Peritoneal Dialysis for Chronic Kidney Disease

Peritoneal dialysis (PD) is a type of dialysis treatment for people with end-stage kidney disease (ESKD), or kidney failure. This is a stage of kidney disease in which the kidneys have stopped or nearly stopped working. During PD treatment, your blood is cleaned inside your body using a special fluid instilled into your belly.^1-3

How does peritoneal dialysis work?

You do not have to go to a dialysis center to get PD. After training, you can do it at home.^1-3

With PD, you insert a special fluid into your belly through a thin tube (catheter). This fluid, called dialysate, cleans the inside of your body.^3,4

The dialysate stays in your body for a few hours. This period is called the dwell time. After the dwell time, the fluid is then drained out through the same catheter.^3-5

More fluid is then replaced in a process called the exchange. The exchange takes about 30 minutes to complete. To get good cleaning of the blood, several exchanges usually need to be done.^3-5

PD is unlike hemodialysis, in which your blood is filtered in a special machine.^3,4

What are the types of peritoneal dialysis?

There are 2 types of PD: continuous cycler-assisted peritoneal dialysis and continuous ambulatory peritoneal dialysis.^3-5

Continuous cycler-assisted peritoneal dialysis (CCPD)

With CCPD, a machine called a cycler does the exchanges for you at night while you sleep. The cycler can do 3 to 5 exchanges each night.^3-5

When you wake up, your belly will be filled with dialysate, where it will stay during the day. You may feel full while the fluid is in your belly, but it should not be painful.

When you go to bed, you will do your CCPD treatment once again. This cycle is repeated each night and cannot be skipped.^3-5

Continuous ambulatory peritoneal dialysis (CAPD)

With CAPD, you must do the exchanges yourself each day. Most people can expect to do about 4 exchanges per day. At night, you will fill your belly with dialysate and let it sit overnight while you sleep. In the morning, you will do an exchange.^3-5

Your doctor can tell you how long your dwell times will need to be depending on your situation. Each exchange takes about 30 minutes to fully drain and refill. Make sure you are in a clean, dry space while you do the exchanges.^3-5

How do I prepare for peritoneal dialysis?

Before starting PD, you will need to have a catheter inserted into your abdomen. You will also receive special training in which your doctor and care team will teach you how to do the exchanges on your own. With PD, you may need a dialysis partner to help you with the exchanges if you are unable to manage the heavy fluid bags and supplies.^3-5

You will need to designate a room in your home where you will do the exchanges. Make sure it is clean and dry and away from any pets. Keep your PD machine and supplies in a safe and dry location in your home as well.^3-5

What are the possible side effects?

Compared to hemodialysis, PD allows for more flexibility in your life. You do not have to travel anywhere to do the treatment, and you can resume normal activities while the fluid is doing its work of cleaning your body.^3-5

While PD has benefits, there are some side effects and health problems (complications) that can arise from it. These may include:^3-5

• Infection – This is the most common complication of PD. It can happen around the catheter site or inside the belly but is easily treatable.
• Hernia – The catheter can weaken the abdomen muscles and may lead to a hernia. A hernia happens when fatty tissue pushes through a weak spot in the wall of the abdomen.
• Bloating and feeling too full – Because there is fluid in the belly during PD, some people might feel bloated. Due to this feeling of fullness, they may have difficulty eating. This can lead to your body not getting the amount of vitamins and minerals it needs (malnutrition).
• Weight gain – The solution needed to clean your body contains sugar, which can be absorbed by the body during longer dwell times. This can lead to weight gain.
• Mood changes – These may include depression.

These are not all the possible side effects of peritoneal dialysis. Talk to your doctor about what to expect from dialysis. If you have any concerns about the side effects you are having, tell your doctor. It is important to note that while side effects from PD may occur, they are easily treatable.

Ways to prevent infection

Because PD requires a catheter in the belly, it is very important to keep it clean. A common infection that arises with people on PD is peritonitis, an infection in the belly. This happens when bacteria get into your belly.³

You can help avoid infection by doing the following:³

• Wash your hands with warm water and soap before and after each exchange.
• Do your exchanges in a clean, dry space.
• Keep pets and plants out of the room where you do the exchanges in order to keep it clean.
• Wear a face mask while doing the exchanges.
• Clean your catheter area with an antibiotic cleanser each day.
• Keep your catheter dry. Showers are okay once the area has healed after the surgery. But most doctors do not recommend swimming or being submerged in water.

If you see any signs of infection, contact your doctor right away. These signs might include drained fluid that looks murky or redness, pain, or swelling near the catheter site.³

Other things to know

Because PD treatment is continuous, you may not have to follow as strict a diet as you were before you began PD. This is because the dialysis solution helps reduce the buildup of phosphorus and potassium in your body. PD may also lead to longer-lasting kidney function over time than hemodialysis.⁴

Is peritoneal dialysis right for you?

Before making the decision to go on PD for your kidney disease, talk with your doctor. Tell them about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs. Be sure to ask any questions you may have. Here are a few to consider:^3,4

• Which type of PD – CCPD or CAPD – is right for me?
• What changes will I have to make when going on PD?
• How will PD make me feel?
• Will PD work with my lifestyle?

Together with your doctor, you can weigh the pros and cons and decide which type of end-stage kidney disease treatment is right for you.

Learn more about:

• How your kidneys work
• When to consider a kidney transplant
• Myths and misconceptions about chronic kidney disease