Which is best? Hemo or PD

I have been on hemodialysis for about 10 months now. I have a lot of problems with cramping in my feet and legs every time I have a treatment. I’m thinking of PD, if cramping is not a problem on PD. I figure if I dialise every day, I can get the extra fluid off every day. The nurses seem to think I put too much fluid on between hemo treatments. Does any body have any comments about cramping? Has PD helped anyone else out with fluid problems? I’m at my wits end. PLEASE HELP

Hi David, and welcome to Home Dialysis Central! I’m an administrator of this site, not a patient but an educator–but I can feel the frustration in your post, and didn’t want you to have to wait too long before others post replies to you.

The choice of which treatment is “better,” PD vs. HD is really a very personal one. But if you read through the summaries of different home therapies on this site (http://www.homedialysis.org/v1/types/) and our comparison chart of ALL dialysis treatments, you’ll see that all of the forms of home dialysis have one thing in common: MUCH LESS LIMITED DIET AND FLUIDS. I hate to shout, but this is such a key point for day-to-day quality of life on dialysis–along with the ability to schedule treatments AROUND your life instead of fitting your life around dialysis.

It’s frustrating to contantly hear that patients are “putting on too much fluid between treatments,” (even though it’s true!) because the alternative on in-center hemo is to be obsessive about the fluid limit around the clock–and it doesn’t have to be this way if the dialysis would do more of the “heavy lifting” so you don’t have such a high burden of “compliance” with diet and fluids.

Leg cramps are much less of a problem with PD, although it’s important to note that every treatment has its pros and cons, and PD can cause abdominal cramping for some patients (this can usually be dealt with). It’s only common sense that continuous therapies, like PD, work more like your kidneys do. The treatment is gentler, since it doesn’t have to do as much work in a short time.

Not everyone is suited for PD; if you are a very large person or have had abdominal surgeries, it may not work for you. If this is not the case, and you decide you’re interested in PD, then talk to your doctor about it and look up your area in our “Find a Center” database to see what’s available. Sometimes people have to change doctors to get to a treatment they want; others are able to work out their choices through good communication with their care team.

Good luck, and I hope you get lots of other good answers.

Good luck for you

So far as your fluid intake, have you talked with your dietitian about what you can do to manage your fluids? Have you asked your doctor or nurse to review your medicines to see if any have the side effect of thirst or dry mouth and if so, whether there are others that do the same thing without causing this side effect? If you’re diabetic, have you talked with the doctor or dietitian about how to keep your blood sugar under tighter control (high blood sugar makes you thirsty). Have you seen the fact sheet on fluids (www.lifeoptions.org/catalog/pdfs/teaching/Fluid.pdf) or the patient and staff tips on fluid control (www.lifeoptions.org/stories/stories.php)?

I worked with PD patients for years and don’t remember any of them complaining of leg cramps unless it was from another condition like nerve damage in the legs. Some of them complained of pain in their rectal area or feeling full when their body was getting used to having a catheter and extra fluid in the abdomen. However, when warmed solution is drained into the body, patients generally don’t report abdominal cramps. I have seen some messages on the message boards where patients have complained of painful fills and drains so asking a nurse who trains patients to do PD about how common this is and what can be done about it would be very wise.

As Dori said, large people or those who have had multiple abdominal surgeries generally can’t do PD with the typical PD catheter that’s inserted into the abdomen below the beltline. However, if your doctor is concerned about whether this kind of PD catheter would work for you, there is a different kind of catheter that has been used for over 10 years successfully. It’s called a presternal PD catheter. It allows people that would otherwise have not been able to do PD to do it. Some patients with presternal catheters can take baths in a tub or soak in a hot tub, two things that most PD patients with the traditional abdominal PD catheters can’t do.

Hers’s a link to an article about the presternal catheter that you might want to show to your doctor:

It should not be accepted as normal to have cramps every treatment on 3 times per hemodialysis. I was on that method of dialysis for almost 3 years, and I only had cramps a few times at the beginning. If you put on too much fluid between treatments, the dialysis will have to take off more fluid in the same amount of treatment time. This is where cramps come from - because much of that fluid is not in the blood, where it’s easily accessible, but rather in the cells and extracellular tissues where it isn’t as easy to get at. As it gets pulled out into the blood circulation to replace the fluid being taken out by dialysis, it causes cramps. There are always exceptions, but most people who constantly have cramps and have trouble with too much fluid intake are often eating too much salt. Cut down the salt, and the thirst follows. I’ve seen some people with severe cramp problems every treatment actually eat a whole bag of salty chips while on treatment, thereby ensuring they have a head start on cramps for the next treatment (if you eat chips - not that I’m saying you do, for example, during a treatment, the sodium will not have enough time to be digested during that treatment, so, it’s going to be in you until the next treatment). There’s no substitute for cutting down the sodium. The only other solution is to go on daily dialysis, and, if fluid is really the problem, it will probably take daily nocturnal hemodialysis to deal with it. Short daily hemodialysis just isn’t long enough to deal with lots of fluid.

PD may or may not be the solution, but it’s not a guarantee. While PD is more continuous and daily, its method of removing fluid (sugar in the dialysate draws out fluid from the blood in the peritoneal membrane) is nowhere near as efficient as the ultrafiltration of hemodialysis. So, in the end, the difference in ability to drink fluid between PD and 3x week hemodialysis is not really dramatic. I’ve had many friends and acquaintances on PD, and their fluid restriction was pretty much the same as mine was on in-centre hemo. If that’s your only reason to switch from the known of hemo to the unknown of PD, then you may be setting yourself up for disappointment.


I use to cramp alot in center as well…I talked to my Dr. and nurses but they didn’t do much so I went to my primary Dr. and they did some blood work and found my pottasium to be low…so I go back to my clinic and demanded them to increase my K bath from 1K to 2K…

I also had cramps from low calcium bath and also increased that a bit…after that cramps was minimized greatly…

Other times cramping was from low-sodium in the blood, but blood pressure has great influence on that so in most cases a low blood pressure + fluid weight can have an effect on cramping…