This is initiated when the patient has an extremely low GFR with uremic symptoms (anorexia, nausea, vomiting, severe itching, insomnia, slow mentation) and shortness of breath. There are two types of dialysis, hemodialysis and peritoneal dialysis (a form of home dialysis). My favorite is peritoneal dialysis. This is a modality that uses the peritoneal membrane as an artificial kidney.
It requires the usage of a special solution that is infused into the abdominal cavity via a surgically placed catheter. It is done in the comfort of one’s home, even when one sleeps! It is a much more gentle process than hemodialysis. It is a no brainer to choose this modality. The other one is in-center hemodialysis, where one is dialyzed at a facility thrice per week via an AVF in the arm or leg.
If one cannot perform peritoneal dialysis, then there is the other option. My second preferred option is “home hemodialysis”. This modality is one where a patient does hemodialysis at home! Patients have the lowest mortality with this option. Home dialysis is the way to go, whether it is peritoneal or home hemodialysis.