There are two means of dialysis available, hemodialysis and peritoneal dialysis. In general, the principles of both dialysis methods are basically the same, i.e., small molecules of toxins, such as creatinine and urea, are removed from the body through the diffusion function of the semi-permeable membrane, and excess water is also removed from the body using the principle of convection. However, the specific operation is very different. Hemodialysis is the physical process of drawing blood out of the body through an artificial semi-permeable membrane, commonly known as a “dialyzer”. Peritoneal dialysis, on the other hand, has the same principle, but the semi-permeable membrane is located in the large omentum of the human abdominal cavity, also known as the peritoneum, and therefore, this semi-permeable membrane is already present in the human body. This is the most fundamental difference between the two. Both dialysis modalities in general have their advantages and disadvantages. The main advantage of hemodialysis is that the removal of water and toxins is faster and the mode of treatment and the adequacy of dialysis can be adjusted by adjusting various parameters in dialysis. Another advantage is that the patient comes to the hospital regularly to receive treatment, and relatively speaking his own initiative is not so demanding, because there are doctors and nurses at your service. In addition, compared to peritoneal dialysis, hemodialysis is less protective of patients’ residual kidney function, and it is possible that some patients will gradually lose their urine volume after dialysis, or even end up without a drop of urine. There are also some patients with poor cardiovascular function, such as frequent hypotension during dialysis, there is also a certain risk of performing hemodialysis. Compared to hemodialysis, peritoneal dialysis has its own advantages, mainly in the protection of residual kidney function, as patients generally do not lose residual kidney function prematurely. In addition, since peritoneal dialysis is self-administered at home, it can save a great deal of money in terms of transportation problems. The protection of cardiovascular function is also one of its advantages. Because peritoneal dialysis ultrafiltration is generally slow, cardiovascular function is generally not greatly affected. However, peritoneal dialysis requires a small procedure in the abdomen to bury a tube for peritoneal dialysis into the abdominal cavity, so the risk of infection and tube-related problems are also common risks of peritoneal dialysis. In addition, for some patients, peritoneal dialysis needs to be performed by themselves, and they have to do all the hygiene and sterilization operations at home, which is difficult for many patients to accept. From the above analysis, it is difficult to say which of the two is better: peritoneal dialysis and hemodialysis, both of which have their own merits. In fact, as long as adequate dialysis is performed, both modalities are feasible, and many cases of long-term survival and even better quality of life have been reported in both modalities. If I were to give both modalities a score out of 100, hemodialysis would score 90 and peritoneal dialysis would score 85, both excellent scores. How do you choose for each patient specifically? In fact, the majority of patients can choose both peritoneal and hemodialysis. Only a small percentage of patients can choose only one of these options. For example, for patients who cannot establish good blood access, internal fistulas and central venous lines are not successful, so peritoneal dialysis is the only option. For patients who have had major abdominal surgery and have poor peritoneal function, the only option is hemodialysis. However, the number of patients in this group is only a small percentage of the total. Another factor that affects the choice of patients is the health insurance policy and physicians’ habits. Currently in China, the vast majority of end-stage renal disease patients receive hemodialysis, which is the exact opposite of Hong Kong. More than 90% of patients in Hong Kong receive peritoneal dialysis, which is closely related to the Hong Kong government’s medical insurance policy. In Hong Kong, peritoneal dialysis is almost completely free of charge, while hemodialysis is completely self-funded, so it is only natural that peritoneal dialysis has become the inevitable choice. In China, with the gradual improvement of medical insurance policies, both peritoneal dialysis and hemodialysis have entered the medical insurance system in various places, and the reimbursement rates are basically the same. Therefore, the choice between peritoneal dialysis and hemodialysis depends mainly on the habits of each hospital. Due to historical reasons, hemodialysis is still the main alternative treatment mode for end-stage renal disease patients in China. However, in recent years, especially since 2010, the number of dialysis patients in China has been increasing geometrically, and many large dialysis centers, such as ours, have already entered a state of overload. In this situation, the Ministry of Health has started to promote the peritoneal dialysis treatment model, and many units that had been doing well in hemodialysis have started to focus their efforts on peritoneal dialysis. It is foreseeable that in the next few years, peritoneal dialysis will be used more and more in the treatment of end-stage renal disease patients, gradually reaching a point where it can be on par with hemodialysis.