Peritoneal Dialysis

Peritoneal dialysis (PD) is a home-based medical treatment for kidney failure. It uses the natural lining of your abdomen (peritoneum) and a special fluid (dialysate) to filter waste products and excess fluid from your blood. A soft tube (catheter) is surgically placed in your belly to allow these fluid exchanges, helping to manage end-stage kidney disease.

What is Peritoneal Dialysis?

Peritoneal dialysis (PD) is a medical procedure that cleans your blood inside your body when your kidneys fail. It uses the natural lining of your abdomen (peritoneum) as a filter. A special fluid, called dialysate, is put into your belly through a soft tube (catheter) to absorb waste products and excess fluid.

Your peritoneum is a membrane that lines your abdominal cavity and covers your organs. It has many tiny blood vessels. In PD, the dialysate fluid stays in your abdomen for several hours. During this time, waste products and extra fluid from your blood pass through the peritoneum into the dialysate. Once the waste has been absorbed, the fluid is drained out and replaced with fresh dialysate. This process is called an "exchange." Peritoneal dialysis is usually done at home, either manually throughout the day or with a machine overnight. This treatment helps your body maintain a healthy balance of fluids and chemicals. It removes toxins that your kidneys can no longer filter, preventing them from building up and causing serious health problems. Your healthcare team will teach you how to perform these exchanges safely and effectively.

Why it's done

Peritoneal dialysis is performed when your kidneys can no longer effectively filter waste products and excess fluid from your blood, a condition known as end-stage kidney disease (ESKD). It is a vital treatment option to sustain life and manage symptoms, serving as an alternative to hemodialysis or kidney transplantation.

Your kidneys normally remove waste products like urea and creatinine, along with extra water, from your blood. When your kidneys fail, these substances build up in your body, leading to serious health problems such as swelling, fatigue, and high blood pressure (hypertension). Peritoneal dialysis takes over this filtering function. Many people choose peritoneal dialysis because it offers more independence and flexibility than in-center hemodialysis. It allows you to perform treatments at home, often while you sleep, or during the day at times that fit your schedule. This can mean fewer trips to a clinic and a more active lifestyle. PD is also often considered a gentler form of dialysis, as it typically causes less stress on your heart and blood vessels compared to hemodialysis. It avoids the need for needles during treatment, which many people prefer, and may help preserve any remaining kidney function longer.

How to prepare

Preparing for peritoneal dialysis involves a minor surgical procedure to place a soft tube (catheter) into your abdomen, typically several weeks before starting treatment. You will also receive comprehensive training from a healthcare team on how to safely perform the dialysis exchanges and care for your catheter site at home.

The catheter insertion surgery is usually a simple procedure performed by a surgeon. A small, flexible tube is placed into your lower abdomen, usually near your belly button. This tube will remain in place permanently and will be used to fill and drain the dialysate fluid. The site needs time to heal, typically a few weeks, before you can begin dialysis. After the catheter is placed and healed, a specialized healthcare team, including nurses and dietitians, will teach you everything you need to know. This training covers how to connect and disconnect the dialysate bags, how to perform exchanges cleanly to prevent infection, and how to properly care for your catheter exit site. They will also teach you how to recognize and report any problems or complications. You will also need to prepare your home environment. This includes identifying a clean, dedicated space for performing your exchanges and storing your dialysis supplies. Your healthcare team will help you ensure your home is ready for safe and effective treatment, and they will help you arrange for regular delivery of your supplies.

What happens during

During peritoneal dialysis, a cycle of "exchanges" occurs, involving three main steps: fill, dwell, and drain. First, a special fluid (dialysate) flows into your abdomen through the catheter. This fluid then "dwells" inside your body for several hours, absorbing waste. Finally, the waste-filled fluid is drained out.

The "fill" step involves connecting a bag of fresh dialysate to your catheter. Gravity helps the fluid flow into your peritoneal cavity, usually taking about 10 to 20 minutes. Once the fluid is in, the bag is disconnected, and the "dwell" time begins. During the "dwell" time, which can last from a few hours to overnight, the dialysate remains in your abdomen. Your peritoneum acts as a natural filter, allowing waste products and excess water from your blood to pass into the dialysate. The type of dialysate and the dwell time are prescribed by your doctor based on your individual needs. The "drain" step involves reconnecting the catheter to an empty bag. The fluid, now containing the waste, flows out of your abdomen into the bag. This usually takes 20 to 30 minutes. Once drained, you can either start a new exchange with fresh dialysate or disconnect until your next scheduled exchange. There are two main types of peritoneal dialysis. Continuous ambulatory peritoneal dialysis (CAPD) involves manual exchanges throughout the day, typically three to five times. Automated peritoneal dialysis (APD) uses a machine called a cycler to perform exchanges automatically, usually overnight while you sleep.

Recovery & timeline

Recovery from the catheter placement surgery for peritoneal dialysis typically takes a few weeks, allowing the site to heal before treatment begins. After healing, you will undergo several days to weeks of training to learn how to perform exchanges safely. Peritoneal dialysis is an ongoing, daily treatment for kidney failure, not a temporary cure.

The initial recovery period focuses on healing the catheter insertion site. It is crucial to keep the area clean and dry to prevent infection. Your healthcare team will provide specific instructions on wound care during this time, including how to clean the site and when to change dressings. You may experience some mild discomfort, which can be managed with over-the-counter pain relievers. Once the catheter site has healed, you will start your training. This comprehensive education ensures you are confident and competent in managing your dialysis at home. The duration of training varies but usually lasts from a few days to a couple of weeks, depending on individual learning pace and the type of PD chosen (CAPD or APD). Peritoneal dialysis is a long-term treatment. It becomes a regular part of your daily life, requiring consistent adherence to your exchange schedule. While it effectively manages kidney failure, it does not cure the underlying kidney disease. Many people continue PD for several years, but some may eventually transition to hemodialysis or receive a kidney transplant if their needs change or complications arise.

Risks & side effects

The most common and serious risk of peritoneal dialysis is peritonitis, an infection of the abdominal lining, which requires immediate medical attention. Other potential risks include catheter site infections, hernias, weight gain, and high blood sugar due to the sugar (dextrose) in the dialysate fluid.

Peritonitis is a serious infection that can occur if bacteria enter your abdomen through the catheter. Symptoms often include severe abdominal pain, fever, chills, nausea, vomiting, and cloudy dialysate fluid. It is crucial to contact your healthcare team immediately if you suspect peritonitis, as prompt treatment with antibiotics is necessary to prevent serious complications and preserve your peritoneal membrane. Infections can also occur at the catheter exit site, where the tube exits your body. Proper hygiene and meticulous catheter care, as taught during your training, are essential to minimize this risk. Signs of a catheter site infection include redness, swelling, pain, or pus around the catheter. These also require prompt medical attention. Some people may develop a hernia, a weakening of the abdominal muscles, due to the constant presence of fluid in the abdomen. This can sometimes require surgical repair. Additionally, the dextrose (a type of sugar) in the dialysate can be absorbed by your body, potentially leading to weight gain and elevated blood sugar levels (hyperglycemia), especially for those with diabetes. Your care team will monitor these factors closely and adjust your treatment plan as needed. Other less common side effects can include abdominal pain or discomfort, a feeling of fullness, and fluid leakage around the catheter site. Your healthcare team will discuss all potential risks and side effects with you and provide guidance on how to manage them.

Success rate

Peritoneal dialysis is a highly effective treatment for end-stage kidney disease, successfully removing waste products and excess fluid from the body. It significantly improves quality of life for many patients, allowing for greater independence and flexibility compared to in-center hemodialysis.

Peritoneal dialysis effectively performs the filtering function of failing kidneys, helping to keep the body's chemistry balanced and preventing the buildup of harmful toxins. Studies show that survival rates for people on peritoneal dialysis are comparable to those on hemodialysis, particularly in the first few years of treatment. The "success" of peritoneal dialysis is often measured not only by its ability to clean the blood but also by how well it integrates into a person's life. Many individuals report a better quality of life and greater satisfaction with PD due to the ability to perform treatments at home and maintain a more flexible schedule, allowing them to continue working, studying, or pursuing hobbies. While PD is effective, it is not a permanent cure for kidney failure. Over time, some people may experience changes in their peritoneal membrane's filtering ability or develop complications like recurrent peritonitis. These factors might necessitate a switch to hemodialysis or a kidney transplant. However, for many, PD provides a successful and sustainable treatment option for several years, offering a good quality of life while managing their kidney disease.

Frequently asked questions

Can I travel while on peritoneal dialysis?

Yes, many people on peritoneal dialysis can travel. You will need to plan ahead to arrange for your dialysis supplies to be delivered to your destination. Your healthcare team can help you coordinate this and provide advice for traveling safely with your catheter and managing your treatment schedule while away from home.

How long can someone stay on peritoneal dialysis?

The duration varies greatly among individuals. Many people successfully use peritoneal dialysis for several years. However, some may eventually need to switch to hemodialysis or receive a kidney transplant due to changes in their body's response to PD, such as reduced filtering efficiency of the peritoneum, or complications like recurrent infections.

Does peritoneal dialysis hurt?

The catheter insertion surgery involves some discomfort during recovery, which is managed with pain medication. During the actual dialysis exchanges, most people do not feel pain, though some may experience a feeling of fullness or mild abdominal discomfort, especially during the "fill" phase as the fluid enters the abdomen. This usually subsides as you get used to the treatment.

What foods should I avoid on peritoneal dialysis?

Your diet on peritoneal dialysis will be different from a standard kidney diet. You may need more protein, but still need to limit sodium, phosphorus, and potassium. A registered dietitian will work closely with your healthcare team to create a personalized meal plan for you, considering your specific needs and the nutrients absorbed from the dialysate.

Is peritoneal dialysis better than hemodialysis?

Neither peritoneal dialysis nor hemodialysis is inherently "better"; the best choice depends on your individual health, lifestyle, and preferences. PD offers more flexibility and home treatment, while hemodialysis is performed in a clinic several times a week. Your doctor will discuss the pros and cons of each option to help you decide which is best for you.

How do I know if I have peritonitis?

Signs of peritonitis, a serious infection, include new or worsening abdominal pain, fever, chills, nausea, vomiting, and cloudy dialysate fluid. If you experience any of these symptoms, you must contact your healthcare team immediately for evaluation and treatment, as prompt intervention is crucial to prevent serious complications.

Sources

• MedlinePlus — Peritoneal Dialysis
• Mayo Clinic — Peritoneal Dialysis
• Cochrane Library — Peritoneal Dialysis