After my kidney surgery, everything changed. I had to switch from peritoneal dialysis (PD) to hemodialysis (HD). PD is the type where you dialyze at home through your abdomen. HD is what most people picture - sitting in a clinic hooked to a machine.

I didn’t have a choice in this. The surgery made the decision for me.

What I Miss Most About PD

I miss my nights. With PD, I just hooked up before bed. The machine worked while I slept. Eight hours of gentle, continuous cleaning. No alarms, no nurses, no commute.

I could roll over. I could get up for water. I could live.

Now that freedom is gone. PD was like a gentle stream cleaning my blood all night. HD feels like a pressure washer blasting through me. Both work, but one lets you forget you’re sick.

Understanding Ultrafiltration

Let me explain ultrafiltration. It’s just a fancy word for removing extra fluid. Your kidneys normally do this when you pee. Dialysis has to do it artificially.

With PD, I could remove about twice as much fluid. The peritoneum - that’s your abdominal lining - acts like a filter. Glucose in the dialysis fluid pulls water from your blood. It’s osmosis, really.

HD uses pressure instead. It forces fluid out through an artificial membrane. It works, but there’s a limit. Push too hard and you cramp. Your blood pressure drops. You feel awful.

The HD Reality

Four hours. That’s what HD demands from me. Four hours of complete stillness every two days.

Try lying perfectly still for four hours. Your arm with the needles can’t move. One wrong shift and alarms scream. Blood might leak. The nurses rush over.

My back aches after two hours. My legs want to stretch. My mind goes crazy with boredom. I watch the clock like it’s my enemy.

Some people sleep through it. I can’t. I just lie there, waiting.

What HD Does Better

I have to be fair here. HD removes phosphate and potassium like a champion. These minerals build up when your kidneys fail. Too much potassium stops your heart. Too much phosphate destroys your bones.

HD clears them efficiently. Three times a week, boom - levels drop. With PD, it was always a struggle. I took binders with every meal. I avoided certain foods.

So yes, HD has its advantages. But at what cost?

The Trade-Off I’d Make

Give me back my PD tomorrow. I’ll take the phosphate binders. I’ll skip the bananas and potatoes. I’ll manage the potassium myself.

What good is efficient toxin removal if it steals your life? I’d rather have good days with some dietary restrictions. HD gives me perfect labs and exhausting treatment days.

Quality of life matters. Being able to work matters. Traveling without planning around clinics matters. Sleeping in your own bed every night matters.

I’d make that trade in a heartbeat.

Looking Forward

My doctors say I might return to PD eventually. The surgical site needs to heal completely first. I’m counting the days.

If you’re choosing between PD and HD, think beyond the medical numbers. Consider your lifestyle. Value your independence. Ask about all your options.

HD works well for many people. Some prefer the structure. Some like not managing their own care. That’s valid too.

But for me? I just want my nights back. I want to wake up dialyzed, not exhausted. I want treatment that fits my life, not life that fits my treatment.

Until then, I’ll endure my four-hour sessions. I’ll appreciate what HD does well. But I’ll keep hoping for the day I can go home again.

Remember: every patient is different. What works for me might not work for you. Always discuss your options with your nephrologist.