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.

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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.

Component Topics

Peritoneal DialysisHemodialysis

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