Peritoneal dialysis is a home treatment method that helps people whose kidneys have stopped working properly by using the natural lining of their belly to clean their blood from the inside.

When kidneys fail, the body can no longer remove waste products and extra water on its own. Peritoneal dialysis offers a way to perform this essential cleaning function without having to visit a medical facility several times a week. Unlike the more common type of dialysis that uses a machine outside the body, peritoneal dialysis works inside your abdomen, giving many people more control over their treatment schedule and allowing them to maintain their daily routines more easily.^[1]

Understanding How Peritoneal Dialysis Works

The treatment relies on a thin, natural membrane called the peritoneum, which lines the inside of your belly and surrounds your organs. This membrane acts like a filter. A surgeon places a soft, flexible tube called a catheter into your abdomen a few weeks before you start treatment. This gives the area time to heal before you begin using it.^[2]

During treatment, a special cleansing fluid called dialysate flows through the catheter into your belly. The dialysate is made of water, salt, and other substances that help draw waste products and extra fluid from your blood through the peritoneum. The fluid stays inside your belly for several hours, during which time it slowly absorbs wastes and toxins. After this period, you drain the used fluid out through the catheter into an empty bag, then dispose of it safely in a toilet or tub. You then fill your belly with fresh dialysate to start the process again.^[2]

Each time you drain out the used solution and refill with fresh fluid is called an exchange. Most people need to do four to six exchanges every day to keep their blood properly cleaned. The reason for this frequent schedule is that fresh dialysate works best at absorbing waste. As time passes, the fluid becomes less effective, so it needs to be replaced regularly.^[2]

Different Types of Peritoneal Dialysis

There are two main approaches to peritoneal dialysis, each designed to fit different lifestyles and needs. The first type is called continuous ambulatory peritoneal dialysis, or CAPD. With CAPD, you perform the exchanges yourself during the day without using a machine. You attach a bag of dialysate to your catheter and hold it above your shoulder so gravity pulls the fluid down into your belly. This takes about thirty minutes. After the fluid has stayed in your abdomen for the prescribed time—usually four to six hours—you drain it out and immediately refill with fresh solution. You need to do three to five exchanges throughout the day. The advantage is that you can do an exchange anywhere that is clean, dry, and well-lit, and you’re free to move around and do your normal activities while the fluid is inside you.^[4]

The second type is automated peritoneal dialysis, also called APD or continuous cycling peritoneal dialysis. This method uses a machine called an automated cycler that pumps fluid in and out of your belly automatically. Most people use this machine at night while they sleep, with the cycler performing three to five exchanges during the session. This means you don’t have to stop your daytime activities for treatments.^[4]

There is also a less common type called intermittent peritoneal dialysis, or IPD. It uses the same type of machine as automated dialysis but takes longer for each session. Healthcare providers usually perform IPD in a hospital setting rather than at home.^[4]

Who Can Benefit from Peritoneal Dialysis

Peritoneal dialysis is designed for people whose kidneys have failed or are failing. Kidney damage often develops slowly over many years because of long-term health conditions. The two most common causes are diabetes and high blood pressure. Both of these conditions can gradually harm the tiny filtering units inside the kidneys until they no longer work well enough to keep the blood clean.^[1]

However, peritoneal dialysis isn’t suitable for everyone with kidney failure. To do this treatment at home, you need to be able to use your hands skillfully and be capable of following detailed instructions for cleaning and connecting equipment. If you can’t perform the treatment yourself, you need a trusted caregiver who can help you with the process safely. Some people simply prefer not to take on the responsibility of managing their own treatments at home.^[1]

How Common Is Peritoneal Dialysis

Despite its advantages, peritoneal dialysis is actually the least common type of dialysis treatment. Only about ten percent of people who need dialysis receive peritoneal dialysis. The vast majority of patients receive a different type called hemodialysis, which is performed in medical facilities using external machines.^[4]

There are several reasons why peritoneal dialysis is less popular than it could be. Many people simply don’t know that peritoneal dialysis exists as an option, or they don’t fully understand how it works. Healthcare systems also play a role—there aren’t enough doctors and nurses who specialize in teaching and supporting peritoneal dialysis. For patients who need assistance with treatments, finding someone trained to help with peritoneal dialysis can be difficult. Additionally, if someone’s kidneys fail suddenly and there isn’t time to place a catheter and allow it to heal, they may have to start with hemodialysis instead.^[4]

Preparing for Peritoneal Dialysis

Before you can begin peritoneal dialysis at home, you’ll need minor surgery to have the catheter placed in your abdomen. A surgeon performs this procedure, usually a few weeks before you plan to start treatment. This waiting period is important because it allows the area where the catheter enters your body to heal properly before you begin using it for exchanges.^[2]

You’ll also receive thorough training on how to perform the treatment safely. Healthcare providers will teach you how to connect the dialysate bags to your catheter, how to monitor for problems, and most importantly, how to keep everything clean to prevent infections. This training is essential because doing exchanges correctly protects you from serious complications.^[2]

Living with Peritoneal Dialysis

Most people find that peritoneal dialysis fits more easily into their daily lives than other types of dialysis. You can do treatments at home, at work, or even while traveling, which gives you more freedom and flexibility. While the dialysate is inside your belly doing its work, you can go about your normal activities—you don’t have to sit still or be connected to a large machine.^[1]

When the cleansing fluid is inside your abdomen, you may feel the same as usual, or you might feel somewhat full or bloated. Your belly may look a little larger, and some people find they need to wear slightly bigger clothing. You shouldn’t feel pain, and most people appear and feel normal despite having their belly filled with fluid.^[2]

Staying on schedule is crucial for the treatment to work properly. Missing exchanges or not doing the full treatment can lead to waste products building up in your blood, which can cause both immediate problems and long-term health complications. If you’re using automated dialysis at night, you need to use the machine every night as prescribed.^[2]

Possible Complications and Warning Signs

One of the most serious risks with peritoneal dialysis is an infection of the peritoneum called peritonitis. This happens when germs get into your belly through the catheter or the area where it enters your body. Peritonitis is a significant concern because it can prevent you from being able to continue with peritoneal dialysis if it becomes severe or happens repeatedly.^[21]

Preventing infection requires careful attention to cleanliness. You must always wash your hands thoroughly before touching your catheter or doing an exchange. It’s important to perform all exchanges in a clean, dry, well-lit area. During exchanges, many people wear a surgical mask to prevent germs from spreading. You should also learn the proper technique for connecting and disconnecting equipment and never skip steps in the process.^[21]

Monitoring Your Treatment

To make sure peritoneal dialysis is cleaning your blood effectively, you’ll need regular monitoring. At least once a month, you’ll need to visit a clinic to have blood samples taken and tested. Periodically, you’ll also need to collect your urine and used dialysate over a twenty-four-hour period and bring these samples to the clinic for testing. These tests tell your healthcare team whether you’re getting enough dialysis and whether any adjustments to your treatment plan are needed.^[2]

Changes in the Body During Peritoneal Dialysis

Peritoneal dialysis works by using the peritoneum as a natural filter. When dialysate sits in your abdominal cavity, waste products and extra fluid from your blood pass through the tiny blood vessels in the peritoneum and into the dialysate. This process happens because of differences in concentration between your blood and the dialysate—substances naturally move from areas of higher concentration to areas of lower concentration. The dialysate contains special sugars or other substances that help pull excess water out of your blood as well.^[2]

Your body relies on healthy kidneys to remove toxins, manage fluid balance, control blood pressure, and maintain the right levels of important minerals called electrolytes. When kidneys fail, these toxins build up in the blood in a condition called uremia, which is ultimately fatal without treatment. Peritoneal dialysis takes over these critical functions, helping to remove toxins, pull out extra fluid, and help manage electrolyte levels and blood pressure.^[4]