There are 2 main types of dialysis that can help remove waste and fluid build-up from the body when the kidneys no longer work properly.
Peritoneal dialysis (PD) uses the inside lining of the patient’s belly as a natural filter. A cleansing fluid called dialysate is used to remove waste. This fluid is then washed out of the belly in cycles using a permanent catheter.1
Haemodialysis (HD) involves blood being pumped out of the body to an artificial kidney machine. It is then filtered and returned to the body by tubes that connect the patient to the machine via a specially formed blood vessel (fistula or graft) or central vascular catheter (CVC).
Dialysis delivery
The nephrologist (kidney doctor) will prescribe the type of dialysis solution for each person having HD. This is determined by regular blood tests (usually monthly). HD can be done at home or in a health facility.
Hybrid or combination dialysis
Some patients may benefit from combining home PD with facility HD. For example, one to 2 HD sessions per week plus 5 to 7 days of PD per week. This can improve fluid and waste removal. It may also reduce hospital admissions. Hybrid dialysis requires both a PD catheter and vascular access for the HD.
Incremental dialysis
Incremental dialysis is a personalised approach to starting dialysis where, over time, the nephrologist adjusts the number of sessions and how long each one should take. This depends on the patient's remaining kidney function.
Dialysis access
There are several ways to access a patient’s blood for dialysis. HD and PD will need different entry points. Patients need to take care of their access site.
Learn more from the Access for Dialysis Fact Sheet by Kidney Health Australia.
Choosing the best dialysis treatment
Many factors will determine whether someone is suitable to receive dialysis, and which type and in which setting it is delivered. These include medical, logistical, financial and personal reasons.
The renal care team should discuss all options and key considerations with the patient, their family members or carers, so they can make an informed decision about the best treatment for them.
Comparing different kinds of dialysis
Use the comparison below to understand the differences between the different types of dialysis.
Summary
Continuous ambulatory peritoneal dialysis (CAPD)
- Dialysis fluid goes in and out of the peritoneal cavity (in the abdomen) through a tube.
- The fluid is usually changed 4 times a day (called an exchange).
Automated peritoneal dialysis (APD)
- A machine controls the dialysis fluid exchanges, which goes in and out of the peritoneal cavity through a tube overnight during sleep.
Haemodialysis
- Blood is circulated through tubes outside the body and cleaned by a special filter attached to a machine.
- Requires the insertion of needles (cannulas) to access the blood.
Haemodialysis
- Blood is circulated through tubes outside the body and cleaned by a special filter attached to a machine.
- Requires the insertion of needles (cannulas) to access the blood.
Time on dialysis
CAPD
- A dialysis exchange usually takes 30 to 60 minutes, 4 times every day, and can be adapted to suit lifestyle.
- The patient will manually change the dialysis fluid that goes in and out of the peritoneal cavity.
APD
- Dialysis usually happens for 6 to 10 hours during sleep and can be adapted to suit lifestyle.
- Sometimes a manual CAPD exchange is also required during the day.
Haemodialysis
- Dialysis usually happens 3 to 6 times a week, with time on dialysis flexible.
- Dialysis times can be changed to suit lifestyle.
- Some people dialyse overnight.
Haemodialysis
- Dialysis usually happens 3 times a week and takes 4 to 6 hours.
- Dialysis times are usually on set days and times.
- There will also be travel and waiting times before and after dialysis.
Training and support
CAPD and APD
- Training will take one to 2 weeks with ongoing and after-hours support from the dialysis unit.
Haemodialysis
- Training will usually take 6 to 12 weeks with ongoing and after-hours support from the dialysis unit.
Haemodialysis
- There is no training for the patient.
- Trained nursing staff will manage dialysis at the dialysis unit.
Daily life and activities
CAPD
- Dialysis equipment is portable, and the treatment is simple.
- Dialysis can be done in most places.
- Depending on work, sport, hobbies or social activities, there may be some precautions or restrictions.
APD
- Dialysis happens during sleep, so there are fewer changes to daytime activities.
- Sometimes a manual CAPD exchange is also required during the day.
- Depending on work, sport, hobbies or social activities, there may be some precautions or restrictions.
Haemodialysis
- Dialysis is done at home.
- It can be arranged around daily activities.
- Depending on work, sport, hobbies or social activities, there may be some precautions or restrictions.
Haemodialysis
- Patients need to go to the dialysis unit for treatments.
- Daytime activities will need to be scheduled around the treatments.
- May be difficult to change dialysis days or times.
- Limited or no availability of spaces in dialysis unit close to home may mean travel to a unit further from home or that facility dialysis is not an option.
- Depending on work, sport, hobbies or social activities, there may be some precautions or restrictions.
Diet and fluids
CAPD and APD
- A special diet is needed when on peritoneal dialysis. Advice from a renal dietitian about the best diet to follow is recommended.
Haemodialysis
- A special diet is needed when on haemodialysis. Advice from a renal dietitian about the best diet to follow is recommended.
Haemodialysis
- A special diet is needed when on haemodialysis. Advice from a renal dietitian about the best diet to follow is recommended.
Travel for holidays
CAPD
- Travel is possible if transport and delivery of supplies can be arranged, or the patient can pack supplies to travel with them.
- PD allows more time and location flexibility with travel.
- Overseas travel is also possible.
APD
- Travel is possible if transport and delivery of supplies can be arranged, or the patient can pack supplies to travel with them.
- The machine may be transported, although special arrangements may be required when flying.
- PD allows more time and location flexibility with travel.
- Overseas travel is also possible.
- Patients can sometimes return to CAPD if travel plans require it, e.g. non-powered camping.
Haemodialysis
- Travel may be possible, but it must be planned well in advance.
- It depends on availability of a dialysis unit with an empty chair close to the destination.
- Overseas travel is possible but may involve out-of-pocket costs.
- There is some risk of blood borne viruses and other infections.
Haemodialysis
- Travel may be possible, but it must be planned well in advance.
- It depends on the availability of a dialysis unit close to the destination having a space free for ‘holiday dialysis’.
- Overseas travel is possible but may involve out-of-pocket costs.
- Some risk of blood borne viruses and other infections.
Resources
Big Red Kidney Bus: holiday haemodialysis
This bus is set up with dialysis machines and moves to scheduled scenic locations. It provides free holiday haemodialysis respite, which people on dialysis can book in advance.
Source: Kidney Health Australia
Away from home haemodialysis
A program that allows a person the flexibility to travel for education, work or short holidays and still receive haemodialysis at participating private dialysis units across Australia.
Source: Enable NSW
Treatment costs
CAPD
- CAPD bags and dialysis items are supplied free of charge and delivered to the patient’s home.
- Patients may need to pay for some medication and occasional small supplies.
- Check what the dialysis unit supplies.
- Isolated Patients Travel and Accommodation Assistance Scheme (IPTAAS) can provide support for the cost of travel for training, specialist appointments and procedures or investigations related to dialysis.
- Some councils provide extra bins for waste.
APD
- APD bags, cycler machine and dialysis items are supplied free of charge and delivered to the patient’s home.
- Patients may need to pay for some medication and occasional small supplies.
- Check what the dialysis unit supplies.
- IPTAAS can provide support for the cost of travel for training, specialist appointments and procedures or investigations related to dialysis.
- Electricity rebates are available.
- Some councils provided extra bins for waste.
Haemodialysis
- The main dialysis equipment is free and is delivered to the patient’s home.
- Patients may need to pay for some medication and occasional small supplies.
- Plumbing and electrical changes are required, and may be organised by the dialysis unit.
- There may be personal costs for home modifications, with some rebates available.
- Other equipment such a chair suitable for dialysis is required.
- Check what the dialysis unit supplies.
- IPTAAS can provide support for the cost of travel for training, specialist appointments and procedures or investigations related to dialysis.
- Water and electricity rebates are available.
- Some councils provided extra bins for waste.
Haemodialysis
- Travel to the dialysis unit is usually a cost to the patient.
- Patients may need to pay for some medication.
- Check what the dialysis unit supplies.
- Country patients may get travel subsidiary via IPTAAS for travel to dialysis unit.
Resources
IPTAAS (Isolated Patients Travel and Accommodation Assistance Scheme)
Financial assistance for costs associated with accessing specialised treatment that is not available locally.
Source: NSW Government
Procedures
CAPD and APD
- There is a procedure to put a small tube in the peritoneal cavity.
- This needs to be kept very clean.
- This tube remains permanently while PD therapy continues.
Haemodialysis
- There is a procedure, usually on the arm, to form a fistula or graft (connection between an artery and vein) for the dialysis needles that connect to the machine.
- Some people need a tube (central venous catheter) in their neck or chest, rather than a fistula.
- The needles (cannula) are usually inserted and removed each treatment.
Haemodialysis
- There is a procedure, usually on the arm to form a fistula or graft (connection between an artery and vein) for the dialysis needles that connect to the machine.
- Some people need a tube (central venous catheter) in their neck or chest, rather than a fistula.
- The needles (cannula) are usually inserted and removed each treatment.
Home environment
CAPD and APD
- Patients need a suitable space at home to keep and set up dialysis equipment.
- Patients will need a place to wash their hands.
Haemodialysis
- Patients need a suitable space at home to keep and set up dialysis equipment.
- Electrical and plumbing work will be necessary for the dialysis machine.
- Patient will need a suitable recliner chair and table to set up equipment.
- Patients will need a place to wash their hands.
Haemodialysis
- No change to home environment needed.
Adapted from Kidney Health Australia, My Kidneys My Choice.
Withdrawal from dialysis
A patient may decide that dialysis no longer provides benefit to their health and enjoyment of life. Some may consider that it is unnecessarily prolonging a life of ill health. Patients need to know that they have the right to stop dialysis treatment at any time.
On rare occasions, it may not be possible to do dialysis treatment for medical reasons:
- It may not be safe if blood pressure is too low, as the machine will not be able to remove the fluid and waste products.
- If there is no means of connecting to the machine, dialysis may not be possible.
The patient and the renal team should discuss the reasons for withdrawal. The renal team will continue to care for the patient and their carers during the withdrawal process, and refer them to palliative care services, if required.2
Patients with renal disease can access voluntary assisted dying, if they meet the eligibility criteria under the Voluntary Assisted Dying Act 2022.3
References
- National Kidney Foundation. Peritoneal Dialysis. 2021. Cited 1 Sep 2023.
- Renal Resource Centre. Withdrawing from Dialysis Treatment: Information for patients and their families. 2010. Cited 9 Feb 2024.
- NSW Government. Voluntary Assisted Dying Act 2022, No. 17. Accessed 30 July 2025.