If your kidneys have failed, the two most common types of dialysis are haemodialysis (HD) and peritoneal dialysis (PD). Both remove waste and extra fluid from your body, but how, where and when they are done are very different.
There is no single best option for everyone. This guide explains how the two compare, so you and your family can talk it through with your nephrologist with more confidence. The final decision should be made together with your care team.
How haemodialysis works
In haemodialysis, your blood is cleaned outside your body.
- Blood flows through tubing to a machine and a special filter called a dialyser, sometimes called an artificial kidney. Waste and extra fluid are filtered out, and the cleaned blood is returned to your body.
- Two needles are placed in your AV fistula or graft at every session. Some people use a catheter in the neck or chest instead.
- Treatment is usually three times a week, for about four hours each session, on a fixed schedule. For example Monday, Wednesday and Friday, or Tuesday, Thursday and Saturday.
- In Malaysia, most haemodialysis takes place at a dialysis centre and is carried out by trained nurses or medical assistants, under a doctor's supervision.
Remember to allow for travel time to the centre and waiting time before your session starts.
How peritoneal dialysis works
In peritoneal dialysis, your blood is cleaned inside your own body. The lining of your abdomen (the peritoneum) acts as a natural filter.
- A soft tube (PD catheter) is placed in your abdomen in a minor operation.
- Dialysis fluid, usually about 2 litres, flows into your abdomen through the catheter. It stays there for a few hours while waste and extra fluid pass into it.
- The used fluid is then drained out and replaced with fresh fluid. This is called an "exchange".
- There are no needles and no blood leaves your body.
There are two main ways of doing PD.
CAPD (continuous ambulatory peritoneal dialysis)
You do the exchanges yourself by hand, usually four times a day. Each exchange takes about 20 to 30 minutes. Between exchanges you can move about and carry on with your day.
APD (automated peritoneal dialysis)
A small machine does several exchanges automatically overnight while you sleep, usually over 8 to 10 hours. Your days are freer.
Before starting PD at home, you and your carer will be trained by a PD nurse. You will also have regular follow-up visits at the clinic.
At a glance
| Aspect | Haemodialysis | Peritoneal dialysis |
|---|---|---|
| Where | Usually at a dialysis centre | At home, or anywhere clean |
| How often | 3 times a week, about 4 hours | Every day (CAPD 4 times a day, or APD overnight) |
| Who does it | Trained nurses or medical assistants | You or your carer, after training |
| Access | Fistula or graft (needles each session), or a catheter | Catheter in the abdomen, no needles |
| Diet and fluids | Stricter limits | Usually less strict |
| At home | No equipment needed | Clean space needed to store supplies |
Benefits and trade-offs
Haemodialysis
Benefits:
- Trained staff carry out the treatment. You do not have to run it yourself.
- You are free of dialysis on non-treatment days.
- You see the staff and other patients regularly, which can be a source of support.
- No medical supplies need to be stored at home.
Things to consider:
- A fixed schedule and travel to the centre three times a week.
- Needles at every session.
- Stricter fluid and food limits, because waste and fluid build up between sessions.
- Some people feel tired or dizzy, or get muscle cramps, after a session.
- A convenient shift can be hard to get in some areas.
Peritoneal dialysis
Benefits:
- Done at home, so it is easier to keep working, studying or caring for your family.
- No needles.
- Treatment is gentle and continuous, and may help preserve your remaining kidney function.
- Usually fewer diet and fluid restrictions.
- Easier to take with you when travelling, with some planning.
Things to consider:
- It has to be done every day, with no days off.
- A risk of infection inside the abdomen (peritonitis) or at the catheter exit site if hygiene steps are not followed carefully.
- You need a clean space at home to store boxes of dialysis fluid.
- Your abdomen may feel full and your waistline may increase.
- It needs good enough eyesight, hand skills and motivation, or a carer who can help.
Which one suits you?
- PD suits many people, including those who are still working, live far from a dialysis centre or want more control over their own schedule. The Ministry of Health Malaysia encourages PD as the first choice for patients who are suitable for it, a policy known as "PD First".
- PD may be less suitable if you have had major surgery on your abdomen, have no clean place to do exchanges, or have no one to help if you cannot manage it yourself.
- HD may suit you better if you would rather have staff handle your treatment, or if support at home is limited.
- Your choice is not permanent. Many people switch from one type to the other as their health or life changes.
Tip: Before you decide, ask to speak to both an HD nurse and a PD nurse. If you can, talk to patients who are already on each treatment. Hearing about their real experience helps a lot.
You can also read more about PD on the National Kidney Foundation of Malaysia (NKF) website.
When to get urgent help
If you are on haemodialysis, contact your dialysis centre straight away if:
- Your needle site keeps bleeding even with pressure
- You can no longer feel the buzz (thrill) in your fistula
- You have a fever or shivering during or after a session
If you are on peritoneal dialysis, contact your PD unit straight away if:
- The fluid you drain out looks cloudy
- You have tummy pain or a fever
- Your catheter exit site becomes red, swollen, painful or has pus
On either type, call 999 or go to the nearest emergency department if you are severely breathless or have chest pain.
Next steps
- Not sure about the basics? Read what is dialysis.
- Find a dialysis centre near you, or list only centres offering peritoneal dialysis.
- Get ready for your first dialysis session.
- PERKESO (SOCSO) covers haemodialysis and CAPD for eligible insured persons. See the list of PERKESO panel centres.