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Peritoneal Dialysis (PD): A Comprehensive Guide

Peritoneal dialysis is a home-based treatment for kidney failure that uses the lining of your abdomen (peritoneum) as a natural filter to remove waste and excess fluid from your blood.

Medical Emergency

If you experience severe abdominal pain, fever, cloudy or bloody drainage fluid, or catheter site redness/swelling, contact your healthcare provider immediately. For severe symptoms, call 911 or your local emergency number. This website provides informational content only and is not a substitute for medical advice or emergency services.

How Peritoneal Dialysis Works

Peritoneal dialysis works on the principle of diffusion across a semipermeable membrane. Here's the basic process:

  1. The Peritoneum: The lining of your abdominal cavity (peritoneum) serves as the semipermeable membrane that allows waste products and excess fluid to pass from your bloodstream into the dialysis solution.
  2. Catheter Placement: A soft, flexible catheter is surgically placed in your abdomen. The catheter has a portion outside your body that allows you to connect to bags of dialysis solution.
  3. Fill Phase: Dialysis solution (dialysate) flows through the catheter into your peritoneal cavity during the "fill" phase.
  4. Dwell Phase: The solution remains in your abdomen for a prescribed period (usually 4-6 hours) called the "dwell" time. During this time, waste products and excess fluid move from your blood into the dialysis solution.
  5. Drain Phase: After the dwell time, the used solution, now containing wastes and excess fluid, is drained from your body.
  6. Exchange: The process of draining used solution and replacing it with fresh solution is called an "exchange" or "cycle."

Types of Peritoneal Dialysis

Continuous Ambulatory Peritoneal Dialysis (CAPD)

CAPD doesn't require a machine and is performed manually throughout the day.

How CAPD Works:

  1. The patient connects a bag of dialysate to the catheter and allows the solution to flow into the peritoneal cavity (fill phase)
  2. The empty bag is rolled up and tucked away under clothing during the dwell phase (4-6 hours)
  3. After the dwell time, the solution is drained into the empty bag
  4. A new bag of solution is connected, and the process begins again

Typical Schedule: 4-5 exchanges per day

Exchange Duration: 30-40 minutes to drain and fill

Best For: People who prefer a machine-free approach and value flexibility during the day

Automated Peritoneal Dialysis (APD)

APD uses a machine called a cycler to automatically perform exchanges while you sleep.

How APD Works:

  1. The patient connects to a cycler machine before going to bed
  2. The machine automatically performs multiple exchanges throughout the night
  3. In the morning, the final fill remains in the abdomen during the day (known as the "day dwell")
  4. The patient disconnects from the machine in the morning

Typical Schedule: 8-10 hours of cycling at night, sometimes with an additional daytime exchange

Cycles per Night: Usually 3-5 cycles

Best For: People who have busy daytime schedules or prefer treatment while sleeping

Benefits of Peritoneal Dialysis

  • Independence and Flexibility: PD can be performed at home, work, or while traveling, offering greater flexibility than in-center hemodialysis.
  • No Blood Access Required: Unlike hemodialysis, PD doesn't require needles or direct access to your bloodstream.
  • Preserves Residual Kidney Function: PD may help preserve your remaining kidney function longer than conventional hemodialysis.
  • More Liberal Diet: The continuous nature of PD often allows for fewer dietary restrictions compared to conventional hemodialysis.
  • Better Hemodynamic Stability: Since fluid removal is gradual, PD typically causes less strain on the heart and vascular system.
  • No "Dialysis Hangover": Many patients report feeling better overall with PD, without the post-treatment fatigue common with hemodialysis.

Potential Challenges and Complications

Peritonitis

Peritonitis is an infection of the peritoneum and is the most significant complication of PD. It requires prompt treatment.

Symptoms include:

  • Cloudy dialysis fluid
  • Abdominal pain or tenderness
  • Fever
  • Nausea or vomiting

Prevention: Strict adherence to sterile technique during exchanges and proper exit-site care are essential to prevent peritonitis.

Other Potential Complications

  • Exit-Site and Tunnel Infections: Infections at the catheter exit site or along the tunnel under the skin
  • Catheter-Related Issues: Migration, obstruction, or leakage
  • Hernias: Increased abdominal pressure can lead to hernias
  • Weight Gain: From absorption of glucose from the dialysis solution
  • Ultrafiltration Failure: Gradually decreased ability of the peritoneal membrane to remove fluid

Is Peritoneal Dialysis Right for You?

Peritoneal dialysis may be a good option if you:

  • Want to be actively involved in your care
  • Prefer flexibility in your treatment schedule
  • Have trouble with blood access for hemodialysis
  • Want to continue working or have an active lifestyle
  • Have a clean home environment
  • Have good manual dexterity or a caregiver to assist
  • Can adhere to sterile technique

PD might not be ideal if you:

  • Have had multiple abdominal surgeries
  • Have significant abdominal adhesions
  • Have inflammatory bowel disease
  • Have limited dexterity or vision and no caregiver assistance
  • Cannot maintain a clean environment for exchanges
  • Have body image concerns related to having a permanent catheter

Finding Peritoneal Dialysis Support

If you're interested in peritoneal dialysis, consider these steps:

  1. Discuss PD as an option with your nephrologist
  2. Visit a dialysis center that offers PD training and support
  3. Meet with a PD nurse to learn more about the daily routine
  4. Consider speaking with current PD patients about their experiences
  5. Evaluate your home environment for suitability
  6. Check whether your insurance covers PD supplies and equipment

Use our directory to find dialysis centers that offer peritoneal dialysis training and support services in your area.

Disclaimer: The information provided on this website is for informational purposes only and is not intended as medical advice. This content is not reviewed by medical professionals and is simply an aggregation of information found online. This site makes no claim to be a medical expert, professional, or doctor in any way. Always consult with a qualified healthcare provider for personalized medical advice about dialysis treatment options. In case of emergency, call 911 or your local emergency number.

Find PD Support Centers

Use our directory to find centers that offer peritoneal dialysis training and support.

Related Information

Understanding Kidney Disease Dialysis Treatment Options Home Dialysis Guide

Common PD Questions

Most patients report that PD is not painful. The catheter insertion procedure is performed under anesthesia. Once healed, exchanges shouldn't cause pain, though you may feel a sensation of fullness when the abdomen contains dialysis fluid.

Yes! One of the major advantages of PD is the ability to travel. Supplies can be shipped to your destination within the US, and many companies can coordinate international deliveries as well. Always plan ahead and consult with your PD nurse before traveling.

You'll need approximately 50-100 square feet of clean, dry storage space for a month's supply of PD solution and equipment. This is roughly equivalent to a small closet or pantry area. The solution boxes are delivered monthly and should be stored at room temperature.