Use of peritoneal dialysis or haemodialysis

Haemodialysis is significantly more efficient than peritoneal dialysis (CAPD) at removing solutes from the blood. However, there may be difficulty with:

• vascular access
• cardiovascular stability - especially, in patients who may be elderly, hypotensive, or have a recent history of myocardial infarction

The efficiency of peritoneal dialysis is constrained by the volume of dialysis fluid used. Volumes greater than two litres are poorly tolerated. Haemodialysis achieves clearance rates of 100 ml/min compared to values of 25-30 ml/min for peritoneal dialysis. Thus, peritoneal dialysis becomes increasingly inadequate with:

• increasing uraemia
• increasing body weight

Peritoneal dialysis also may cause respiratory difficulty, even with 1 litre exchanges, and peritonitis remains a major complication. The haemodynamic stresses caused by CAPD are less than for haemodialysis.

NICE guidance states that:

• offer all people with stage 5 CKD a choice of peritoneal dialysis or haemodialysis, if appropriate, but consider peritoneal dialysis as the first choice of treatment modality for:
  • children 2 years old or younger
  • people with residual renal function
  • adults without significant associated comorbidities

Reference:

• 1) NICE (July 2011). Peritoneal dialysis - Peritoneal dialysis in the treatment of stage 5 chronic kidney disease