Peritoneal Dialysis
Peritoneal dialysis is a type of dialysis that filters waste products and excess fluids out of your blood. There are two main types of peritoneal dialysis — one that you perform several times during the day and one that you do at night while you sleep. A healthcare provider can explain the pros and cons of each type of peritoneal dialysis.
Peritoneal dialysis is a type of dialysis. It does the work of your kidneys when they don’t function properly or don’t work at all (kidney failure). Your kidneys are part of your urinary system. They remove waste products and excess fluids from your blood and make urine (pee). When your kidneys don’t filter out waste products, the waste products (toxins) build up in your blood (uremia) and your kidneys eventually fail. Kidney failure is ultimately fatal without treatment.
Peritoneal dialysis uses the lining of your belly (peritoneum) as a natural filter to remove waste, toxins and extra water from your body. Healthcare providers place a soft tube (catheter) in your body during a minor procedure. Through this tube, a special cleansing fluid (dialysate) enters your belly. The fluid stays there for a few hours, during which the peritoneum filters waste and excess water from your blood into the dialysate.
Once complete, the fluid drains out along with the waste products, and you add fresh fluid to start the process again. You can do this at home multiple times a day or overnight while you sleep. This offers more flexibility than other types of dialysis.
Peritoneal dialysis helps treat kidney (renal) failure.
There are two main types of peritoneal dialysis:
- Continuous ambulatory peritoneal dialysis (CAPD). CAPD is a do-it-yourself option that doesn’t need a machine. 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. You must perform three to five CAPD exchanges per day. 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.
- Automated peritoneal dialysis (APD). APD uses a machine (automated cycler) to add dialysis solution to your abdomen and then drain it. The automated cycler performs three to five exchanges per session. Most people do APD at night. Another name for APD is continuous cycling peritoneal dialysis (CCPD).
Intermittent peritoneal dialysis (IPD) is another type of peritoneal dialysis. It isn’t as common as CAPD and APD. It uses the same type of automated cycler as APD, though treatments take longer. Healthcare providers usually perform IPD in a hospital.
Peritoneal dialysis is the least common type of dialysis. Only about 10% of people who need dialysis receive peritoneal dialysis.
There are many reasons why peritoneal dialysis isn’t as common as hemodialysis, including:
- Not enough education. Many people don’t know that peritoneal dialysis is an option or how it works.
- Lack of trained healthcare providers. There aren’t enough doctors and nurses who specialize in peritoneal dialysis.
- Limited help for assisted peritoneal dialysis. It can be difficult for some people who need help with peritoneal dialysis to find someone to assist them.
- Barriers to urgent-start peritoneal dialysis. If your kidneys fail suddenly and there’s no time to place a peritoneal dialysis tube, you might have to start hemodialysis instead. Many hospitals aren’t set up to start peritoneal dialysis quickly in emergencies.
A few weeks before you start peritoneal dialysis, a surgeon will insert a permanent catheter in your abdomen, usually near your belly button (navel). This is a minor procedure. A healthcare provider will also teach you how to:
- Use the peritoneal dialysis equipment
- Connect the dialysis solution bags
- Take care of your catheter site to prevent infections
Once you heal, you can start peritoneal dialysis.
It depends on what type of peritoneal dialysis you get. Before starting any peritoneal dialysis, it’s important to thoroughly wash your hands with soap and clean water. Using a hand sanitizer and wearing a face mask is also a good idea. These steps help reduce your risk of infection.
Continuous ambulatory peritoneal dialysis
During CAPD:
- Connect the catheter to a branch in a Y-shaped tube. The tube connects to the dialysis solution, which flows into your abdomen.
- Hang the dialysis solution bag from a pole above your shoulder. Gravity helps the solution drain into your peritoneal cavity.
- Once the dialysis solution bag is empty, disconnect the tube and catheter. It takes about 10 minutes for the bag to drain.
- Place a cap on the catheter.
- Go about your typical activities. A healthcare provider will let you know what exercises you perform during CAPD.
- After 60 to 90 minutes, attach a clean, empty bag to one branch of the Y-shaped tube and remove the cap from the catheter. Drain the dialysis solution into the bag.
Repeat these steps three to five times per day, according to a healthcare provider’s instructions.
Automated peritoneal dialysis
During APD:
- Clean the automated cycler.
- Prepare the dialysis solution.
- Connect the tubing to the automated cycler.
- Clamp off the tubes.
- Connect the drainage bag and turn on the machine.
- Attach the tubing to the catheter.
- Run the machine.
Most people choose to perform APD while they sleep. The automated cycler will add and drain dialysis solution about six times over an eight-hour period. When you wake up, disconnect the tubing from the machine, cap off your catheter, dispose of the drainage bag and go about your day.
A healthcare provider may recommend writing down some information in a record book every time you perform peritoneal dialysis, including:
- Your body weight before you start peritoneal dialysis.
- Your temperature.
- Your blood pressure.
- The kind of dialysis solution.
- How much dialysis solution.
- How long it takes the dialysis solution to drain (dialysis flow rate).
- Your body weight after you drain the dialysis solution (dry weight).
Continuous ambulatory peritoneal dialysis typically takes about 40 minutes. You need three to five sessions each day.
Automated peritoneal dialysis typically takes eight to 12 hours. Most people choose to do APD while they sleep.
After peritoneal dialysis, disconnect the drainage bag and clean your access area. You may then continue your typical activities.
No, peritoneal dialysis isn’t painful. You may feel full or bloated while the dialysis solution is in your abdomen, which may feel uncomfortable.
It depends. Your body is unique, and how it reacts to kidney disease may differ from others. Most people continue to make urine (pee) after starting peritoneal dialysis. However, you make less pee the longer you’re on dialysis.
Talk to a healthcare provider. They can tell you what to expect.
The main benefit of peritoneal dialysis is that it filters waste products and excess fluids from your blood when your kidneys no longer work as they should. Kidney failure is fatal without dialysis or a kidney transplant.
Other peritoneal dialysis benefits include:
- Convenience. Unlike hemodialysis, you don’t need to go to a special healthcare facility to receive treatment. You can perform peritoneal dialysis at home, at work, while traveling or in any other clean space.
- Fewer changes to your eating patterns. You perform peritoneal dialysis daily, so fewer waste products and fluids build up. Unlike hemodialysis, you may not have to avoid foods that contain a lot of potassium, phosphorus or sodium or drink less fluids. Greater control of the amount of fluids in your body may also reduce stress on your blood vessels and heart.
- No needles. A surgeon will place a catheter in your abdomen before you start peritoneal dialysis, which you use to add and drain the dialysis solution. Hemodialysis uses needles, which can be uncomfortable or even overwhelming for people who have a fear of needles (trypanophobia).
For some people, the most significant disadvantages of peritoneal dialysis include:
- You must perform it every day
- You have a permanent catheter in your abdomen
- It may not be possible if you’ve had prior surgeries on your abdomen or if you have overweight (a body mass index (BMI) greater than 25)
Other peritoneal dialysis risks or complications may include:
- Peritonitis. Peritonitis is a bacterial infection that causes inflammation in the lining of your abdomen. Peritonitis is most common within the first two years of peritoneal dialysis.
- Hernia. Extra pressure in your belly may cause a hernia to develop.
- Peritoneum scarring. Scarring may prevent fluids and waste products from passing through your peritoneum.
- Malnutrition. Your kidneys won’t be able to filter enough waste products and fluids from your blood. It’s a good idea to work with a dietitian who specializes in kidney health (renal dietitian) to follow a kidney-health diet and ensure you’re getting the right amounts of calories, vitamins, minerals and proteins.
- Weight gain. Dialysate contains sugar (dextrose). If your body absorbs some of this fluid, it might cause you to take in hundreds of extra calories daily.
- Ultrafiltration failure. Ultrafiltration is the name of the process that removes extra fluid from your blood using pressure. Ultrafiltration failure occurs when too little fluid filters through the peritoneum.
- Catheter issues. Catheter issues may include blockage and the fatty tissue in your abdomen (omentum) wrapping around the catheter (omental wrapping), which can block the catheter or cause it to move.
- Treatment becomes less effective. Peritoneal dialysis can stop working after several years. You may need to switch to hemodialysis.
In some cases, healthcare providers aren’t as familiar with peritoneal dialysis as they are with hemodialysis. They may be less likely to recommend peritoneal dialysis without proper education or training.
If you’re on peritoneal dialysis, you should avoid:
- Certain medicines that can harm your kidneys, like nonsteroidal anti-inflammatory drugs (NSAIDs)
- Spending a lot of time in the water, which includes soaking in baths or hot tubs, or swimming in places like lakes, ponds, rivers or unchlorinated pools
Spending extended amounts of time in the water increases your risk of infection. It’s safe to take daily showers. You can also swim in a chlorinated pool once the area in which your catheter comes out has completely healed. Be sure to dry the area and change into dry clothes right after swimming or showering.
The average life expectancy after starting peritoneal dialysis is 5 to 10 years. But some people live up to 30 years on dialysis without major changes to their quality of life.
It usually takes two to three weeks to heal from the catheter surgery.
Once starting peritoneal dialysis, some people begin to feel relief from their kidney failure within a week. But it may take others a few months to start to feel better. Talk to a healthcare provider about what to expect.
Many people can and do return to work or school while on peritoneal dialysis. You can do automated peritoneal dialysis while you sleep, so you don’t have to worry about it in a work or school environment. And as long as you have access to a clean environment, you can do continuous ambulatory peritoneal dialysis at work or school.
When should I call a healthcare provider?
Contact a healthcare provider if you experience:
- Abdominal pain or swelling
- Fever
- Fast heart rate (tachycardia)
- Shortness of breath (dyspnea)
- Nausea and vomiting
- Trouble peeing
- Signs of low blood pressure (hypotension), including dizziness, fainting or dehydration
It’s also a good idea to contact a provider if the dialysis solution looks cloudy or the color seems off after you drain it from your abdomen.
References
- Chaudhary K. Peritoneal Dialysis Drop-Out: Causes and Prevention Strategies (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205769/). Int J Nephrol. 2011 Oct;2011:434608. Accessed 12/3/2024.
- Merck Manuals, Consumer Version. Dialysis (https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/dialysis/dialysis). Last reviewed/updated 7/2024. Accessed 12/3/2024.
- National Health Service (UK). Dialysis (https://www.nhs.uk/conditions/dialysis/). Last reviewed 9/29/2021. Accessed 12/3/2024.
- National Institute of Diabetes and Digestive and Kidney Diseases (U.S.). Peritoneal Dialysis (https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/peritoneal-dialysis). Last reviewed 1/2018. Accessed 12/3/2024.
- National Kidney Foundation (U.S.). Multiple pages reviewed for this article (https://www.kidney.org/). Accessed 12/3/2024.
- National Library of Medicine (U.S.). Dialysis – Peritoneal (https://medlineplus.gov/ency/article/007434.htm). Last reviewed 10/19/2022. Accessed 12/3/2024.
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