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Dialysis including peritoneal dialysis and hemodialysis refers to medical therapies that substitute most kidney functions for people with kidney failure. These treatments remove waste products and excess fluids, balance electrolytes, and help regulate acid-base status. Dialysis may be used for chronic kidney disease requiring ongoing treatment or for acute kidney injury in hospitalized patients.

There are two main modalities. Hemodialysis uses a machine and an artificial kidney (dialyzer) to filter blood across a semipermeable membrane. Peritoneal dialysis uses the patient’s peritoneal membrane as the filter, introducing dialysate into the abdomen and then draining it after waste exchange. Within peritoneal dialysis there are automated (APD) and continuous or manual forms (CAPD). In acute settings, continuous renal replacement therapy (CRRT) may be used for critically ill patients.

How dialysis works is based on diffusion, osmosis, and convection. In hemodialysis, a vascular access point connects the patient to the machine, allowing blood to flow to the dialyzer where waste and excess fluid diffuse into the dialysate. In peritoneal dialysis, dialysate placed in the abdomen creates a concentration gradient across the peritoneal membrane to remove waste and water.

Access and logistics vary. Hemodialysis commonly requires in-center treatment three times weekly, with alternatives including home hemodialysis. Peritoneal dialysis can be performed at home, typically daily. Diet and fluid restrictions, along with regular medical monitoring, help manage complications such as hypotension, infection, electrolyte imbalances, and access problems.

Dialysis is a life-sustaining therapy for kidney failure but not a cure. Kidney transplantation remains the definitive treatment when possible, while some patients pursue dialysis in conjunction with other medical management or conservative care.