I thought I'd start a thread specifically for dialysis options. Hopefully this thread will become a good starting point for people at Stage 4 renal failure who need to begin to decide which dialysis is best for them.
I have only had actual experience of dialysis for a few weeks, over 20 years ago, so most of the following info is what I have recently read, rather than what I have experienced. So please feel free to correct me if anything is incorrect.


When choosing dialysis there are 2 main options - Haemo and Peritoneal.
Beyond that the next choice is - at home or in clinic/hospital.
Beyond that it is - frequency and the choice of nocturnal or day time.


There is a mass of information regarding the various options, so I will try to pick out some main points, but will try to answer any specific questions I don't cover.


"Which is best?" is likely to be one of the first questions, but there is no one-fits-all answer. The correct dialysis should not only be the one that prolongs life, but also lets you live, socialise, work, etc.
No current dialysis matches the performance of a living donor transplant. The best dialysis is that which mimics a kidney as close as possible. Considering a healthy kidney works quietly behind the scenes 24/7, the best dialysis (for prolonging life) would be if you were attached to the dialysis machine 24/7.
This is obviously not practical. Therefore the best "realistic" dialysis is dialysis that happens frequently, for many hours.
For this reason nocturnal dialysis, every night (or most nights) is usually a good choice.


Pro and cons


Heamodialysis at clinic/hospital.
Pros - Some patients only feel safe when professionally trained nurses deal with dialysis.
- If space is limited at home, there's no issue
- Home is always home and a place to relax. Your home hasn't become a full time medical facility
- Get to meet other dialysis patients
- Usually get 4 days a week off dialysis completely (in reality this isn't good for kidneys though)


Cons - Slower, more frequent dialysis has the best results. Hospital/clinic dialysis is the opposite. You are likely to get 3x4hrs/week. Therefore out of a 168hr week, your body only has the equivalent of 12 hours kidney function.
- Food and fluid intake is restricted (often quite severely)
- Usually need extra meds to combat the inefficiency of this method
- With travelling, parking, waiting and preparation for dialysis, waiting to be "unpluged", etc, a 4 hours dialysis can take up most of the day.


Peritoneal, Continuous Ambulatory Peritoneal Dialysis (CAPD)
Pros - Done at home, or wherever there's a clean environment, so no trips and waiting at clinic/hospital.
- The "exchange" is done 4-5 times a day, every day so results are good (less pressure on heart)
- Fluid and diet is either not restricted or only mildly
- No machines involved, which makes travel more accessible.
Cons - 4-5 times/day (approx 40 mins), every day, is a big commitment
- Peritonitis (infection) is a bit of a risk
- Some people don't like having tubes hanging out of their stomach
- The Peritoneal lining in your stomach is unlikely to manage this type of dialysis permanently (usually 3 years)


Peritoneal, Automated Peritoneal Dialysis (APD)
Pros - Done through the night, so you can get on with life during the day, every day, without using dialysis
- Done at home, or wherever there's a clean enviroment, so no trips and waiting at clinic/hospital.
- Done most nights, for long period, so results are good (less pressure on heart)
- Fluid and diet is either not restricted or only mildly
- Machine is quite small and portable
Cons - May make sleep hard to achieve, especially the first few weeks.
- Peritonitis (infection) is a bit of a risk
- Some people don't like having tubes hanging out of their stomach
- The Peritoneal lining in your stomach is unlikely to manage this type of dialysis permanently (usually 3 years)


Haemodialysis at home.
Pros - Can be done more frequently and during the night, giving best results and least strain on heart
- No travelling and waiting at hospital/clinic
- If you dialyse during night, you have every day to yourself
- Not restricted on fluid/diet if you have frequent dialysis
Cons - Using needles and high-tech machines at home can be daunting for some.
- Some machines need to be plumbed-in, so may not be suitable for all homes


I am due a home visit soon to discuss my options. If they have any relevant info, I shall add it to this thread.