This guide to dialysis options is for adults in Fort Worth and across DFW whose kidney function has fallen to stage 4 or stage 5 chronic kidney disease (CKD, a gradual, long-term loss of kidney function), and for the family members who will help them decide what comes next. If your nephrologist (kidney specialist) has started talking about dialysis, you are far from alone. The CDC estimates that about 35 to 37 million U.S. adults (roughly 14 to 15 percent) have CKD, and in 2023 more than 131,000 Americans started treatment for kidney failure. Most of them faced the question you are facing now: get treatment at a dialysis center, or do it at home?
The right answer depends on your health, your home, your work and the people around you. You can also revisit it later. This guide explains each option in plain terms, what the research shows, and what to ask your care team before you decide.
The short answer: In-center hemodialysis means going to a dialysis center about three times a week for sessions of 3 to 5 hours, with nurses and technicians running each treatment. Home dialysis means doing treatment yourself after training, using either peritoneal dialysis (daily, often overnight) or home hemodialysis. Neither is best for everyone. The best choice fits both your medical needs and the way you live, and it is yours to make with your nephrologist.
Medically reviewed by Michael Babigumira, MD, board certified by the American Board of Internal Medicine in nephrology and internal medicine, Fort Worth Renal Group. Last reviewed September 27, 2026.
What Does Dialysis Do, and Why Do You Get a Choice?
Dialysis takes over part of the job your kidneys can no longer do: removing waste, extra fluid and excess minerals such as potassium from your blood. It becomes necessary at kidney failure, also called end-stage kidney disease (ESKD), when kidney function falls to about 15 percent of normal or less (stage 5 CKD). The exact timing of dialysis is based on your symptoms and lab values, not a single number, and it often begins when function is even lower. Dialysis is a treatment, not a cure. It keeps you well until a kidney transplant, or for the long term if transplant is not the right path for you.
There are two ways to clean the blood, both explained on our hemodialysis and peritoneal dialysis page. Hemodialysis pumps your blood through a filter outside your body, called a dialyzer, and returns it. Peritoneal dialysis (PD) uses the thin lining inside your abdomen, the peritoneum, as a natural filter, so your blood never leaves your body.
Those two methods can be done in three settings: hemodialysis at a center, hemodialysis at home, and peritoneal dialysis at home. You have a choice because, for most people, more than one of these is medically reasonable. Nationally, the choice is shifting. According to the USRDS 2025 Annual Data Report, more people starting kidney failure treatment are choosing peritoneal dialysis or a transplant than ever before. In 2023, 14.1 percent of new patients started on PD, a record high.
What Is In-Center Hemodialysis Like?
In-center hemodialysis is still the most common treatment in the United States. You go to a dialysis clinic on a fixed schedule, usually three days a week (Monday, Wednesday, Friday or Tuesday, Thursday, Saturday), and choose a morning, afternoon or evening shift based on what the clinic has open. Each session typically lasts 3 to 5 hours. Trained nurses and patient care technicians connect you to the machine, watch your blood pressure and fluid removal, and handle any problems during treatment.
For many people, that structure is a relief. Someone else is responsible for the equipment, supplies stay at the clinic, and the other patients and staff can become a real source of support. The tradeoffs are time and energy. Travel and treatment can take up much of three days a week. Because your blood is cleaned only three times a week, fluid and waste build up between sessions, which usually means tighter limits on fluid, salt and potassium. Many patients also feel drained for several hours after a session, known as post-dialysis fatigue.
Hemodialysis requires a vascular access, the connection point where blood leaves and returns to your body. There are three types:
- Arteriovenous (AV) fistula: a surgeon joins an artery and a vein, usually in your arm. It lasts longest and has the lowest infection risk, but it needs weeks to months to mature before use.
- AV graft: a soft tube connects an artery and a vein when your own vessels are not suitable for a fistula.
- Central venous catheter: a tube placed in a large vein in the neck or chest. It can be used right away but carries a higher risk of infection and is usually meant to be temporary.
Home Dialysis Options for Fort Worth Patients
Home dialysis is two different treatments that share one feature: you, sometimes with a care partner, run the treatment on your own schedule after training from a home dialysis nurse. Training for PD usually takes days to a couple of weeks, while home hemodialysis training takes longer, often several weeks. Your nephrologist and home program team still monitor your lab work and see you regularly, often with monthly visits.
Peritoneal Dialysis (PD)
PD starts with a small, soft tube called a PD catheter, placed in your abdomen in a minor procedure. Cleansing fluid called dialysate flows in through the catheter, sits in your abdomen while it draws waste and extra fluid out of the blood vessels in the peritoneum, then drains out. Each fill-and-drain cycle is called an exchange.
There are two ways to do it. Continuous ambulatory peritoneal dialysis (CAPD) is done by hand, usually four exchanges spread through the day, each taking about 30 minutes. Automated peritoneal dialysis (APD) uses a machine called a cycler to do exchanges overnight while you sleep, which leaves most of the day free. PD uses no needles, and because it runs every day, it removes fluid more gradually than three-times-a-week hemodialysis. Many patients find their diet and fluid limits are less strict as a result.
PD does ask something of you. You will need storage space for boxes of supplies, a clean area for exchanges, and consistent care of the catheter exit site to prevent peritonitis, an infection of the abdominal lining. The dialysate also contains sugar, which adds calories and matters if you have diabetes, something to plan for with your care team and a renal dietitian.
Home Hemodialysis
Home hemodialysis uses the same blood-cleaning method as the center, with a smaller machine designed for home use. You or a trained partner place the needles and run each treatment. Schedules vary. Some patients dialyze three times a week like the center, while others use shorter, more frequent sessions or longer treatments overnight. Whatever the schedule, you need to keep to it as reliably as you would in a clinic.
The main appeal is control over time and dose. More frequent or longer treatments can mean steadier fluid levels and more flexibility with food and drink. The main demands are training, space for the machine and supplies, and in most programs a care partner who is present during treatment.
In-Center vs. Home Dialysis: Side-by-Side Comparison
| In-center hemodialysis | Home hemodialysis | Peritoneal dialysis (PD) | |
|---|---|---|---|
| Where | Dialysis center | Your home | Your home (exchanges can also be done at work or while traveling) |
| Typical schedule | 3 times a week, 3 to 5 hours per session, set shifts | Set with your care team; often more frequent or overnight sessions | Daily: about 4 hand exchanges (CAPD) or overnight with a cycler (APD) |
| Who runs treatment | Nurses and technicians | You, usually with a trained care partner | You, sometimes with help |
| Access needed | Fistula, graft or catheter | Fistula, graft or catheter | PD catheter in the abdomen |
| Needles | Yes, each session | Yes, placed by you or your partner | No |
| Training | None required | Required, often several weeks | Required, usually days to a couple of weeks |
| Diet and fluid | Usually the strictest limits between sessions | Often more flexible with frequent treatment | Often more flexible; dialysate adds sugar calories |
| Main risks to discuss | Access infection or clotting; low blood pressure and cramping during treatment | Access infection or clotting; bleeding or needle problems at home | Peritonitis and exit-site infection; weight gain or high blood sugar from dialysate |
| Home space | None | Machine plus supply storage | Supply storage and a clean exchange area |
What Most Dialysis Conversations Leave Out
Most comparisons stop at schedules and convenience. Three other factors can shape how well a treatment works for you, and they are worth raising with your nephrologist directly.
Residual Kidney Function
Starting dialysis does not always mean your kidneys stop working entirely. Many people still make urine and keep some filtering ability for months or years, known as residual kidney function. That remaining function is linked to better blood pressure and fluid control, better nutrition and longer survival. A 2008 review in Kidney International found that PD is associated with a slower loss of residual function than conventional hemodialysis, though more recent systematic reviews rate this evidence as low certainty. Some patients may also be candidates for incremental dialysis, which starts at a lower dose and increases it as needed. If you still make a good amount of urine, ask whether protecting that function should factor into your choice.
Dialysis Access Planning Time
The type of access you have on day one affects your early risk of infection and hospitalization. The Centers for Medicare & Medicaid Services counts an “optimal start” as beginning on home dialysis, receiving a kidney transplant before dialysis, or starting in-center hemodialysis with a permanent fistula or graft rather than a catheter (USRDS 2025). A fistula can take months to mature, so the access conversation often needs to start well before dialysis does.
At Fort Worth Renal Group, access planning is part of the dialysis conversation from the start. Our vascular access coordinator helps patients plan access placement early, and our interventional nephrology team works with patients to keep that access working once treatment begins.
Home Program Experience
Home dialysis works best with an experienced team behind you. National data summarized by Home Dialysis Central shows that in 2022, 43.9 percent of patients in home hemodialysis programs with fewer than six patients had switched to in-center treatment within two years, compared with 37 percent in programs with more than 10 patients. It is fair to ask any home program how many patients it supports and what help is available at night and on weekends.
What Does the Research Say About Quality of Life?
Some research favors home dialysis on quality of life, but the evidence is limited and mixed. A 2020 meta-analysis in Kidney Medicine found slightly better physical quality of life among home dialysis patients, while noting that many of the studies were weak. A 2025 nationwide study of dialysis patients in Sweden found that home hemodialysis patients started with higher physical quality of life and were the only group whose mental quality of life improved over time. PD patients began with better physical scores than in-center patients, but those scores declined faster. Care systems differ between countries, so results from Sweden may not apply directly in the United States.
People who choose home dialysis also tend to be younger or healthier at the start, which makes direct comparisons difficult. The most useful takeaway is personal: the treatment that fits your routine, energy and support system is the one you are most likely to stay with and do well on. Many people do well with in-center care, and choosing it is not settling for less.
How to Choose: Questions to Bring to Your Care Team
You do not need to decide alone or all at once. Bring these questions to your nephrologist, and bring a family member if you can. Our CKD educational resources can help you prepare.
- Which options are medically safe for me, given my heart health, past abdominal surgeries, diabetes, and eyesight or hand strength?
- How much kidney function do I have left, and how might each option affect it?
- What are the main risks of each option for someone with my health history?
- When should I have my access placed, and which type do you recommend?
- Does my work schedule, travel or caregiving role favor one option?
- Do I have space at home for supplies, and a person who could be my care partner if needed?
- How long is home training, and who do I call if something goes wrong at 2 a.m.?
- Am I a candidate for a kidney transplant, and can I be referred now?
- If I start one way and it is not working, how easy is it to switch?
That last question matters. Your first choice is not permanent. Patients move from in-center to home, from home to in-center, and between PD and hemodialysis as their health and lives change.
For Referring Physicians: When to Start the Dialysis Conversation
The KDIGO 2024 CKD guideline supports nephrology referral at an eGFR (estimated glomerular filtration rate, a measure of kidney filtering) below 30, a urine albumin-to-creatinine ratio above 300 mg/g, or a 5-year kidney failure risk of 3 to 5 percent. Its practice points tie a 2-year kidney failure risk above 40 percent (or eGFR below 15 to 20) to planning dialysis access and preemptive transplantation; education about options and transition to multidisciplinary care are recommended earlier, once 2-year risk is meaningfully elevated (around 10 percent). Referring at those points gives patients time to choose a treatment and start with a permanent access. Primary care physicians, internists and cardiologists across Tarrant County can refer a patient to Fort Worth Renal Group online.
How Fort Worth Renal Group Helps Tarrant County Patients Decide
Fort Worth Renal Group is an independent, renal-exclusive nephrology practice, built in Fort Worth, for Fort Worth. For us, the dialysis decision starts well before your first treatment. Your nephrologist walks through every option with you, including kidney transplant referral, and explains the benefits and risks of each in terms of your own health and daily life. The choice is yours. Our role is to make sure you understand every option well enough to make it.
Kidney disease does not exist in isolation, and neither does our care. Our nurse educator helps you and your family understand what each treatment involves day to day, and renal nutrition support is part of the plan, because diet and fluid needs change with each treatment.
One of our seven locations is likely close to your home: our main office on Windsor Place, Fort Worth Alliance, our NorthStar Clinic on South Hulen Street, North Richland Hills, Lake Worth, Burleson and Willow Park.
Frequently Asked Questions About Dialysis Options
Will I be on dialysis for the rest of my life?
Not necessarily. Many people use dialysis as a bridge to a kidney transplant, and others stay on dialysis long term and live full lives. A small number with sudden kidney injury recover enough function to stop. Ask your nephrologist about your transplant eligibility early, because the evaluation takes time and, in some cases, waiting time can start before dialysis.
Is it safe to do dialysis at home without a nurse in the room?
For patients who are good candidates and complete training, home dialysis is an established treatment option. Like any dialysis, it carries risks. With PD, the main one is infection, including peritonitis. With home hemodialysis, risks include access infection, bleeding and problems with needle placement. Training is designed to reduce those risks: you will not start until your home dialysis nurse is confident you can run treatment safely and recognize warning signs. Home programs provide a phone line for urgent questions, and your team reviews your lab results and treatment records regularly. If the idea still worries you, say so. Your comfort level is a legitimate part of the decision.
What if I choose home dialysis and it doesn’t work for me?
You can switch. Moving from home to in-center dialysis, or back again, is common and does not mean you failed. Health changes, a care partner’s availability or a move can all be reasons to change treatment, and your care team plans those transitions with you.
Does dialysis hurt?
Peritoneal dialysis uses no needles, and most people feel only fullness during exchanges. With hemodialysis, needle placement can sting at first; numbing cream or spray helps many patients, and it usually gets easier as the access matures. Cramping or dizziness during hemodialysis often comes from fluid shifts, so tell your team if it happens. They can often adjust your treatment.
Can I keep working and traveling on dialysis?
Many people do. Overnight PD and home hemodialysis leave your days more open, and PD supplies can often be shipped to your destination. In-center patients can arrange treatment at clinics in other cities with advance planning. Ask your care team and social worker about scheduling and your rights at work.
Will choosing home dialysis affect my chances of a kidney transplant?
Your dialysis type does not remove you from transplant consideration. What matters more is getting a referral and completing the evaluation. Ask your nephrologist about transplant referral whichever option you choose.
Does insurance cover home dialysis?
Medicare generally covers both in-center and home dialysis, including home training, though eligibility and timing rules apply. Coverage under other plans varies. Our billing team can review your plan with you, and our insurance and billing page lists the plans we accept.
Take the Next Step Toward the Right Dialysis Choice
Facing a dialysis decision, or helping someone who is? Schedule an appointment with our nephrology team today, or call us at 682-207-1700. Fort Worth Renal Group proudly serves patients throughout Fort Worth, Tarrant County, and the greater North Texas area, with our office located at 1902 Windsor Place in Fort Worth.
We don’t just treat kidney disease. We change what happens next.
Sources
- Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, updated March 2026.
- United States Renal Data System. 2025 Annual Data Report: Incidence and Prevalence.
- American Journal of Kidney Diseases. US Renal Data System 2025 Annual Data Report executive summary.
- Home Dialysis Central. Home Dialysis Updates from the 2024 USRDS Annual Data Report, January 2025.
- Cochrane Database of Systematic Reviews. Peritoneal dialysis versus haemodialysis for people commencing dialysis, 2024.
- Kidney International. Benefits of preserving residual renal function in peritoneal dialysis, 2008.
- Quality of life trajectories for different dialysis modalities: a nationwide study (Sweden), 2025.
- Kidney Medicine. Health-Related Quality of Life in Home Dialysis Patients Compared to In-Center Hemodialysis Patients, 2020.
- Annals of Internal Medicine. Evaluation and Management of Chronic Kidney Disease: Synopsis of the KDIGO 2024 Clinical Practice Guideline.
Medical and Educational Disclaimer
This article is provided for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. Health information is general in nature and may not apply to your specific situation. Reading this article does not create a physician-patient relationship with Fort Worth Renal Group or any of its providers.
Always consult your physician, nephrologist, or other qualified healthcare provider regarding any questions you have about a medical condition or before making changes to your healthcare, medications, or lifestyle. Never delay or disregard professional medical advice because of information contained in this article. If you are having a medical emergency, call 911.
