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Making the right decision

Perhaps you have already thought about how different parts of your everyday life might change as a result of dialysis treatment.

It is understandable if the idea of changes scares you at first. We have picked out a few aspects of daily life below, such as self-esteem, work, exercising, travel, mental health, and socio-legal aspects.

You may find it reassuring to be well informed in advance; however, we cannot replace talking to your physician. Every decision needs to be made together with your physician. And always remember: Your dialysis team is there for you if you get stuck and need more support.

Tips that may support choosing the right therapy

With these tips we would like to support you on your path to finding the right therapy

Tip 1: Ask questions
Therapy will have a huge impact on your life. Do some research on therapy options, e.g., on this website as well as others and ask physicians, nurses, relatives, ... questions

Tip 2: Involve your loved ones along the way
Your therapy will also affect your loved ones as well. Take them with you to physician's visits or patient meetings. Talk with your loved ones about the challenges of therapy and share your feelings.

Tip 3: Exchange ideas with your physician
Your physician is the first point of contact when choosing your therapy modality. Take advantage of the time you have with your physician and ask questions.

Tip 4: Exchange ideas with your care team
Your dialysis team in the dialysis center has already gained a lot of experience with the therapies. Use this knowledge and exchange ideas. A talk with an experienced nurse may provide you with valuable insights.

Tip 5: Talk to people who are already being treated
People who are already being treated with kidney replacement therapy have already gained experience. They can share lot of information about each therapy. Ask your physician or dialysis team for a contact.

Tip 6: Take notes about what is important to you
Every therapy has advantages and disadvantages. Take notes about each therapy option and use them to help you decide.  Your notes can be the basis for a discussion with your physician. Then talk to your physician about your therapy options and their advantages and disadvantages in a shared decision-making process.

Comparing different options

CAPD APD Home hemodialysis (HHD) In-center hemodialysis (HD)
Three to five exchanges (each about 30 minutes) performed during the day by yourself or with the help of a caregiver Typically performed every night (about eight hours) by yourself or with the help of a caregiver Longer, shorter and more frequent or overnight treatments are possible in your home. Treatment is done by yourself or with the help of a caregiver Typically performed three times a week at a dialysis unit for four to five hours each session

 

CAPD APD Home hemodialysis (HHD) In-center hemodialysis (HD)
Less but regular visits Less but regular visits Less but regular visits Regular visits required, usually three times a week

 

CAPD APD Home hemodialysis (HHD) In-center hemodialysis (HD)
  • Space is needed for liquids, disposables, and racks
  • No modifications to your home infrastructure are needed
  • Space is needed for the machine, liquids, disposables, and racks
  • Electrical outlets may need modification
  • Space at home is needed for disposables and the dialysis machine. In many countries, there are also small dialysis machines available
  • Depending on the system you use for HHD, electrical and water systems might need to be modified
  • No storage space is needed at home, as treatments are performed in a center
  • No need for modifications at home as treatments are performed in a center

 

CAPD APD Home hemodialysis (HHD) In-center hemodialysis (HD)
If the hygienic requirements are met, the bag exchange can also be carried out at the workplace or at a hotel room May have less impact on your work during the day since treatments are mainly performed at night 
  • Working prior to as well as after the dialysis treatments is possible due to flexible options. HHD may have less impact on post-treatment recovery.
  • More flexibility in scheduling your treatments
  • No travel from and to the dialysis center needed (except for routine visits)
  • Working prior to as well as after the dialysis treatments is possible but may be limited due to post-treatment recovery depending on your clinical status
  • Travel to and from the dialysis center needs to be considered

 

CAPD APD Home hemodialysis (HHD) In-center hemodialysis (HD)
  • Sports that might be well suited for PD patients are walking, jogging and cycling. Depending on your clinical status, your physician will guide you on what might be suitable for you. 
  • You should avoid sports that could put pressure on your abdomen. This includes, for example, martial arts.
  • Because of the risk of infection at the catheter exit site, water sports  may need to be avoided
  • Sports that may be good for HD and HHD patients are swimming, walking and cycling. Depending on your clinical status, your physician will advice you on what might be suitable for you.  
  • To prevent possible complications, you must protect your arm with the vascular access well during sports. For example, you can put on special cuffs for this purpose.
  • As soon as the vascular access is healed after the surgery, the arm or leg can be moved for light activities such as housekeeping

 

CAPD APD Home hemodialysis (HHD) In-center hemodialysis (HD)
  • Hygienic requirement for your dialysis must be met at your vacation destination
  • The transportation of your necessary supplies needs to be planned in advance
  • Your dialysis team at your home dialysis center will support you with the requirements.
  • Dialysis at a dialysis center at your vacation destination must be possible
  • Exchange ideas with other dialysis patients
  • Contact your dialysis team at your home dialysis center to understand the necessary requirements for a proper continuum of your dialysis care.
  • For HHD, it may be possible to take your small dialysis machine and your solution bags with you.

 

CAPD APD Home hemodialysis (HHD) In-center hemodialysis (HD)
Typically not needed, as dialysis takes place via the peritoneal catheter. Typically, two needle insertions per treatment of access via fistula/ graft or via a catheter.

 

 

 

Kidney replacement therapy decision aid tool for patients

A decision aid tool might support you and your family to compare different treatment options based on your lifestyle needs and have more meaningful discussions with healthcare professionals. While the decision aid tool provides valuable information to patients and their families, it is important to note that it does not replace the advice and support of healthcare professionals.

Learn more

Staying fit on dialysis

Almost everyone finds it difficult at first to motivate themselves to exercise regularly. There will be also additional limitations due to your chronic kidney disease. However, an appropriate amount of exercise can have a positive effect on body awareness, circulation and sleep rhythm.

As a dialysis patient, there are many ways to get involved in exercising. Perhaps you can find a sports partner with whom you can get and stay fit together? By doing so, you can do something good for your body through exercise and for your soul through conversation.

Be aware: Before you start exercising, it is important that you talk with your physician about the different types of sports you would like to do and whether this would be an appropriate option for you.

Work and dialysis

You may continue to work even as a dialysis patient if your health status allows you to. In any case, follow your physician's recommendations.

Which dialysis treatment is suitable for work?

There are differences regarding your flexibility and different treatment options. This has an impact on the compatibility of your job and your treatment. Please consult your physician on which may be the best option for you.

Peritoneal dialysis Home hemodialysis Hemodialysis
If hygienic requirements are met, bag exchanges can also be performed at your workplace. APD allows for treatment overnight, enabling you to work during the day. PD procedures offer a comparatively high degree of flexibility. If you perform hemodialysis independently at home, you can decide for yourself when to perform the dialysis sessions. As a result, you are more flexible in the way you practice your profession, even when doing dialysis. If your hemodialysis treatment takes place at a centre, you would be expected to attend the appointments there. As a result, you can only do your job before or after your dialysis sessions.

Appointments at the clinic

It is advisable to talk to your employer about your dialysis schedule in the clinic in advance. Outline how often and how long you have to be there for your treatment. If you inform your employer openly and have a transparent exchange, misunderstandings can be avoided in advance. You can also talk to a member of the human resources department, the disability officer or someone you trust.

Facts about the different treatment options

Facts about Dialysis

Peritonial Dialysis (PD)

Continuous Ambulatory PD (CAPD)

Travel to a dialysis center is only required for check-up visits.

You have a certain flexibility on the timing of fluid exchanges.

No needle insertions involved.

Storage space is needed at home, mostly for fluids.

Patient training usually takes a few weeks.

Special requirements for hygiene.

Some exchanges have to be done during the day.

Automated PD (APD)

Travel to a dialysis center is only required for check-up visits.

As it is typically done during night-time, you are free to decide on your plans for the day.

No needle insertions involved.

Storage space for a machine and fluids is needed at home.

Electrical outlets may need to be modified for the cycler.

Patient training usually takes a few weeks.

Special requirements for hygiene.

Hemodialysis (HD)

In-center HD

The treatment will be done for you by an experienced care team.

Continuous surveillance during the treatment.

No storage at home required.

Significant amount of time spent at the center and travelling to the center.

Limited flexibility and freedom during the treatment.

Needle insertions are typically necessary for blood access.

Home HD (HHD)

More flexible and convenient treatment possible in a familiar environment.

Better control of your plans for the day since you can decide when to dialyse.

Travel to a dialysis center is only required for check-up visits.

Storage at home required for machine and equipment.

Infrastructural adaptions in your home might be required (water systems and electricity access); energy and water consumption will increase.

Needle insertions are typically necessary.

Facts about Transplantation

A successful kidney transplantation is close to natural kidney function and is considered the most effective treatment for ESRD.

Fewer restrictions on your diet.

The waiting time for a kidney transplant typically takes several years.

Continuous intake of anti-rejection medication is necessary.

If the new kidney fails, dialysis can still become necessary.

Facts about Conservative care

Kidney function is not replaced and your kidneys will eventually stop working, leading to natural death.

Focus lies on maintaining quality of life (not extending life) and treating symptoms.

The decision to choose conservative care should be made with careful consideration and involve your treating physician and loved ones.

Find some answers to further questions related to your treatment options in the next section.

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