Peritoneal Dialysis

Peritoneal dialysis is a treatment that allows people with kidney failure to clean their blood at home, using the natural lining of their abdomen as a filter instead of relying on a machine outside the body.

Table of contents

• What is Peritoneal Dialysis?
• When is Peritoneal Dialysis Needed?
• How Peritoneal Dialysis Works
• Types of Peritoneal Dialysis
• Preparing for Peritoneal Dialysis
• Where Can You Do Peritoneal Dialysis?
• What You Might Feel
• Benefits of Peritoneal Dialysis
• Possible Problems
• Lifestyle Changes
• Monitoring Your Treatment

What is Peritoneal Dialysis?

Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can no longer do this job properly^[1]. It’s a treatment for kidney failure, which means your kidneys can’t filter blood well enough any longer^[1]. When your kidneys don’t filter out waste products, the waste products (also called toxins) build up in your blood, and your kidneys eventually fail. Kidney failure is ultimately fatal without treatment^[4].

Peritoneal dialysis is different from another common type of dialysis called hemodialysis. Hemodialysis filters blood outside the body in a machine^[1]. With peritoneal dialysis, the filtering happens inside your body^[1].

When is Peritoneal Dialysis Needed?

You need dialysis if your kidneys no longer work well enough^[1]. Kidney damage often becomes worse over many years due to health issues such as diabetes and high blood pressure^[1].

Peritoneal dialysis is not a treatment option for everyone with kidney failure. You need to be able to use your hands in a skillful way and care for yourself at home. Or you need a trusted caregiver to help you with this process^[1].

How Peritoneal Dialysis Works

Peritoneal dialysis uses the lining of your abdomen (belly) to filter your blood inside your body^[2]. Health care providers call this lining the peritoneum^[2]. The peritoneum acts as a natural filter and removes wastes from blood^[1].

A few weeks before you start peritoneal dialysis, a surgeon places a soft tube, called a catheter, in your belly^[2]. When you start treatment, a cleansing fluid called dialysate flows from a bag through the catheter into your belly^[1]. The dialysate is water with salt and other additives^[2].

When the bag is empty, you disconnect it and place a cap on your catheter so you can move around and do your normal activities^[2]. While the dialysis solution is inside your belly, it absorbs wastes and extra fluid from your body^[2]. The fluid stays there for a few hours, during which the peritoneum filters waste and excess water from your blood into the dialysate^[4].

After a few hours, the solution and the wastes are drained out of your belly into the empty bag^[2]. You can throw away the used solution in a toilet or tub^[2]. Then, you start over with a fresh bag of dialysis solution. This process is called an exchange^[2].

When the solution is fresh, it absorbs wastes quickly. As time passes, filtering slows. For this reason, you need to repeat the process of emptying the used solution and refilling your belly with fresh solution four to six times every day^[2]. For the best results, it is important that you perform all of your exchanges as prescribed^[2].

Types of Peritoneal Dialysis

There are two main types of peritoneal dialysis^[4]:

Continuous ambulatory peritoneal dialysis (CAPD) is a do-it-yourself option that doesn’t need a machine^[4]. In this approach, you attach a bag of dialysis solution to the catheter and place the bag above your shoulder. Gravity continuously pulls the solution down into your abdomen. After about 30 minutes, you remove the solution^[4]. You must perform three to five CAPD exchanges per day^[4]. You can perform an exchange anywhere that’s clean, dry and well-lit. You’re free to do your regular activities while the cleansing fluid is inside your body^[4].

Automated peritoneal dialysis (APD) uses a machine called an automated cycler to add dialysis solution to your abdomen and then drain it^[4]. The automated cycler performs three to five exchanges per session. Most people do APD at night^[4]. Another name for APD is continuous cycling peritoneal dialysis (CCPD)^[4].

You can do your exchanges during the day, or at night using a machine that pumps the fluid in and out^[2].

Preparing for Peritoneal Dialysis

Before you start peritoneal dialysis, a surgeon places a soft tube (catheter) in your belly during a minor procedure^[4]. This happens a few weeks before you start treatment^[2].

Where Can You Do Peritoneal Dialysis?

Peritoneal dialysis treatments can be done at home, at work or while you travel^[1]. You can do this at home multiple times a day or overnight while you sleep. This offers more flexibility than other types of dialysis^[4].

What You Might Feel

You may feel the same as usual, or you may feel full or bloated when the dialysis solution is inside your belly^[2]. Your belly may enlarge a little. Some people need a larger size of clothing. You shouldn’t feel any pain^[2]. Most people look and feel normal despite a belly full of dialysis solution^[2].

Benefits of Peritoneal Dialysis

Peritoneal dialysis has several advantages. Because peritoneal dialysis works inside the body, it’s different from hemodialysis, which filters blood outside the body in a machine^[1]. Treatments can be done at home, at work or while you travel, offering greater flexibility^[1].

Possible Problems

One of the most common problems with peritoneal dialysis is the risk of an infection called peritonitis^[21]. This is when your peritoneum, that natural lining in your stomach, gets infected. This might happen if germs get into your belly through your catheter^[21].

There are steps you can take to reduce your risk of getting an infection. To help prevent an infection, you should learn the right way to do your exchanges. Keep all of your peritoneal dialysis supplies in a clean, dry place. Do all of your exchanges in a clean, dry place. Always wash your hands before doing an exchange. Wear a surgical mask when you do exchanges^[21].

If you think you do have an infection, get treatment quickly. Tell your doctor right away if you see pink or red around your catheter, have pain around your catheter, your catheter shifts or starts to come out, any of the clamps on your catheter break, your dialysate looks cloudy, you have a fever, or you feel very sick or throw up^[21].

Bad infections can keep you from being able to do the peritoneal dialysis treatments you need^[21].

Lifestyle Changes

Peritoneal dialysis requires a catheter or tube in the abdomen to fill and drain dialysate during each exchange, so it is vital to keep the exit site and catheter clean^[18].

Whether you do your exchange process every 4 to 6 hours or by using a cycler overnight, it helps if you stay on a schedule and do the full treatment^[18]. Missing a treatment can lead to short- and long-term consequences^[18].

Monitoring Your Treatment

To ensure you are getting enough dialysis to effectively filter your blood, you will need to have blood samples drawn at a clinic at least once a month^[18]. Periodically, you will also need to collect your urine and filtered dialysate over a 24-hour period and submit these specimens for testing during a clinic visit^[18].

Dialysis can help you feel better and live longer, but it is not a cure for kidney failure^[2].