In-Center vs Home Hemodialysis vs Peritoneal Dialysis
There are three main ways to get dialysis: in-center hemodialysis (a machine filters your blood at a clinic, usually 3×/week), home hemodialysis (the same therapy at home, often more frequently), and peritoneal dialysis (your abdominal lining filters waste via a catheter, done daily at home). All three are covered by Medicare. The right one depends on your health, independence, home setup, and schedule — and you can switch later.
Side-by-side comparison
| Factor | In-center hemo | Home hemo | Peritoneal (PD) |
|---|---|---|---|
| Typical schedule | 3–4 h, 3×/week at clinic | 4–6 sessions/week, flexible or nocturnal | Daily — 4 manual exchanges, or overnight cycler |
| Where | Dialysis center | Your home | Your home, work, or travel |
| Training needed | None | Several weeks, often with a care partner | 1–2 weeks, usually self-managed |
| Needles | Yes (staff insert) | Yes (you/partner insert) | No — abdominal catheter |
| Independence | Lowest — fixed slots | High | Highest day-to-day |
| Clinic visits | Every treatment | ~Monthly check-ins | ~Monthly check-ins |
| Best suited to | Those wanting staff-managed care and routine | Motivated patients with support at home | People prioritizing flexibility, work, travel |
What each choice feels like in practice
In-center hemodialysis
The default in the US. Staff run everything; you show up, dialyze, and go home — but the schedule anchors your week, and many patients feel washed out for hours afterward. If you work, ask about evening "late shift" slots — center pages on this site flag facilities offering them.
Home hemodialysis
Same blood-filtering therapy, run by you (often with a partner) after formal training. More frequent, gentler sessions tend to mean fewer post-treatment crashes and better fluid control. The trade: equipment in your home, supply storage, and the discipline to self-cannulate. 2,414 US centers currently offer home hemo training.
Peritoneal dialysis
No needles and maximum schedule freedom — many people do exchanges at work or run a cycler overnight. It requires a permanent abdominal catheter, daily consistency, and storage space for supplies; peritonitis (infection) is the main risk to manage. 4,085 US centers (54%) support PD patients.
Frequently asked questions
Which dialysis type has the best survival rates?
Studies show broadly comparable survival between modalities for matched patients; what matters most is consistent, adequate treatment. More frequent home hemodialysis can improve blood pressure control and recovery time for some patients. Discuss your specific case with your nephrologist.
Can I switch from in-center to home dialysis later?
Yes. Many patients start in-center and transition to peritoneal or home hemodialysis after training. Switching back is also possible. Look for centers offering home training programs.
Does Medicare pay for home dialysis?
Yes — Medicare covers home hemodialysis and peritoneal dialysis, including training, equipment, and supplies, on the same basis as in-center treatment. See our Medicare dialysis coverage guide for details.
How many hours a week does each dialysis type take?
In-center hemodialysis typically runs 3–4 hours, 3 times a week, plus travel. Home hemodialysis is often 4–6 shorter or nocturnal sessions weekly. CAPD peritoneal dialysis involves about four 30-minute exchanges daily; CCPD runs overnight while you sleep.
Do all dialysis centers offer peritoneal dialysis?
No. In the current CMS data, 54% of US facilities offer peritoneal dialysis and fewer offer home hemodialysis training — check the services listed on each center's page.
General information, not medical advice — modality choice is a decision for you and your nephrology team. Service counts from CMS facility data. See also: what Medicare pays · choosing a center.