Peritoneal dialysis is a treatment approach for people whose kidneys no longer work properly, using the body’s own abdominal lining to filter waste and excess fluids from the blood—a process that can be performed at home, offering flexibility and independence in managing kidney failure.

Understanding the Outlook When Using Peritoneal Dialysis

When your kidneys fail and you begin peritoneal dialysis, it’s important to understand what this means for your future. Peritoneal dialysis is not a cure for kidney failure. It is a treatment that helps your body do the work your kidneys can no longer manage. Without any form of dialysis or a kidney transplant, kidney failure would eventually be fatal, as waste products and toxins would continue to build up in your blood—a dangerous condition called uremia.^[1][2]

The good news is that dialysis can help you feel better and live longer. Many people on peritoneal dialysis are able to maintain a good quality of life for years. The treatment works by using the natural lining of your abdomen, called the peritoneum, as a filter. A cleansing fluid called dialysate is introduced into your belly through a soft tube, and it absorbs waste products and extra water from your blood. After a few hours, the fluid is drained out, taking the waste with it.^[1][2]

Your long-term outlook depends on many factors, including how well you follow your treatment schedule, how carefully you manage your diet and medications, and whether you experience complications such as infections. Performing all your exchanges as prescribed is essential. Missing treatments can lead to both immediate and long-term health consequences, as waste and fluid can build up quickly in your body.^[2][4]

For many people, peritoneal dialysis serves as a bridge to kidney transplantation, which can offer a longer and more flexible life. Others may continue on dialysis for many years. The key is to stay engaged with your healthcare team, monitor your health closely, and maintain the discipline required to perform your treatments consistently.

What Happens If Peritoneal Dialysis Is Not Used or Stopped

If someone with kidney failure does not start dialysis or stops their peritoneal dialysis treatments, the body’s ability to remove waste products and extra fluid becomes severely compromised. Without treatment, toxins that your kidneys would normally filter out continue to accumulate in your bloodstream. This buildup leads to a condition known as uremia, where high levels of waste products poison your body.^[1][4]

Over time, untreated kidney failure causes serious and life-threatening complications. You may experience extreme fatigue, confusion, nausea, vomiting, difficulty breathing, and swelling in your legs, ankles, or around your lungs due to fluid overload. Your heart may struggle to function properly, and dangerous levels of potassium or other electrolytes can accumulate, leading to irregular heartbeats or even cardiac arrest.^[1]

The natural progression without dialysis is that kidney failure will ultimately be fatal. The timeline varies from person to person, but without intervention, the body cannot sustain itself. This is why dialysis—whether peritoneal dialysis or another form—is considered a life-sustaining treatment. It essentially takes over the essential functions your kidneys can no longer perform.^[1][4]

Some people may choose not to pursue dialysis, a decision often called conservative management or palliative care. In these cases, the focus shifts to managing symptoms and ensuring comfort rather than prolonging life. This is a deeply personal choice that should be made with the support of family, healthcare providers, and counselors who can help navigate the emotional and practical aspects of such a decision.

Possible Complications and Risks

Peritoneal dialysis, while effective and offering many benefits, does come with potential complications that patients and their families need to be aware of. The most common and serious complication is an infection of the peritoneum, known as peritonitis. This happens when germs enter your abdominal cavity, often through the catheter used for dialysis. Peritonitis can cause severe abdominal pain, fever, nausea, and cloudy dialysate fluid.^[2][4]

If you develop peritonitis, it’s critical to seek treatment immediately, as untreated infections can prevent you from continuing peritoneal dialysis and may require switching to another form of dialysis. To reduce your risk, you must maintain strict cleanliness when performing exchanges, always wash your hands thoroughly, wear a surgical mask during the procedure, and keep all supplies in a clean, dry environment. The exit site where the catheter enters your body must also be kept clean and monitored regularly for signs of infection, such as redness, swelling, or discharge.^[2][4]

Another possible complication is fungal peritonitis, which can occur especially if you have been taking antibiotics for a prolonged period. Fungal infections are more difficult to treat than bacterial ones and may have serious consequences for your ability to continue with peritoneal dialysis.^[21]

Problems with the catheter itself can also arise. The catheter may become blocked, shift out of position, or in rare cases, break. If any of the clamps on your catheter break or malfunction, this needs to be addressed right away to prevent infection or treatment failure.^[2]

Some people may also experience discomfort or a feeling of fullness in their abdomen when the dialysis solution is inside their body. Your belly may enlarge slightly, and you might need to wear looser clothing. Though most people adjust to this sensation, it’s important to report any pain, as pain is not a normal part of the process and could indicate a problem.^[2][4]

Over time, the peritoneum itself can change in response to the repeated introduction of dialysate. In some cases, the peritoneum may become less effective as a filter, a condition that may eventually require switching to a different form of dialysis.

Impact on Daily Life

Living with peritoneal dialysis requires significant lifestyle adjustments, but many people find that it offers more freedom and flexibility compared to other dialysis options. One of the major advantages is that you can perform your treatments at home, at work, or even while traveling, rather than having to go to a dialysis center several times a week.^[1][4]

There are two main types of peritoneal dialysis. Continuous ambulatory peritoneal dialysis (CAPD) does not require a machine. You manually perform three to five exchanges each day, with each exchange taking about 30 minutes. During the time the cleansing fluid is in your abdomen—usually four to six hours—you are free to go about your normal activities. You can work, exercise, socialize, and sleep with the fluid inside you. The exchange process itself must be done in a clean, dry, and well-lit area.^[2][4]

The other main type is automated peritoneal dialysis (APD), also called continuous cycling peritoneal dialysis. This method uses a machine called an automated cycler that performs the exchanges for you while you sleep. The machine typically runs for eight to ten hours overnight, doing three to five exchanges automatically. Many people prefer this method because it frees up their daytime hours.^[2][4]

Regardless of which type you use, you will need to manage your schedule carefully. Consistency is key—missing exchanges or not completing the full treatment can lead to a dangerous buildup of waste and fluid in your body. You’ll need to plan your day around your exchanges, and for those using the cycler, you’ll need to ensure you have uninterrupted time at night to complete your treatment.^[2][18]

Dietary changes are also part of life on peritoneal dialysis. While you may have fewer restrictions than people on hemodialysis, you’ll still need to pay close attention to your nutrition. Your healthcare team will likely provide guidance on managing protein, potassium, phosphorus, sodium, and fluid intake. Because the dialysate contains sugar, some people may gain weight or experience blood sugar changes, which is especially important to monitor if you have diabetes.^[2][18]

Emotionally, adapting to peritoneal dialysis can be challenging. It’s normal to feel overwhelmed, anxious, or even depressed when you first start. The reality of having a chronic condition that requires daily treatment can take a toll on your mental health. Some people struggle with body image issues due to the catheter or the slight enlargement of the abdomen. Others may feel isolated or worry about how dialysis affects their relationships, work, or hobbies.

However, many people on peritoneal dialysis report that they are able to maintain an active and fulfilling life. You can continue working, traveling, and enjoying social activities with proper planning. Traveling is possible with peritoneal dialysis, as supplies can often be shipped to your destination, and the treatment can be performed in hotel rooms or other clean spaces. Many dialysis programs offer support for travelers.^[1][4]

Physical activity is generally encouraged, though you may need to avoid heavy lifting or contact sports that could damage your catheter. Many people swim, walk, cycle, and participate in other forms of exercise. Staying physically active is important for your overall health and can help you feel more energized and positive.

Sexually intimate relationships can also continue, though some adjustments may be needed. Open communication with your partner about any concerns or physical changes is important. Your healthcare team can provide advice on managing intimacy while on dialysis.

Support for Family Members

If your loved one is considering or already undergoing peritoneal dialysis, your role as a family member or caregiver is incredibly valuable. Understanding the treatment and how you can help will make a significant difference in their quality of life and success with dialysis.

First, educate yourself about peritoneal dialysis. Knowledge is one of the best tools you can have. Take advantage of free classes and resources offered by kidney care organizations. Attending a class together with your loved one ensures that you both understand what to expect and can make informed decisions about treatment options.^[18]

In the beginning, your loved one will need to make many choices, and you may be asked to help. Understanding the different types of peritoneal dialysis, the pros and cons of each, and how they fit into daily life will empower you to support their decisions. If your loved one is unable to perform the exchanges themselves due to physical limitations, poor vision, or dexterity issues, you may become their care partner and be trained to help with the procedure.^[18]

Maintaining cleanliness is one of the most critical aspects of peritoneal dialysis, and you can play an important role here. Help ensure that the exit site and catheter are kept clean. You’ll both learn the proper cleaning techniques during the training program, but ongoing vigilance is necessary. Make sure that supplies are stored in a clean, dry place and that exchanges are done in a hygienic environment.^[18]

Be a timekeeper. Whether your loved one is doing manual exchanges throughout the day or using a cycler at night, staying on schedule is essential. Help remind them when it’s time for an exchange, and gently encourage them to complete the full treatment every time. Missing treatments can have short- and long-term health consequences.^[18]

Keep track of important health numbers. Your loved one will need regular blood tests, urine collections, and monitoring of lab results to ensure the dialysis is working effectively. As a family member, you can help by keeping a record of these results and accompanying them to clinic visits. If your loved one has diabetes, help monitor their blood sugar levels as prescribed.^[18]

Encourage healthy eating. Diet plays a big role in managing kidney disease and dialysis. While people on peritoneal dialysis may have more dietary flexibility than those on other forms of dialysis, they still need to follow specific nutritional guidelines. You can support them by learning what foods are kidney-friendly, helping with meal planning, and cooking together. Limiting salt, managing phosphorus and potassium, and ensuring adequate protein intake are all important.^[18]

Emotional support is just as important as practical help. Living with kidney failure and dialysis is stressful and can be isolating. Your loved one may experience fear, sadness, frustration, or anxiety. Be patient, listen without judgment, and encourage them to talk about their feelings. Connecting with support groups, whether in person or online, can also be very helpful. Many kidney organizations offer peer mentorship programs where patients and caregivers can connect with others who have been through similar experiences.

Finally, take care of yourself. Being a caregiver can be exhausting, both physically and emotionally. Don’t hesitate to seek support for yourself, whether through counseling, caregiver support groups, or simply taking time for your own self-care. You can’t pour from an empty cup, and taking care of your own health will help you be a better support for your loved one.