In-Center vs. Home Dialysis: Hemodialysis, PD and Home HD Compared
The three main ways to do dialysis, side by side: schedule, freedom, diet, equipment, who each suits, and how to find a center that trains you for home dialysis.
Updated 2026-09-29. Sources: CMS, Medicare and federal regulations, linked inline.
In this guide
When your kidneys fail, dialysis takes over the job of filtering your blood. There are three main ways to do it, and the choice shapes your week far more than most medical decisions. Most Americans start with in-center hemodialysis, often because nobody walked them through the alternatives in time. Here is the comparison.
At a glance
| In-center hemodialysis | Peritoneal dialysis (PD) | Home hemodialysis (HHD) | |
|---|---|---|---|
| Where | Dialysis center | Home, work, travel | Home |
| How often | 3 times a week, 3–4 hours | Every day: several short exchanges, or overnight with a cycler | Usually 4–6 shorter sessions a week, or overnight |
| Who does it | Center staff | You (or a helper) | You, usually with a care partner |
| Access | Fistula, graft or catheter in the arm/chest | Soft catheter in the belly | Fistula, graft or catheter |
| Diet and fluid limits | Strictest | Usually looser | Looser with more frequent sessions |
| Training | None | About 1–2 weeks | Several weeks |
In-center hemodialysis
A nurse or technician connects you to the machine at the center, three times a week. Blood leaves your body through your access, passes through a filter, and returns.
Good fit if: you prefer trained staff to do everything, you do not have room or support at home, or you value the routine and social contact of the center.
Downsides: fixed shifts, travel time, and the “long gap” over the weekend when fluid and potassium build up. If you work, look for a center with an evening shift; every listing on this site says whether one exists.
Peritoneal dialysis (PD)
PD uses the lining of your belly as the filter. You fill the belly with dialysis fluid through a catheter, let it sit, then drain it. You can do this by hand several times a day (about 30 minutes each), or connect to a cycler machine that does it while you sleep.
Good fit if: you want independence, you work or travel, you have some remaining kidney function you want to protect, or you live far from a center.
Downsides: it is every day, you need clean storage space for supplies, and there is a risk of infection in the belly (peritonitis) if technique slips.
Home hemodialysis (HHD)
The same kind of treatment as in-center, but on a smaller machine at home, usually more often and for shorter sessions. More frequent dialysis is gentler on the heart and often means fewer diet restrictions and more energy.
Good fit if: you want hemodialysis on your own schedule and have a care partner willing to learn with you.
Downsides: longer training, a bigger commitment from you and your partner, and space for the machine and supplies.
How to get started with home dialysis
- Ask early. It is easier to start on PD than to switch later, and PD catheters need a few weeks to heal before use.
- Pick a center with a home program. Only some centers train patients for PD or home HD. Every center page on this site lists which options it offers, and city pages let you filter for them.
- Ask about backup. Good home programs have a nurse on call around the clock and a plan if you need in-center treatment for a while.
- Medicare covers it. Home dialysis training, equipment and supplies are covered, and Medicare coverage can start in your first month of dialysis if you begin a home training program. Medicare coverage for dialysis.
You can switch
Your first choice is not permanent. Many people move from in-center to home, or back again, as health, work and family change. The best center is one that talks through all the options with you and supports whichever one you choose.
Sources: National Kidney Foundation: Home dialysis, NIDDK: Hemodialysis, NIDDK: Peritoneal dialysis, Medicare: Dialysis services and supplies.