanges/day, 4–8 hours each dwell. APD: automated overnight cycler runs 8–10 hours nightly. |
| Fluid removal | Ultrafiltration — rapid, precise volume removal per session (1–3 L typical). Fluid restriction needed between sessions. | Gradual, continuous fluid removal via osmosis. Less dramatic fluid shifts. Better for hemodynamically unstable. |
| Solute clearance | Rapid, efficient small-solute clearance (urea, creatinine, K⁺). Higher weekly clearance for small molecules. | Slower but continuous small-solute clearance. Better middle-molecule clearance (beta-2 microglobulin) in some cases. |
| Hemodynamic impact | Significant — rapid fluid shifts can cause intradialytic hypotension; less well tolerated in cardiovascular instability | Minimal — gradual fluid removal; better tolerated in heart failure, hemodynamic instability, hypotension-prone patients |
| Cardiovascular patients | More challenging in severe HF, low BP, hemodynamic instability — rapid fluid shifts stress the heart | Preferred in patients with severe cardiovascular disease, hemodynamic instability, limited vascular access |
| Advantages | Most efficient small-solute clearance; professional monitoring at center; rapid correction of hyperkalemia/acidosis; AV access long-term | Home-based (independence, flexible schedule); no vascular access needed; continuous dialysis (more physiologic); better cardiovascular tolerance; preserves residual renal function longer |
| Limitations | Vascular access complications; intradialytic hypotension; schedule inflexibility; requires travel 3×/week; hemodynamic stress | Peritonitis risk; catheter site infections; technique failure; requires manual dexterity and cognitive ability; inadequate in large patients or after abdominal surgery |
| Contraindications | No reliable vascular access; severe coagulopathy (anticoagulation required); hemodynamic instability (relative) | Recent abdominal surgery (within 2–4 weeks); abdominal adhesions (reduces membrane function); hernias; severe COPD/respiratory failure (diaphragmatic pressure); severe protein malnutrition; inability to perform exchanges |
| Anticoagulation | Systemic heparin or regional citrate anticoagulation required to prevent circuit clotting | Not required for dialysis itself — heparin may be added to dialysate to prevent fibrin clots in catheter |
| Infection risks | Vascular access infections (CVC > graft > fistula); potential for bloodborne pathogen exposure in center | Peritonitis (most serious complication); catheter exit site infection; tunnel infection — often from Staph aureus or coagulase-negative Staph |
| Protein loss | Minimal protein loss through dialyzer (small amount of albumin) | Significant protein loss through peritoneal membrane (6–12 g/day) → increased dietary protein requirements |
| Dietary requirements | Restrict K⁺, phosphorus, Na⁺, fluid between sessions. Adequate protein intake. | Higher protein requirement (compensate for losses); lower potassium restriction typically possible; watch dextrose glucose absorption (glucose from dialysate absorbed — watch for hyperglycemia in diabetics) |
| Nursing considerations | Assess access patency (bruit/thrill); pre/post vital signs and weight; monitor for intradialytic hypotension; hold antihypertensives pre-dialysis; never use fistula arm for BP/IV/blood draw | Teach sterile exchange technique; assess catheter exit site; monitor for signs of peritonitis (cloudy effluent, abdominal pain, fever); accurate measurement of instilled vs drained volumes; daily weight |
Peritonitis Warning Signs (PD Patients)
Peritonitis is the most serious complication of peritoneal dialysis — requires urgent treatment
Cloudy effluent
Most reliable early sign — turbid PD drainage = peritonitis until proven otherwise
Abdominal pain / tenderness
Diffuse or localized; may be severe
Fever
Temperature >37.5°C with other signs = urgent evaluation
Nausea / vomiting
GI symptoms accompany abdominal peritoneal irritation
Action: Send cloudy effluent for cell count, differential, culture. Empiric antibiotics per protocol. Do NOT delay treatment.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with National Kidney Foundation KDOQI Guidelines; KDIGO 2022 CKD Guidelines. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →