Guides · Treatment decisions

HD vs PD vs transplant

When kidney function drops below ~10–15, you and your nephrologist need to pick a replacement therapy. There is no single “best” choice — only the best fit for your body, your life, and the resources around you. Here's a side-by-side to start the conversation.

Hemodialysis (HD)

Your blood is cleaned by a machine, 3 times a week at a centre.

Best for: Patients who have a reliable travel route to a dialysis unit, prefer professional supervision, and don't want to handle catheters at home.

Less suitable if: Patients with limited transport access, irregular work hours, or who travel often.

Peritoneal Dialysis (PD)

Your own abdomen is the filter — fluid is exchanged via a catheter at home.

Best for: Patients who want independence, have a clean storage area for bags, and can train a family member to assist.

Less suitable if: Patients with prior abdominal surgeries that scarred the peritoneum, severe lung disease, or no clean home setup.

Kidney transplant

A donor kidney is surgically placed — the gold-standard option when available.

Best for: Patients fit for surgery, with a willing donor (living-related ideal), and able to commit to lifelong immunosuppression and follow-up.

Less suitable if: Patients with active cancer, active infection, severe heart/lung disease, or who can't afford or commit to immunosuppressants long-term.

Side-by-side comparison

Dimension	HD	PD	Transplant
Where it happens	A dialysis centre, 3 times a week.	At home — usually overnight (APD) or manually 4 times a day (CAPD).	After the surgery, anywhere. No machines.
Time commitment	~4 hours/session + travel = 15–20 hours/week.	~30–45 min/day to set up + 8–10 hr while you sleep.	A one-time surgical recovery (~4–6 weeks) then back to normal.
Diet restrictions	Tight on fluid, potassium, phosphorus, salt.	Slightly relaxed on fluid + K (because removal is continuous).	Most foods come back. You may need to watch sodium and weight; some immunosuppressants raise BP.
Independence	Dependent on the unit's schedule. Travel needs planning.	Self-managed at home — high independence.	Effectively normal once stable.
Infection risk	Vascular access (fistula or catheter) infections.	Peritonitis — abdominal infection from the catheter. Hand hygiene is everything.	Long-term immunosuppressants → higher general infection risk.
Energy through the day	Post-session fatigue is common; "washed out" feeling.	Steadier energy day-to-day; less of the post-session crash.	Most patients report dramatic energy recovery within months.
Cost in India	₹2,000–4,000 per session × 3/week. Government and trust hospitals offer subsidised slots.	Comparable monthly bag cost; logistics for bag delivery + storage.	Big upfront cost (surgery + matching) + lifelong immunosuppressants. Government schemes (Ayushman Bharat etc.) help.
Long-term survival	Median survival on HD in India: 5–10 years (varies hugely with comorbidities).	Comparable to HD overall; PD often advantageous early years.	Best outcomes — most transplanted kidneys last 10–15+ years with good care.

Questions to take to your nephrologist

1. Given my age, comorbidities, and home setup, which modality do you recommend, and why?
2. Am I a candidate for transplant? If yes — living donor options?
3. When should we place a fistula or PD catheter? (Both need time to mature.)
4. What does the dialysis schedule look like in practical terms — am I free Saturdays?
5. What happens if I switch later — can I move from PD to HD or vice versa?
6. What\'s the realistic out-of-pocket monthly cost for each option in our city?

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Not medical advice. Your nephrologist sees the rest of your medical picture; this guide is to help you arrive at that conversation prepared.