side by side comparison
Hemodialysis vs Peritoneal Dialysis: Machine vs Abdomen — Access, Schedule, Complications
An NCLEX question describes cloudy drainage from an abdominal catheter — you pick peritonitis. Another asks about a missing bruit in the arm — you recognize AV fistula clotting. Mixing up which access and which complication belongs to which dialysis type costs you the question every time.
Comparison
Side-by-side2 compared
Dimension
Hemodialysis
Peritoneal Dialysis
Mechanism / access
- Blood filtered through external machine
- AV fistula (preferred), graft, or CVC
- Peritoneum is the filter membrane
- Tenckhoff catheter; dialysate dwells/drains
Patient experience
- 3–4 hr/session, 3× per week
- Rapid fluid removal; hypotension risk
- CAPD 4–5 manual exchanges/day; CCPD nightly cycler
- Home-based; gradual continuous removal
Access assessment
- ★Palpate thrill, auscultate bruit (fistula)
- Absent thrill/bruit = clotted emergency
- Inspect exit site for erythema/drainage
- Assess effluent clarity each drain
Nursing priorities
- No BP, IV, or venipuncture on fistula arm
- Monitor intradialytic hypotension; weigh pre/post
- Strict aseptic technique; mask at connection
- Warm dialysate; track inflow/outflow balance
Diet & medication needs
- Strict K+/Na+/phosphorus + fluid restriction
- Phosphate binders, EPO; hold antihypertensives pre-HD
- More liberal diet; ↑ protein (lost in effluent)
- Watch glucose load from dialysate
Patient teaching
- Protect access arm; don't sleep on/compress it
- Keep appointments; guest dialysis to travel
- Sterile technique; report cloudy effluent
- Daily exit-site care; can travel with supplies
Red flags — escalate
- ★Disequilibrium: headache, nausea, seizures
- Severe hypotension during session
- ★Cloudy effluent = peritonitis until ruled out
- Abdominal pain, fever, rebound tenderness
Complications
- Access clotting, infection, stenosis
- Hypotension, muscle cramps, anemia
- Peritonitis (most common)
- Exit-site infection, hernia, hyperglycemia
Mechanism / access
Hemodialysis
- Blood filtered through external machine
- AV fistula (preferred), graft, or CVC
Peritoneal Dialysis
- Peritoneum is the filter membrane
- Tenckhoff catheter; dialysate dwells/drains
Patient experience
Hemodialysis
- 3–4 hr/session, 3× per week
- Rapid fluid removal; hypotension risk
Peritoneal Dialysis
- CAPD 4–5 manual exchanges/day; CCPD nightly cycler
- Home-based; gradual continuous removal
Access assessment
Hemodialysis
- ★Palpate thrill, auscultate bruit (fistula)
- Absent thrill/bruit = clotted emergency
Peritoneal Dialysis
- Inspect exit site for erythema/drainage
- Assess effluent clarity each drain
Nursing priorities
Hemodialysis
- No BP, IV, or venipuncture on fistula arm
- Monitor intradialytic hypotension; weigh pre/post
Peritoneal Dialysis
- Strict aseptic technique; mask at connection
- Warm dialysate; track inflow/outflow balance
Diet & medication needs
Hemodialysis
- Strict K+/Na+/phosphorus + fluid restriction
- Phosphate binders, EPO; hold antihypertensives pre-HD
Peritoneal Dialysis
- More liberal diet; ↑ protein (lost in effluent)
- Watch glucose load from dialysate
Patient teaching
Hemodialysis
- Protect access arm; don't sleep on/compress it
- Keep appointments; guest dialysis to travel
Peritoneal Dialysis
- Sterile technique; report cloudy effluent
- Daily exit-site care; can travel with supplies
Red flags — escalate
Hemodialysis
- ★Disequilibrium: headache, nausea, seizures
- Severe hypotension during session
Peritoneal Dialysis
- ★Cloudy effluent = peritonitis until ruled out
- Abdominal pain, fever, rebound tenderness
Complications
Hemodialysis
- Access clotting, infection, stenosis
- Hypotension, muscle cramps, anemia
Peritoneal Dialysis
- Peritonitis (most common)
- Exit-site infection, hernia, hyperglycemia
★ marks the fact that sets a column apart.
Clinical Pearl
Fistula arm — feel thrill, hear bruit; peritoneal catheter — cloudy effluent means peritonitis until proven otherwise.
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