One of the most common problems that hemodialysis participants frequently complained of it was fatigue. Fatigue, is the most common and is the severest symptom in hemodialysis patients[14]. For many hemodialysis patients, on regular basis after each dialysis session felling of fatigue occurs[15].
Wasting time theme suggested waiting in the ward before the commencement of dialysis session, having to go there three times a week and each time for 4 hours in the dialysis ward and spending time to recover after dialysis. Although hemodialysis patients refer to centers based on appointments, but sometimes their session doesn't start on time, and the amount of time they must wait is too long. They had to wait before each dialysis session, and they have to wait after dialysis due to related changes that occur in their physical condition. These patients aren’t satisfied since their time is being wasted and have to spend more than the usual time in an unsuitable condition. Our findings suggested that hemodialysis participants seem to be upset for losing their time because of treatment.
Although hemodialysis participants were willing to travel and thought of traveling, but they lost their motivation because of problems and loss of physical strength attributed to hemodialysis. Even if they had the motivation and ability to travel, they must coordinate with their destination hemodialysis center for continuing their treatment and at the destination facilities must be available to perform hemodialysis, and/or referred to a city or a location near their destination where it has dialysis facilities.
Despite the fact that the studied hemodialysis patients were sleepy and tired after dialysis and felt weak, however, they couldn't get enough sleep especially in the evening after dialysis session. These patients usually suffered from not being able to sleep until late at night, frequent awakening during the night and not being able to go back to sleep after waking up. It seems that taking a nap during hemodialysis makes more problems with night sleeping for them. Since peritoneal dialysis patients are active while the dialysis process, therefore, they sleep less during the day, so they have a better night sleep[16].
Some studied peritoneal dialysis patients suffered from fluid drainage pain in their abdomen at the end of each session. But gradually this feeling disappeared. Initially, peritoneal dialysis catheter was felt like a foreign object in the abdomen, but this feeling was gradually reduced over time.
Hygiene, cleanliness and preventing catheter contamination are critical in peritoneal dialysis. Since not everyone can comply with these instructions or due to space limitation, location and the proximity of peritoneal dialysis catheter to the digestive system, some people are more susceptible to catheter contamination. Since peritoneal catheter infection is the most common and serious complication of peritoneal dialysis, and despite the fact that participants had been trained to observe sterility, but some of the participants were concerned about catheter infection.
Although dialysate is sufficiently provided, but these patients have to prepare the equipment four times a day and each time for 30–40 minutes as well as exchanging the dialysate, hence, performing these steps are time consuming. Despite being time-consuming the spent time seems reasonable, but for some patients this producer seems too long. Since this type of dialysis should be performed in a suitable location which is not contaminated, but sustaining such an environment is not always possible, sometimes creating such an environment during a trip or work place is too difficult and according to them, this is a major limitation for this type of dialysis. Another limitation of this method as experienced by hemodialysis patients was going on a vacation. If the dialysate solution was not available in the destination, transferring high volume of this fluid was too hard and it was not feasible. Although unemployed and housewives did not need to carry dialysate and they could do dialysis at home, but it was more difficult for people who worked to take the fluid along with themselves as well as finding a suitable place at workplace and this was considered as another limitations in this approach. Since peritoneal dialysis patients are not dependent on the availability of dialysis ward, travelling is easier for them. Peritoneal dialysis patients need a pre-determined and arranged plan for medical care support arrangement during their journey. These people may need to contact peritoneal dialysis center where they wish to go on a vacation and request assistance if any problem arise. If they want to stay for a long period of time it is better that they send the required equipment to the destination before travelling and make sure that the equipment has reached the destination. Before travelling, these patients need to designate a clean space to conduct dialysis fluid exchange[17].
Mainly, the number and diversity of complications were much higher in hemodialysis patients. Since peritoneal dialysis patients experienced infection directly, from these patients' perspective, infection seemed to be a very big problem. If during fluid exchange the trained hygiene procedures were observed as well as with advancement in providing peritoneal dialysis equipment and surgery, peritoneal dialysis patients' problems were less than hemodialysis ones. There are many advantages in peritoneal dialysis such as; capability of executing it at home, maintaining residual renal function, fluid, blood pressure control, being cost effective, reducing the number of mortality and better quality of life[18].
Our data have shown that peritoneal dialysis patients are more satisfied with their treatment and they believed that their treatment had less impact on their life in comparison with hemodialysis patients. Peritoneal dialysis patients have significantly less co-morbidity in comparison with hemodialysis patients. Studies have shown that patients who use peritoneal dialysis feel more freedom and are able to manage their own treatment[19]. Patients who use peritoneal dialysis showed to be more flexible with regards to the time of dialysis[20].