Category: Nephrology — Choosing Kidney Replacement Therapy
Hemodialysis vs peritoneal dialysis: which is better, and which is riskier? A guide to choosing kidney replacement therapy in kidney failure (HD, CAPD/APD, transplant, and conservative care)
AI Overview / Quick Answer (BLUF)
Hemodialysis (HD) filters blood by machine via an arm fistula, 3×/week in-centre;
peritoneal dialysis (PD) uses the patient’s own peritoneum as a daily home filter.
Survival is broadly similar; choice depends on heart, veins, abdomen, home support, lifestyle.
Transplant is best long-term if eligible
(USRDS/KDOQI).
What this page covers, and what to read alongside it
- This page is for people with stage 4–5 chronic kidney disease and their families deciding between hemodialysis, peritoneal dialysis, a transplant, or conservative care.
- Already on PD and just starting exchanges → Starting peritoneal dialysis (CAPD) safely: infection control and nutrition
- PD exit site red, or blood pressure high → Exit-site care and hypertensive crisis on peritoneal dialysis
- On an APD cycler and the power goes out → Power outage, missed APD for one night: emergency guide
- Very high blood pressure with headache or blurred vision → Hypertensive emergency in dialysis patients
- Salt, low-sodium sauces, and potassium on PD → Low-sodium sauce and potassium risk on peritoneal dialysis
- Already transplanted → Frequent infections after kidney transplant: immunosuppressants and prevention
A question from one reader
The shortest answer is that no single method is best for everyone. Large studies show similar overall survival.
What really differs is whether you go to the machine or the machine comes to you, the frequency, the diet, and the type of risk.
Which one is “riskier” depends on each person’s heart, blood vessels, abdomen, eyesight, hands, and help at home —
this page gives you the picture before you meet your nephrologist, with a checklist to fill in yourself in section 6.
Red flags — contact your dialysis unit now, or call 1669 in Thailand
On hemodialysis (HD)
- You cannot feel the buzz or hear the whoosh in your fistula (thrill/bruit gone) — it may be clotted; tell the unit the same day, because early treatment can reopen it
- Bleeding from a needle site that will not stop after 10–15 minutes of pressure — keep pressing firmly and call the unit; if bleeding is heavy or spurting, keep pressing and call 1669
- Fistula or neck catheter that is red, hot, swollen, painful, or leaking pus
- Fever or chills during or after dialysis, especially with a catheter — possible bloodstream infection
- The fistula-side hand or arm is cold, pale, painful, numb, or weak (poor blood flow to the hand)
On peritoneal dialysis (PD)
- Cloudy drained fluid — keep the bag and call the PD unit the same day; do not wait for your appointment
- Abdominal pain, a rigid belly, nausea, vomiting, or fever
- Exit site that is red, swollen, or draining pus, or tender along the catheter tunnel
- Fluid will not fill or drain, or drains much less than was put in over several exchanges
- Rapid weight gain (for example more than 1–2 kg in 1–2 days), swollen legs or face
On either method
- Shortness of breath, cannot lie flat, waking at night to sit up to breathe — fluid overload / fluid on the lungs
- Chest pain, irregular palpitations, or generalized muscle weakness — possible high potassium
- New confusion, unusual drowsiness, or a seizure
- A missed dialysis session or missed exchanges together with any symptom above
- Very high blood pressure with severe headache, blurred vision, or limb weakness → read Hypertensive emergency in dialysis patients
1. Which is better, which is riskier: the direct answer
Direct answer: there is no “best” method for everyone — HD and PD give broadly similar overall survival.
The most avoidable risks are hemodialysis through a catheter, which has the highest infection rate,
and poor exchange technique on PD, which leads to peritonitis
(Ravani P, J Am Soc Nephrol 2013;
ISPD 2022).
- HD strengths: nurses run every session, no solution storage at home, and 4 treatment-free days a week
- PD strengths: done at home, no needles, slow continuous fluid removal with fewer blood-pressure swings, better early preservation of remaining kidney function, and more flexibility for travel and work
- Kidney transplant: if you are fit enough and a kidney is available (living or deceased donor), it gives the best long-term survival and quality of life
- Conservative kidney management without dialysis: a reasonable option for very elderly people with several other serious conditions
Risk by type of dialysis access (compared with an arm fistula = 1.00)
A systematic review of 62 cohort studies with 586,337 patients found that catheter users had 1.53 times the risk of death from any cause and 2.12 times the risk of fatal infection compared with fistula users.
These are observational data; people who need catheters are often sicker to begin with (selection bias). But every guideline points the same way: prepare a fistula in advance to avoid a catheter.
2. How hemodialysis (HD) works
Direct answer: blood is drawn from the fistula through two needles, passed through the machine’s filter (dialyser), and returned. The standard is 3 sessions a week of about 4 hours each.
The KDOQI 2015 guideline says people with little remaining kidney function should dialyse for at least 3 hours per session, with a target adequacy (spKt/V) of about 1.4 per session (minimum 1.2)
(KDOQI HD Adequacy 2015).
Three kinds of access: fistula first, catheter last
- AV fistula — an artery joined surgically to a vein in the arm. Lowest infection and clotting rates, lasts many years, but needs about 6–12 weeks to mature, sometimes longer. The “rule of 6” is a vein about 6 mm wide, no deeper than 6 mm, with blood flow around 600 mL/min.
- AV graft — a synthetic tube joining artery and vein when the veins are poor. Usable sooner (often about 2–3 weeks) but narrows and gets infected more often than a fistula.
- Tunneled neck catheter — usable immediately, suitable as a bridge or when nothing else is possible, but carries the highest risk of bloodstream infection.
The KDOQI 2019 guideline moved from “a fistula for everyone” to an individualized ESKD Life-Plan that matches the access to each person’s age, conditions, and treatment path
(Lok CE, KDOQI Vascular Access 2019).
Main risks of HD
- Low blood pressure during dialysis — dizziness and nausea from removing fluid quickly within 4 hours; the more weight gained between sessions, the higher the risk
- Cramps and post-dialysis fatigue; some people need hours to recover
- Access narrowing, clotting, or infection, sometimes needing balloon angioplasty or surgical repair
- Fluid and potassium build-up over the long weekend gap — the 2-day interval (for example Friday to Monday) was linked to 22.1 vs 18.0 deaths per 100 patient-years on the day after the long interval
(Foley RN, N Engl J Med 2011)
Protecting the fistula arm
- No blood-pressure cuff, no blood draws, and no IV lines on this arm
- No tight sleeves, watches, or bracelets; do not sleep on it or carry heavy loads with it
- Feel for the buzz (thrill) every morning and evening; if it is gone, call the unit right away
- Wash the arm with soap before each session and watch for redness, swelling, or pus around needle sites
Diet and fluid on hemodialysis
- Fluid: often limited to about 500–1,000 mL a day plus any urine output, as set by the unit, to keep weight gain between sessions low
- Stricter potassium limits (some fruits, raw leafy greens, vegetable juices) and phosphate limits (dairy, organ meats, processed foods, dark colas) than on PD, often with phosphate binders taken with meals
- Protein 1.0–1.2 g/kg/day when metabolically stable, and sodium below about 2.3 g/day
(KDOQI Nutrition 2020)
3. How peritoneal dialysis (PD: CAPD / APD) works
Direct answer: dialysis solution runs into the abdomen through a permanent catheter, dwells so that the patient’s own peritoneal membrane filters waste and draws off fluid, and is then drained — every day at home.
The ISPD 2020 recommendations emphasize goal-directed prescribing shared with the patient, based on symptoms and quality of life, not numbers alone
(Brown EA, ISPD 2020).
CAPD and APD
- CAPD — manual exchanges 3–5 times a day, each about 30–40 minutes; the rest of the time you go about your day with fluid in the abdomen
- APD — an automated cycler does the exchanges while you sleep for 8–10 hours; days are freer, suiting workers and students, but it needs electricity and a power-cut plan
- The PD (Tenckhoff) catheter is usually placed about 2 weeks before starting so the wound heals, followed by 1–2 weeks of nurse training until you or a caregiver can do it
Advantages of PD
- Done at home, no trips to the unit 3 times a week, no needles
- Removes fluid and waste slowly and continuously, with fewer blood-pressure swings — may suit a heart that cannot tolerate rapid fluid removal
- Better early preservation of remaining kidney function and urine output
- Easier travel — solution can be delivered to your destination, or the APD cycler can travel with you
Main risks of PD
- Peritonitis — ISPD 2022 sets a unit-level target of no more than 0.4 episodes per patient-year (on average less than one episode every 2.5 years). Most are treated with antibiotics added to the solution; catheter removal is needed only for refractory or fungal infection
(Li PK, ISPD 2022) - Exit-site or tunnel infection — daily exit-site care per your unit; some units use a topical antibiotic such as mupirocin or gentamicin
- Hernias, leaks, catheter kinking or migration, and poor drainage from constipation
- The body absorbs sugar from glucose-based PD solution, which can raise weight, blood glucose, and triglycerides; people with diabetes need medication adjustments, and icodextrin may be used for the long dwell to reduce glucose exposure
- The peritoneal membrane may filter less well after years, or infections may recur → a switch to HD may be needed (technique failure)
Hygiene during exchanges
- Wash hands step by step and wear a mask every time; switch off fans and close windows while connecting
- Keep pets out of the exchange room — cats biting tubing and animal-borne bacteria have caused peritonitis
- Store solution boxes somewhere clean, dry, and out of direct sun, off the floor
- Check every drained bag; if it is cloudy, keep the bag and call the PD unit the same day
Diet on PD is not the same as on HD
- Potassium and fluid are usually more liberal than on HD, and low potassium is common on PD — do not cut fruit and vegetables on your own unless your blood level is high
- PD loses protein into the dialysate every day, so enough high-quality protein is essential (often about 1.0–1.2 g/kg/day per KDOQI 2020, or as your dietitian sets)
- Limiting salt still matters, because salt drives thirst, fluid overload, and high blood pressure
How serious are your kidney-care warning signs?
Assess the severity of your symptoms and get personalized guidance from our Advisory team.
If you are breathless and cannot lie flat, have chest pain, or fistula bleeding will not stop, call 1669 first — do not do the score first.
Take the Kidney-Care Warning-Sign Score (free)
4. All five options in one table
Direct answer: kidney failure has five main paths — in-centre hemodialysis, manual peritoneal dialysis, overnight cycler PD, kidney transplant, and conservative kidney management without dialysis. Each trades off time, risk, and self-reliance
(NIDDK — Choosing a Treatment for Kidney Failure).
Comparison table: in-centre HD vs CAPD vs APD vs kidney transplant vs conservative kidney management
| Option | How it works | Schedule | Access / surgery | Main risks | Diet and fluid | Who it suits |
|---|---|---|---|---|---|---|
| In-centre hemodialysis (HD) | A machine pumps blood through a semipermeable filter and returns it | 3 sessions/week, about 4 h each, plus travel time | AV fistula (6–12 weeks to mature), AV graft, or neck catheter | Low blood pressure during sessions, cramps, access narrowing/clotting, infection (highest with a catheter), fluid and potassium build-up over the long weekend gap | Tight fluid limit (about 500–1,000 mL/day + urine), strict potassium and phosphate limits | People without help at home, poor eyesight or hand function, major past abdominal surgery, living near a unit |
| Manual peritoneal dialysis (CAPD) | Solution dwells in the abdomen; the peritoneum filters waste and draws fluid by osmosis | Daily, 3–5 exchanges of about 30–40 minutes | PD catheter placed about 2 weeks before starting + 1–2 weeks of training | Peritonitis, exit-site infection, hernia, leaks, weight and blood-sugar gain | More liberal potassium and fluid; needs more protein; watch sugar from solution | People who can self-care or have a caregiver, live far from a unit, have a heart that tolerates slow fluid removal better, still pass urine |
| Automated peritoneal dialysis (APD) | Same principle as CAPD, but a cycler does the exchanges | 8–10 h overnight while asleep; freer days | Same PD catheter + electricity and space for the machine | As for CAPD, plus machine faults or power cuts and sleep disrupted by alarms | As for CAPD | Workers, students, people with a caregiver to help set up at night |
| Kidney transplant (living or deceased donor) | A new kidney works 24 hours a day in place of the failed kidneys | One operation + lifelong daily immunosuppressants and frequent early follow-up | Major surgery after heart, cancer, and infection screening | Early surgical risk, infections from immunosuppression, rejection, some cancers | Most liberal once the kidney works well; food-safety precautions | People fit for surgery — ask for assessment from CKD stage 4 |
| Conservative kidney management | Medicines, diet, and symptom care to slow decline and protect quality of life, without dialysis | Periodic symptom-focused visits; no sessions or exchanges | No surgery | Possibly shorter survival than dialysis in younger or less comorbid people; uremic symptoms increase over time | Tailored to symptoms, focused on comfort and eating well | Very elderly people (for example 80+) with several serious conditions, or those who value avoiding dialysis most |
Summarized from KDOQI Vascular Access 2019,
ISPD 2020,
NIDDK Hemodialysis, and
NIDDK Peritoneal Dialysis — actual numbers depend on each person’s prescription.
5. Which lets you live longer: evidence from large registries
Direct answer: HD and PD give similar survival — US Renal Data System data on 620,020 HD and 64,406 PD patients found no significant difference in the risk of death over 5 years for those starting in 2002–2004,
with median life expectancy of 38.4 months (HD) and 36.6 months (PD),
and in every subgroup by age, diabetes, and comorbidity, PD outcomes improved relative to HD over time
(Mehrotra R, Arch Intern Med 2011).
Kidney transplant: the clearest way to extend life
Among 228,552 dialysis patients, transplant recipients had 48–82% lower long-term mortality than those remaining on the waiting list.
Risk was higher in the first 2 weeks after surgery, but by 18 months the relative risk was 0.32
(Wolfe RA, N Engl J Med 1999),
and a review of 110 studies (1,922,300 people) found substantially better quality of life after transplantation
(Tonelli M, Am J Transplant 2011).
Very elderly patients: dialysis does not always extend life
In Dutch patients aged 70 and over, those choosing dialysis had a median survival of 3.1 years vs 1.5 years with conservative management,
but in those aged 80 and over the difference (2.1 vs 1.4 years) was not statistically significant, and the advantage shrank markedly with multiple comorbidities
(Verberne WR, Clin J Am Soc Nephrol 2016).
A meta-analysis in elderly patients reported 1-year survival of 78.4% on HD, 77.9% on PD, and 70.6% with supportive care
(Foote C, Nephrology 2016).
Data on supportive care are limited (724 patients) and subject to lead-time bias. Use these figures to talk with your doctor, not to predict anyone’s lifespan.
6. Choice checklist: which factors lean toward HD or PD
Direct answer: the real deciding factors are heart, arm veins, abdominal surgery history, remaining urine output, distance, work, eyesight and hands, a helper, home space, and what matters most to the patient — tick through this table before seeing your nephrologist.
Checklist table: factor → leans HD / leans PD / discuss with your nephrologist
| Factor | Leans HD | Leans PD | Discuss with your nephrologist |
|---|---|---|---|
| Heart failure / low blood pressure | When large, precise fluid removal is needed under team supervision | Slow continuous fluid removal, fewer drops in blood pressure | Very weak heart pumping, or frequent low blood pressure during sessions |
| Poor arm veins | Still possible with an AV graft if veins are adequate | No blood vessels needed; avoids long-term catheters | Many past lines with central vein narrowing — vessel imaging first |
| Prior major abdominal surgery / adhesions / hernia | Extensive adhesions stop fluid spreading evenly | Minor surgery, or a hernia repaired before catheter placement | A stoma or multiple past operations |
| Diabetes and glucose load | Very hard-to-control blood sugar or very high lipids | Workable with diabetes medication adjustment and glucose-sparing solutions such as icodextrin | Diabetic foot ulcers or heavily calcified arteries — also affects fistula options |
| Remaining urine output | Some units offer incremental HD | Helps preserve remaining kidney function early | 24-hour urine measurement to set the dialysis dose |
| Distance to a dialysis unit | Living close to a unit with easy transport | Living far away; 3 trips a week are hard or expensive | Long-term travel costs and who will take you |
| Work / travel | Flexible work days and hours, a unit near work | Full-time daytime work (overnight APD) or frequent travel | Heavy lifting at work (hernia risk on PD) |
| Eyesight / hand dexterity | Poor vision, tremor, or arthritis with no caregiver | Good vision and hands, or a caregiver who does it (assisted PD) | Assess during PD nurse training before deciding |
| Caregiver at home | Living alone and unable to self-care | A trained caregiver available every day | Long-term caregiver burden and a backup plan |
| Clean storage space | Small, damp home with no room for solution boxes | A clean, dry corner for many boxes each month | A home visit by the PD nurse may assess this first |
| Pets | Pets cannot be kept out of any room | Pets can be kept out of the exchange room | Several pets in a small home |
| Cost / coverage | Your scheme covers HD and has a network unit nearby | Saves travel costs and time off work | Check the current rules of your scheme (Universal Coverage, Social Security, civil servant) |
A 5-step decision flow
You can always switch later — plan a backup from the start.
7. When to start dialysis: symptoms, not a number alone
Direct answer: dialysis is started for uremic symptoms, fluid overload, high potassium, acidosis, or malnutrition that medicines cannot control — not when eGFR reaches a particular number.
The IDEAL trial randomized 828 patients to an early start (eGFR 10–14) or a late start (eGFR 5–7): deaths were 37.6% vs 36.6%, no different,
and 75.9% of the late-start group began before target because symptoms developed
(Cooper BA, N Engl J Med 2010).
- Loss of appetite, nausea, vomiting, whole-body itch, drowsiness, poor concentration (uremia)
- Swelling, breathlessness, inability to lie flat not controlled by diuretics
- Recurrent high potassium despite diet and medication
- Severe acidosis, or weight and muscle loss from poor intake
Waiting for symptoms does not mean doing nothing — this is the time to get a fistula or PD catheter ready so dialysis can start safely when needed.
8. Preparing access in advance: a timeline
Direct answer: start preparing at CKD stage 4 (eGFR about 15–30), because a fistula takes weeks to months to mature; starting emergency dialysis through a neck catheter is exactly what every guideline tries to avoid
(KDOQI Vascular Access 2019).
- eGFR below 30 (CKD stage 4)Learn every option, request a transplant assessment, and protect the veins in your non-dominant arm — no blood draws, IV lines, or PICC lines in that arm
- eGFR about 15–20, or rapid declineVein-mapping ultrasound and fistula surgery months ahead, allowing 6–12 weeks or longer to mature, with time for a revision if needed
- If the veins are poorAn AV graft is often usable about 2–3 weeks after surgery
- If you choose PDCatheter placement about 2 weeks before starting, then 1–2 weeks of nurse training; some units offer urgent-start PD to avoid a hemodialysis catheter
- When symptoms from section 7 appearStart dialysis with the prepared access; if none is ready, a temporary neck catheter is needed while permanent access is planned quickly
A living-donor transplant before dialysis starts (pre-emptive transplant) is the best option for those who can have one — it also needs early assessment.
9. Coverage in Thailand: Universal Coverage, Social Security, civil servants
Direct answer: all three main schemes cover kidney replacement therapy, but the conditions differ and change — verify the current rules with your hospital or the NHSO hotline 1330 before deciding.
- Universal Coverage Scheme (“gold card”) used a PD First policy from 2008, which enabled nearly 50,000 people with kidney failure to receive dialysis
(Chuengsaman P, Semin Nephrol 2017) - Since 2022, Universal Coverage patients can choose hemodialysis or peritoneal dialysis, and automated PD (APD) in selected cases under set criteria — details may change, so verify the current rules
- Social Security and the civil servant scheme cover both HD and PD under each fund’s own conditions and rates
- Kidney transplantation and post-transplant immunosuppressants are covered by the main schemes — ask the hospital’s transplant centre about joining the waiting list
10. Home hemodialysis, and switching later
Direct answer: you can change after choosing — integrated care treats kidney replacement therapy as a long journey in which a person may use several methods at different stages of life.
- Home hemodialysis — more frequent or longer sessions at home after training; still very rare in Thailand and not a standard benefit, but available in some countries
- PD → HD when the peritoneal membrane filters inadequately, infections recur, hernias are significant, or self-care becomes too hard
- HD → PD when access problems recur, blood pressure drops often during sessions, or work flexibility is needed
- Any method → transplant when a kidney is available and you are fit — ask to be referred early
- Plan a backup, for example vein assessment even if you choose PD, so a switch does not require an emergency catheter
Scientific mechanism (synthesized by the author)
Synthesized by
Asst. Prof. Dr. Norawit Raatpiboon:
both forms of dialysis rely on two mechanisms. Diffusion moves small solutes such as urea, creatinine, and potassium from the more concentrated side to the less concentrated side across a semipermeable membrane,
and ultrafiltration removes excess water by pressure or osmosis.
In HD, blood flows through thousands of hollow fibres in the dialyser while dialysate flows in the opposite direction (counter-current flow), keeping the concentration gradient high along the whole filter,
so large amounts of waste are cleared within a few hours; water is removed by a machine-controlled transmembrane pressure —
and removing a lot of fluid in a short time is exactly what causes intradialytic hypotension, and why the 2-day weekend gap accumulates the most fluid and potassium.
In PD, the peritoneum — with a surface area close to the body’s skin surface and a dense capillary network — acts as the membrane. Waste diffuses from capillaries into the solution during the dwell,
while water is drawn out osmotically by glucose in the solution, which is gradually absorbed, so the osmotic pull fades over the dwell. Icodextrin,
a large molecule absorbed slowly, keeps drawing fluid for longer during the long dwell. The solution is then drained together with waste, excess water, and some protein.
This slow, continuous filtration causes fewer blood-pressure swings, at the cost of protein loss and extra sugar absorption.
Frequently asked questions (FAQ)
What is the difference between arm-fistula hemodialysis and peritoneal dialysis?
Hemodialysis (HD) draws blood from a fistula in the arm through two needles, cleans it in the filter of a dialysis machine, and returns it to the body. The standard schedule is 3 sessions a week of about 4 hours each at a dialysis unit. Peritoneal dialysis (PD) fills the abdomen with dialysis solution through a permanent catheter and uses the patient’s own peritoneal membrane as the filter, every day at home: CAPD means 3–5 manual exchanges a day, and APD uses an automated cycler for 8–10 hours overnight.
Which is more dangerous or riskier, hemodialysis or peritoneal dialysis?
Neither is riskier for everyone; it depends on the person. HD carries risks of low blood pressure during sessions, cramps, access narrowing or clotting, and fluid and potassium build-up over the long weekend gap. PD carries risks of peritonitis, exit-site infection, hernia, and weight or blood-sugar gain. The biggest avoidable risks are hemodialysis through a neck catheter, which in a systematic review carried about 1.5 times the risk of death and about 2 times the risk of fatal infection compared with an arm fistula, and poor exchange technique in PD.
Do people live longer on hemodialysis or on peritoneal dialysis?
Overall survival is broadly similar. US Renal Data System data on 620,020 HD and 64,406 PD patients found no significant difference in the risk of death over 5 years for those starting in 2002–2004, with median life expectancy of 38.4 months on HD and 36.6 months on PD. Results depend on age, diabetes, and other conditions. What clearly extends life is a kidney transplant in suitable candidates: long-term mortality was 48–82% lower than for patients remaining on the waiting list on dialysis.
What are the pros and cons of an AV fistula, and how long before it can be used?
An arm fistula is made by surgically joining an artery to a vein. Its advantages are the lowest rates of infection and clotting, a lifespan of many years, and the lowest risk of death compared with a graft or catheter. The downsides are needle insertion at every session and a maturation period of about 6–12 weeks, sometimes longer or needing a revision procedure, so surgery should be planned months before dialysis is expected. If the arm veins are poor, a synthetic AV graft can be used sooner but narrows and becomes infected more often.
How common is peritonitis on peritoneal dialysis, and how can it be prevented?
The 2022 ISPD guideline sets a target overall peritonitis rate of no more than 0.4 episodes per patient-year, which means on average less than one episode every 2.5 years of treatment. Most episodes are treated with antibiotics added to the dialysis solution, and catheter removal is needed only for refractory or fungal infections. Prevention means careful handwashing and a mask at every exchange, a clean room with fans off, no pets in the room, daily exit-site care, avoiding constipation, and keeping any cloudy bag and calling the PD unit the same day.
Can I switch to the other type of dialysis later?
Yes. Switching is common and can be planned. Many people start on PD while they still pass urine and move to HD when the peritoneal membrane filters less well, infections recur, or self-care becomes too hard. Others start on HD and move to PD for work flexibility. Everyone on any form of dialysis should be assessed early for a kidney transplant. Prepare the new access in advance so a switch does not require an emergency neck catheter.
How does the diet differ between hemodialysis and peritoneal dialysis?
People on HD usually need tighter fluid limits, often about 500–1,000 mL a day plus any urine output, and stricter potassium and phosphate limits because waste builds up between sessions. People on PD can usually be more liberal with fruit, vegetables, and fluid, and low potassium is actually common, but they lose protein into the dialysate every day, so they need enough high-quality protein, and they absorb sugar from the solution, which can raise weight or blood glucose. Both should keep sodium below about 2.3 g a day, with a renal dietitian adjusting to actual blood results.
Does Thailand’s Universal Coverage or other insurance cover both types of dialysis, and what about a transplant?
Thailand’s Universal Coverage Scheme used a PD First policy from 2008, and since 2022 patients can choose either hemodialysis or peritoneal dialysis, including automated PD in selected cases. The Social Security and civil servant schemes cover both methods under their own rules. Kidney transplantation and post-transplant immunosuppressants are covered by the main schemes, but details change, so verify the current rules with the treating hospital or the NHSO hotline 1330 before deciding.
E-E-A-T and academic citations
Written by Asst. Prof. Dr. Norawit Raatpiboon (ผศ.ดร.นรวิชญ์ ราษฎร์พิบูลย์) — synthesized from KDOQI / ISPD guidelines, US Renal Data System registry analyses, and PubMed-indexed research.
- Lok CE, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020 (PMID 32778223)
- National Kidney Foundation. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. Am J Kidney Dis 2015 (PMID 26498416)
- Li PK, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int 2022 (PMID 35264029)
- Brown EA, et al. International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis. Perit Dial Int 2020 (PMID 32063219)
- Mehrotra R, et al. Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med 2011 (PMID 20876398)
- Ravani P, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol 2013 (PMID 23431075)
- Foley RN, et al. Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med 2011 (PMID 21992122)
- Cooper BA, et al. A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med 2010 (PMID 20581422)
- Wolfe RA, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999 (PMID 10580071)
- Tonelli M, et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant 2011 (PMID 21883901)
- Verberne WR, et al. Comparative Survival among Older Adults with Advanced Kidney Disease Managed Conservatively Versus with Dialysis. Clin J Am Soc Nephrol 2016 (PMID 26988748)
- Foote C, et al. Survival outcomes of supportive care versus dialysis therapies for elderly patients with end-stage kidney disease: A systematic review and meta-analysis. Nephrology 2016 (PMID 26265214)
- Chuengsaman P, Kasemsup V. PD First Policy: Thailand’s Response to the Challenge of Meeting the Needs of Patients With End-Stage Renal Disease. Semin Nephrol 2017 (PMID 28532557)
- Ikizler TA, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis 2020 (PMID 32829751)
- NIDDK — Choosing a Treatment for Kidney Failure
- NIDDK — Hemodialysis
- NIDDK — Peritoneal Dialysis
- National Kidney Foundation — Dialysis
Medical disclaimer
This content provides general education about choosing kidney replacement therapy in kidney failure —
it is not medical care, an individual assessment, or a prescription, and it does not replace advice from your nephrologist and dialysis team.
Research figures are averages from specific patient groups and do not predict any individual’s outcome. Medicines and solutions are named generically for understanding only; do not adjust them yourself.
Thai coverage rules may change; verify with your hospital or the NHSO hotline 1330.
If you are breathless, cannot lie flat, have chest pain or a seizure, or fistula bleeding will not stop, call 1669 (Thailand) or your local emergency number immediately.