Peritoneal Dialysis

Introduction

Being told that your kidneys are failing, and that you need dialysis, is a major moment. Many people picture hospital chairs, long sessions on a machine, and a life arranged around clinic appointments. Peritoneal dialysis (PD) is a different kind of dialysis. It is done at home, usually by you or a family member, using the natural lining of your abdomen as a filter. For many people, it allows treatment to fit around daily life rather than the other way around.

This guide is written for people who have been told they need to start dialysis, who are choosing between dialysis options, or who have already started peritoneal dialysis and want to understand what comes next. It explains how PD works, the two main ways it is performed, what the catheter operation and training involve, how daily life changes, what complications to watch for, and how long-term care is organised. It also covers PD in children, which has some important differences from adult care.

Choosing a dialysis approach is a personal and clinical decision. The aim here is to help you understand the medical landscape so that conversations with your nephrologist (a doctor who specialises in kidney care) are clearer and more useful.

What Is Peritoneal Dialysis?

Peritoneal dialysis is a form of kidney replacement therapy — a treatment that does some of the work that healthy kidneys normally do. Healthy kidneys filter waste products, balance salts and water, control blood pressure, and help make red blood cells. When kidneys fail, these jobs need to be taken over either by dialysis or by a kidney transplant.

PD uses a thin membrane inside your body called the peritoneum. The peritoneum lines the inside of your abdomen and covers many of your abdominal organs. It has a rich supply of small blood vessels, which makes it a natural filter.

How It Works in Simple Terms

A soft plastic tube called a peritoneal dialysis catheter is placed through the wall of your abdomen during a small operation. The catheter stays in place for as long as you are on PD. Through this catheter, a sterile cleansing fluid called dialysate is run into your abdominal cavity.

While the dialysate sits inside your abdomen, waste products like urea and creatinine, and extra water and salt, move out of the small blood vessels in the peritoneum and into the fluid. This movement happens by simple physical processes: diffusion (substances moving from where they are concentrated to where they are less concentrated) and ultrafiltration (water being pulled across the membrane by sugar in the fluid).

After a set period of time — called the dwell — the used fluid is drained out through the same catheter, carrying the waste with it. Fresh dialysate is then run in to start the process again. This whole cycle of drain, fill, and dwell is called an exchange.

How PD Differs from Hemodialysis

Hemodialysis, the other main form of dialysis, filters blood through a machine outside the body, usually three times a week for around four hours at a hospital or dialysis centre. Peritoneal dialysis works more continuously and gently, either through several manual exchanges during the day or through a machine at night. PD takes place at home, and once training is complete it does not require travelling to a centre for each treatment.

Both methods can treat kidney failure effectively. They suit different lifestyles, different medical situations, and different preferences.

Who Is Peritoneal Dialysis For?

Peritoneal dialysis is one of the options for people with severe kidney failure, also called end-stage kidney disease or chronic kidney disease (CKD) stage 5. At this stage, the kidneys are no longer able to keep the body in balance on their own.

Common Underlying Conditions

The kidney conditions that most commonly lead to a need for dialysis include:

• Diabetic kidney disease (long-term damage from diabetes)
• High blood pressure (hypertensive kidney disease)
• Chronic glomerulonephritis (long-term inflammation of the kidney’s filtering units)
• Polycystic kidney disease (an inherited condition with cysts in the kidneys)
• Damage from certain medicines, infections, or autoimmune diseases
• A previously transplanted kidney that has stopped working

Situations Where PD May Be a Good Fit

Doctors often consider PD particularly suitable for people who:

• Value treatment at home and the flexibility it allows around work, study, or family
• Still have some remaining kidney function and produce urine, which PD tends to preserve longer than hemodialysis
• Live far from a dialysis centre, so daily travel would be hard
• Have heart conditions that may not tolerate the more sudden fluid shifts of hemodialysis well
• Are children, where PD is often the first choice (covered in a later section)
• Have difficult blood vessels that make creating hemodialysis access challenging

Situations Where PD May Be Less Suitable

PD is not the right fit for everyone. Reasons a nephrologist may suggest a different approach include:

• Previous major abdominal surgery with significant scarring (adhesions) that may block fluid movement
• Large abdominal hernias that cannot be repaired
• Severe inflammatory bowel disease or active abdominal infection
• Conditions where the peritoneum is damaged or scarred
• A home environment that does not allow safe, clean storage of supplies or hygienic exchanges
• Severe lung disease where extra fluid in the abdomen would make breathing harder
• Inability of the patient or a caregiver to learn and safely carry out the technique

These are not absolute rules. Each situation is weighed individually with the nephrologist and the wider PD team.

Alternatives to Peritoneal Dialysis

PD is one of several paths for treating kidney failure. Understanding the alternatives helps you weigh which option fits your medical situation and your life.

Hemodialysis

Hemodialysis filters blood through a machine. It usually requires either an arteriovenous fistula (a surgically created connection between an artery and a vein, normally in the arm), a graft, or a central venous catheter. Most people on hemodialysis go to a dialysis centre three times a week for sessions of around four hours. Home hemodialysis is also possible in some settings and allows more frequent, gentler sessions.

Kidney Transplant

A kidney transplant is generally considered the preferred long-term treatment for kidney failure in people who are medically eligible. A transplant restores most of the work the kidneys normally do, often allows a fuller lifestyle than dialysis, and is associated with better long-term outcomes. Donors may be living (a family member or other matched donor) or deceased. Not everyone is medically eligible for a transplant, and waiting times can be long. Many people are on dialysis while preparing for or waiting for a transplant.

Conservative Kidney Management

For some people, particularly older patients with multiple serious illnesses, dialysis may not improve quality of life or survival. In these situations, conservative (non-dialysis) management focuses on controlling symptoms, supporting comfort, and slowing the disease where possible. This is a serious clinical decision made carefully with the medical team, the patient, and the family.

Many people switch between approaches over time. It is common, for example, to start on PD, transition to hemodialysis later if needed, or receive a transplant while on dialysis.

Types of Peritoneal Dialysis

Continuous Ambulatory Peritoneal Dialysis (CAPD)

CAPD uses manual exchanges spread throughout the day. There is no machine. You connect a bag of fresh dialysate to your catheter, drain the old fluid into an empty bag, fill the abdomen with fresh fluid, disconnect, and go about your activities while the new fluid dwells inside you.

Typical pattern:

• Three to five exchanges every day, usually four
• Each exchange takes around 30 to 40 minutes
• Between exchanges, the fluid stays inside and dialysis continues quietly
• No electricity or machine is needed for the exchange itself

CAPD works well for people whose daily routine allows pauses for exchanges, who prefer not to depend on a machine, or who live in places where reliable overnight electricity is a concern.

Automated Peritoneal Dialysis (APD)

APD uses a small bedside machine called a cycler that performs the exchanges automatically while you sleep. You connect to the cycler at night. It runs a series of fills, dwells, and drains over about 8 to 10 hours. In the morning, you disconnect and go about your day, often with a small amount of fluid still dwelling inside (the “last fill”).

Typical features:

• One overnight session, usually 8 to 10 hours
• Daytime hours largely free of exchanges
• Particularly suited to people who work, study, or care for children
• Requires electricity and space for the cycler at the bedside

Some people use a mixed regimen, with overnight APD plus one extra daytime exchange, when their nephrologist judges that extra clearance is needed.

Choosing Between CAPD and APD

The choice between CAPD and APD depends on lifestyle, sleep patterns, the results of a test called the peritoneal equilibration test (which measures how your peritoneum handles fluid), and what the home set-up allows. Your nephrologist and PD nurse will guide this decision together with you.

The Peritoneal Dialysis Process: Step by Step

Step 1: Evaluation and Decision

Before PD begins, your nephrologist confirms that PD is a reasonable option for you. This usually includes blood tests, an examination of your abdomen, a look at your medical history (especially previous abdominal surgery), and a discussion of your home environment and support. The PD nurse may visit your home or ask detailed questions about your living arrangements, storage space, hygiene, and whether someone can help you if needed.

Step 2: Catheter Placement

The peritoneal dialysis catheter is a soft silicone tube about the thickness of a pencil. It is placed during a small operation, usually under general anaesthetic but sometimes under local anaesthetic with sedation. The catheter is positioned inside the abdominal cavity with its tip near the pelvis. It exits through a small opening (the exit site) on the side of the abdomen, below the navel.

The procedure can be done in different ways:

• Surgical placement through a small open cut
• Laparoscopic placement using a camera and small ports (often preferred where available, as it gives better positioning and lower complication rates)
• Percutaneous placement at the bedside in some centres

You usually go home the same day or after a short stay. Mild discomfort at the site is normal for a few days.

Step 3: Healing Period

After catheter placement, there is typically a waiting period of around two to three weeks (sometimes longer) before regular dialysis begins. This time allows the exit site to heal and the catheter to settle into place. Healing well in this phase reduces the risk of leaks and infection later.

During the healing period:

• The exit site is kept clean and dry
• Dressing changes are done as instructed
• Heavy lifting and straining are avoided
• Baths and swimming are usually avoided until the site has healed

In urgent situations, dialysis may need to start sooner. In that case, the team uses smaller fluid volumes initially and watches carefully for any leaks.

Step 4: Training

Training is one of the most important parts of starting PD. A specialist PD nurse usually trains you (and a family member or caregiver if appropriate) over several days, often spread over one or two weeks. Training covers:

• Hand washing and the importance of a clean technique
• How to connect and disconnect from the bags or cycler
• How to perform an exchange or set up the machine
• How to inspect the fluid that drains out and recognise warning signs
• How to care for the catheter exit site each day
• What to do if something goes wrong, including how to contact the PD team
• How to store supplies safely at home

Training continues until you and your trainer feel confident. There is no rush.

Step 5: Starting Exchanges at Home

Once training is complete, exchanges begin at home. The PD team stays closely in touch in the first weeks, often by phone or video, and arranges early follow-up visits.

Step 6: Ongoing Monitoring and Adjustment

Regular clinic visits, blood tests, and reviews continue for as long as you are on PD. The team checks how well dialysis is working (called dialysis adequacy), how your blood pressure and fluid balance are managed, how your nutrition is, and whether your prescription needs adjusting. Your PD prescription — the number, timing, volume, and strength of exchanges — is not fixed. It changes over time as your needs change.

Daily Life on Peritoneal Dialysis

Once you have settled into PD, much of daily life can continue. The treatment is woven into your routine rather than the other way around.

Work, Study, and Travel

Many people on PD continue to work or study. APD in particular leaves daytime hours mostly free. CAPD is also compatible with work, although it requires a clean, private place for exchanges during the day. Travel is possible with planning: PD fluid and supplies can usually be delivered to your destination in advance, and many PD providers have arrangements for travel within and between countries.

Bathing, Clothing, and Activity

After the exit site has fully healed, most people can shower. Bathtubs, swimming pools, and the sea are generally avoided or handled with extra care, because they can introduce bacteria. Loose clothing is more comfortable. Many people continue light to moderate exercise; activities that involve heavy abdominal strain or impact at the catheter site are usually limited.

Body Image and Self-Confidence

The catheter is a permanent part of your body while on PD. Some people feel self-conscious at first. With time, most adjust, and the catheter is not visible under clothing. Talking openly with the PD team about concerns — including intimacy — is encouraged.

Emotional Adjustment

It is common to feel anxious, overwhelmed, or low in mood at the start. Adjusting to a chronic treatment, even a flexible one, takes time. Confidence usually grows with practice. Peer support groups, counselling, and conversations with others on PD can be helpful. If feelings of depression or anxiety persist, mention them to your team; mental health support is an important part of dialysis care.

Diet and Fluid on Peritoneal Dialysis

Nutrition is part of the treatment, not separate from it. The diet for PD is somewhat different from the diet for hemodialysis.

Protein

Some protein is lost into the dialysate during PD. Protein intake usually needs to be higher than for the general population. A renal dietitian will give individual guidance, but eggs, fish, poultry, dairy, and pulses are common sources discussed.

Sodium and Fluid

Controlling sodium (salt) helps control thirst, fluid retention, and blood pressure. Salty foods, processed foods, pickles, and salty snacks are usually limited. Fluid intake is individualised — people who still pass urine may have more flexibility than those who do not.

Potassium

Because PD removes potassium continuously, dietary potassium is often less restricted than on hemodialysis. Some people on PD actually need to make sure they are getting enough potassium. Specific advice depends on your blood tests.

Phosphorus

High phosphorus levels harm bones and blood vessels over time. Foods high in phosphorus (processed foods, cola drinks, certain dairy and meat products) are usually limited. Medicines called phosphate binders are often taken with meals.

Sugar from the Dialysate

PD fluid contains sugar (glucose) to pull water out of the body. Some of this sugar is absorbed into the blood. Over time, this can affect weight, blood sugar control in people with diabetes, and triglyceride levels. Newer dialysate solutions use other agents to reduce this issue in some patients. Your team will adjust the prescription with these factors in mind.

A renal dietitian is a key member of the PD team and tailors guidance to your individual needs, blood results, and preferences, including cultural and religious considerations.

Medications Commonly Used Alongside PD

Most people on PD take several medicines. The combination is individual, but common groups include:

• Blood pressure medicines
• Phosphate binders, taken with meals to reduce phosphorus absorption
• Vitamin D or analogues to support bone and mineral balance
• Iron supplements, by mouth or by injection
• Erythropoiesis-stimulating agents (ESAs) such as erythropoietin, to help the body make red blood cells and treat anemia
• Diabetes medications, often adjusted for kidney function
• Statins or other heart and vascular medicines, where indicated
• Antibiotics, used only when a specific infection occurs

Peritonitis (Infection Inside the Abdomen)

Peritonitis is the most important complication of PD. It is an infection of the peritoneal cavity, usually caused by bacteria entering through the catheter. Typical signs include:

• Cloudy drained fluid (often the earliest sign)
• Abdominal pain or tenderness
• Fever
• Nausea or vomiting

Peritonitis needs prompt treatment, usually with antibiotics added to the dialysis fluid. Most episodes resolve fully when treated early. Repeated or severe episodes can damage the peritoneal membrane and may eventually mean PD has to be stopped. The International Society for Peritoneal Dialysis (ISPD) publishes detailed guidelines on prevention and treatment, and individual centres follow these closely.

Exit-Site and Tunnel Infections

The skin around the catheter exit site can become red, swollen, or develop discharge. Infections in the tunnel under the skin are less obvious but more serious. Daily exit-site care, as taught in training, is the main way these are prevented.

Catheter Problems

The catheter can move out of position, become blocked, or develop kinks. Symptoms include poor inflow or outflow of fluid. Adjustments, flushing, or sometimes repositioning may be needed.

Hernias and Leaks

The pressure of fluid in the abdomen can lead to hernias (weak spots in the abdominal wall where tissue bulges through) or to leaks of dialysate into surrounding tissue. Hernias may need surgical repair. Leaks may settle with rest from PD or smaller volumes for a period.

Effects on Metabolism and Weight

Glucose absorbed from the dialysate can cause weight gain, raise blood sugars, and affect cholesterol. The diet, the dialysis prescription, and other medicines are adjusted to manage this.

Membrane Changes Over Time

After several years, the peritoneal membrane may change in how it handles fluid and waste. In some cases, PD becomes less effective and people transition to hemodialysis or, if eligible, receive a transplant. A rare but serious long-term complication called encapsulating peritoneal sclerosis (EPS) involves thickening and scarring of the membrane; this is uncommon but is one of the reasons PD duration is regularly reviewed.

Inadequate Dialysis

If symptoms like fatigue, poor appetite, swelling, or breathlessness develop, the dialysis may not be doing enough. Blood tests and PD adequacy tests guide adjustments to the prescription.

Knowing when to call the PD team is a key skill from training. As a general rule, cloudy fluid, fever, severe abdominal pain, problems with fluid flowing in or out, or changes around the exit site all justify a prompt call.

Monitoring, Targets, and Follow-up

Life on PD includes a steady rhythm of monitoring. This is not paperwork — it is what keeps treatment safe and effective.

Regular Clinic Visits

Routine follow-up usually involves clinic visits every one to three months, depending on your stability. Each visit may include:

• A check of weight, blood pressure, and fluid status
• Examination of the exit site
• Review of medicines
• Discussion of any problems with technique or daily life

Blood and Fluid Tests

Blood tests check kidney function markers, electrolytes, blood counts, calcium and phosphorus, and other measures. Adequacy tests (such as Kt/V, a measure of how much waste is cleared) and the peritoneal equilibration test help fine-tune the PD prescription. Diabetes-related markers are also tracked closely if relevant.

Refresher Training

Most centres provide periodic re-training, especially after any infection or technique problem. Habits can drift over time, and refresher visits help keep technique safe.

Transitioning Between Treatments

PD is rarely the only treatment a person uses across their kidney disease journey. Many people move between options over time.

From PD to Hemodialysis

This may happen if the peritoneal membrane stops providing enough dialysis, after recurrent or severe infections, or because of personal preference. The change is planned where possible, with hemodialysis access prepared in advance.

From PD to Transplant

For eligible patients, transplant assessment can take place while on PD. Many people receive a transplant while continuing PD until the transplanted kidney is working. The catheter is usually left in for a few weeks after transplant and then removed once kidney function is stable.

Combined or Switched Approaches

Sometimes a short period of hemodialysis is needed during a specific illness, with a return to PD afterwards. Flexibility between treatments is part of modern kidney care, and the choice at any point reflects the medical situation and personal priorities.

Peritoneal Dialysis in Children

Peritoneal dialysis is widely used in children with kidney failure, including babies and very young children. There are important differences from adult PD that parents and caregivers should know.

Why PD Is Often Preferred in Children

In paediatric kidney failure, PD is frequently the first dialysis modality. Reasons include:

• Hemodialysis access is technically difficult in small children
• PD allows treatment at home, which supports school, family life, and development
• The continuous, gentle nature of PD suits growing children well
• It tends to preserve any remaining kidney function

How PD Is Adapted for Children

Family and School Life

Parents or caregivers usually perform exchanges and set up the cycler. Older children gradually take on more responsibility. Schools are often involved through care plans so that the child can take part normally during the day. Counselling and play therapy may be offered, depending on the child’s age and the family’s needs.

Pathway to Transplant

For children, kidney transplantation is generally considered the preferred long-term treatment when medically possible. PD is often used as a bridge while the child grows large enough or healthy enough for transplant, or while waiting for a suitable donor.

If your child is being considered for or is already on PD, the paediatric nephrology team is the central source of guidance tailored to their age and condition.

Long-Term Outlook on Peritoneal Dialysis

Many people live well on PD for years. Outcomes depend on the underlying cause of kidney failure, other medical conditions, the success of infection prevention, nutrition, and how well dialysis is matched to the person’s needs.

Across studies, survival on PD and on hemodialysis is broadly similar in the early years for comparable patients, with the choice between them often shaped more by lifestyle, medical fit, and access to transplant than by survival alone. Foreign registry numbers should be interpreted with caution; the most useful information for your situation comes from your own nephrology team, who know your medical details.

Most people on PD will eventually either move to hemodialysis, receive a kidney transplant, or, in some cases, transition to conservative management as part of overall care planning. Understanding PD as one stage in a longer journey, rather than a final endpoint, can be helpful.

Frequently Asked Questions

Is peritoneal dialysis painful?

Once the catheter site has healed, exchanges are not usually painful. Some people feel a sense of fullness during the dwell or a brief cold sensation as fluid runs in; warming the bag before use helps. New pain, especially with cloudy fluid or fever, is a reason to contact the PD team promptly.

How long does an exchange take?

A manual CAPD exchange usually takes around 30 to 40 minutes, including draining, filling, and connecting and disconnecting. APD runs overnight for about 8 to 10 hours while you sleep.

Can I sleep normally while on PD?

On CAPD, exchanges are done during the day and most nights are uninterrupted. On APD, you are connected to the cycler at night; many people get used to the gentle sounds and movements of the machine within a few weeks.

Can I shower with a PD catheter?

After the exit site has healed, most people can shower with appropriate care. Baths, swimming pools, and natural water bodies are generally avoided or require special precautions, because they can carry bacteria into the exit site.

Will I still pass urine on PD?

Many people on PD continue to pass some urine, especially in the first years. Preserving this remaining kidney function is one of the reasons PD is often considered as a starting modality.

Can I travel on PD?

Yes. Travel is possible with planning. Supplies can be sent to your destination in advance through the dialysis supplier, and travel cyclers are available. Discuss travel plans with the PD team in advance, especially for international travel.

What happens if I get peritonitis?

Peritonitis is treated with antibiotics, often given directly into the dialysis fluid. Most episodes resolve when treated early. Severe or repeated episodes may require the catheter to be removed and a temporary switch to hemodialysis.

Can I switch from PD to hemodialysis or transplant later?

Yes. Switching between dialysis types is common, and people on PD can be assessed and listed for transplant at the same time. Treatment plans evolve with your needs.

How long can someone stay on PD?

There is no fixed time limit. Some people are on PD for many years. Over time, the peritoneal membrane may change, and a transition to another treatment may become appropriate. This is reviewed regularly with the team.

Do I have to do everything alone?

No. While many people manage their PD independently, a family member, partner, or trained caregiver can be the main person performing exchanges or supervising the cycler — this is called assisted PD. The PD team trains whoever will be doing the treatment.

Conclusion

Peritoneal dialysis is a home-based, continuous, and relatively gentle way of doing the work that failing kidneys can no longer do. It is built around a soft catheter in the abdomen, a sterile cleansing fluid, and a daily rhythm of exchanges — either manually during the day (CAPD) or by a small machine at night (APD). For many people with kidney failure, it offers a way to keep working, studying, raising a family, and travelling, while still receiving life-sustaining treatment.

Starting PD involves several stages: deciding it is the right option, having the catheter placed, allowing time to heal, learning the technique thoroughly, and settling into a routine of exchanges and monitoring. With good training, careful hygiene, and regular follow-up with the nephrology team, most people gain confidence quickly and can live full lives on PD.

PD is not the only path. Hemodialysis, kidney transplantation, and, in some situations, conservative care are all parts of the wider landscape of kidney failure management. The most useful next step is an unhurried conversation with your nephrology team about what fits your medical situation, your home, and your priorities, so that the treatment shape that emerges is one you understand and can live with well.