Peritoneal Dialysis: Home Treatment for Kidney Failure

What Is Peritoneal Dialysis and How Does It Work?

Peritoneal dialysis is a kidney replacement therapy that uses the peritoneum—the thin membrane lining your abdominal cavity—as a natural filter. Dialysis solution is introduced into the abdomen through a catheter, where it absorbs waste products and excess fluid from the blood, then is drained and replaced with fresh solution.

When your kidneys can no longer adequately filter waste products from your blood, dialysis becomes necessary to perform this vital function. Peritoneal dialysis takes advantage of your body's own peritoneum, a membrane rich in tiny blood vessels, to filter the blood naturally. The peritoneum has small pores that allow waste products and excess water to pass through while keeping essential nutrients and blood cells in your body.

During peritoneal dialysis, approximately two liters of a special dialysis solution (also called dialysate) is introduced into your abdominal cavity through a surgically implanted catheter. This sterile solution contains a carefully balanced mixture of salts and glucose that creates an osmotic gradient, drawing waste products and excess fluid from your blood through the peritoneal membrane and into the solution. After a prescribed dwell time—typically 4 to 6 hours—the now waste-laden fluid is drained from your abdomen and replaced with fresh solution.

One of the key advantages of peritoneal dialysis is that it provides continuous, gentle blood cleaning throughout the day or night, more closely mimicking the natural function of healthy kidneys compared to the intermittent treatments of hemodialysis. This continuous nature often results in fewer dietary restrictions, more stable blood pressure, and better preservation of any remaining kidney function.

The Peritoneum as a Natural Filter

The peritoneum is a remarkable biological membrane composed of connective tissue with an extensive network of blood capillaries. This membrane covers the inner wall of the abdominal cavity and wraps around most of the abdominal organs, providing a large surface area for dialysis—roughly equivalent to the surface area of your skin. The tiny pores in the peritoneum allow small and medium-sized molecules like urea, creatinine, and excess potassium to pass through into the dialysis solution.

The dialysis solution is specially formulated to optimize this filtration process. It contains glucose (or sometimes other osmotic agents) at concentrations higher than in your blood, which creates an osmotic pull that draws excess water from your bloodstream into the solution. The solution also contains electrolytes like sodium, calcium, and magnesium at carefully calculated levels to maintain proper blood chemistry. As the solution dwells in your abdomen, waste products move from areas of high concentration in your blood to areas of low concentration in the dialysis solution, following the natural principles of diffusion.

Two Forms of Dialysis

There are two main types of dialysis available for people with kidney failure: peritoneal dialysis (PD) and hemodialysis (HD). In hemodialysis, blood is pumped out of your body through an external machine that filters it and returns it—this typically requires visits to a dialysis center three times per week for several hours each session. Peritoneal dialysis, by contrast, uses your internal peritoneal membrane as the filter and can be performed at home, offering greater flexibility and independence.

Many patients prefer peritoneal dialysis because it allows them to maintain a more normal lifestyle, continue working, and travel more easily. The choice between peritoneal dialysis and hemodialysis depends on many factors, including your medical condition, lifestyle preferences, home situation, and the availability of a caregiver if needed. Your nephrologist will help you understand which option might be best for your individual circumstances.

How Do You Prepare for Peritoneal Dialysis?

Preparation for peritoneal dialysis involves surgical placement of a silicone catheter through the abdominal wall, typically performed 1-2 weeks before your first treatment. The procedure requires fasting beforehand and special skin preparation. Recovery is usually quick, with most patients going home the same day or the next day.

Before you can begin peritoneal dialysis, your body needs to be prepared with the surgical placement of a dialysis catheter. This is a soft, flexible silicone tube approximately 5-6 millimeters in diameter that provides the pathway for dialysis solution to enter and exit your abdominal cavity. The catheter is designed to remain in place for years, becoming a permanent but manageable part of your daily life.

The timing of catheter placement is important. Ideally, the catheter should be inserted 1-2 weeks before your first dialysis treatment to allow the surgical site to heal properly. However, in urgent situations, dialysis can sometimes begin as soon as the day after surgery, though this increases the risk of complications such as fluid leakage around the catheter site.

Catheter Placement Surgery

The catheter insertion is performed by a surgeon, typically under local anesthesia with sedation, though general anesthesia may be used in some cases. During the procedure, the surgeon makes a small incision in your abdomen, usually just below and to the side of your navel. The catheter is threaded into the abdominal cavity and secured in place with sutures on the inside. The external portion of the catheter, approximately 20 centimeters long, exits through a small tunnel in your skin.

Before the surgery, you will need to fast for several hours—your healthcare team will give you specific instructions about eating and drinking. You'll also need to shower and wash your abdomen with a special antiseptic soap to reduce the risk of infection. Some centers may mark the planned catheter exit site beforehand to ensure optimal placement for your body type and daily activities.

Recovery After Catheter Placement

Most patients experience mild discomfort at the surgical site for a day or two after catheter placement, which can usually be managed with over-the-counter pain medications. Your healthcare team will teach you how to care for the catheter exit site, which involves keeping it clean and dry and watching for signs of infection such as redness, swelling, or discharge.

The external portion of the catheter will be secured in a small belt or pouch that you wear under your clothing. Most people find that the catheter doesn't interfere significantly with daily activities once they become accustomed to it. You can shower as usual with the catheter in place, though you should avoid submerging it in bath water, swimming pools, or hot tubs until the exit site is fully healed.

What Are the Types of Peritoneal Dialysis?

There are two main types of peritoneal dialysis: Continuous Ambulatory Peritoneal Dialysis (CAPD), where you manually exchange dialysis fluid 4 times daily, and Automated Peritoneal Dialysis (APD), where a machine performs exchanges overnight while you sleep. Both can be done at home with proper training.

The two primary forms of peritoneal dialysis—CAPD and APD—offer different schedules and methods to fit various lifestyles and preferences. Both achieve the same goal of filtering your blood and removing excess fluid, but they differ in how and when the exchanges occur. Your nephrology team will help you choose the type that best fits your daily routine, work schedule, and personal preferences.

Continuous Ambulatory Peritoneal Dialysis (CAPD)

CAPD, sometimes called "bag dialysis," is the manual form of peritoneal dialysis where you perform exchanges yourself throughout the day. During each exchange, you drain the used dialysis solution from your abdomen into an empty bag, then fill your abdomen with fresh solution from a new bag. The process uses gravity—no machines or electricity required—making it completely portable.

A typical CAPD schedule involves four exchanges per day: morning, midday, late afternoon, and before bed. Each exchange takes approximately 30 minutes, during which time you can sit or lie comfortably and engage in quiet activities like reading, watching television, or listening to music. The solution then remains in your abdomen (the "dwell time") for 4-6 hours while you go about your normal activities. At night, you have solution dwelling in your abdomen but don't perform exchanges until morning.

Many patients appreciate the freedom that CAPD provides. Because it requires no machines, you can perform exchanges anywhere—at home, at work, in a hotel room while traveling, or anywhere with access to a clean space. The supplies needed are lightweight and portable, and many patients find they can maintain nearly normal work schedules and social lives.

Automated Peritoneal Dialysis (APD)

APD uses a machine called a cycler to perform multiple exchanges automatically while you sleep. You connect your catheter to the machine at bedtime, and throughout the night it drains and fills your abdomen multiple times—typically 5-10 exchanges over 8-10 hours. In the morning, you disconnect from the machine and go about your day, usually with a final fill of solution that dwells until your next overnight session.

The APD machine is about the size of a small suitcase and sits on a bedside table or rolling cart. It's programmed with your specific prescription—how much fluid, how long each dwell, how many exchanges—and handles everything automatically once you're connected. Most people learn to sleep through the treatment, as the machine operates quietly and the exchanges are gentle.

APD is particularly popular among people who work during the day or have caregivers who can only assist at bedtime. It leaves your days completely free from dialysis activities. The machine is portable—it can travel with you on wheeled luggage—making overnight trips and vacations possible with proper planning.

How Is Peritoneal Dialysis Treatment Performed?

A peritoneal dialysis exchange involves connecting your catheter to dialysis bags, draining used fluid (10-20 minutes), then infusing fresh solution (10-15 minutes). Strict hand hygiene is essential—always wash thoroughly with soap and water and use hand sanitizer before handling any equipment to prevent infection.

Whether you're performing CAPD or APD, the fundamental process of a dialysis exchange remains similar. Understanding this process thoroughly is essential for successful home treatment. You'll receive comprehensive training from your dialysis nurses before beginning treatment at home, and they'll ensure you're confident and competent before letting you perform exchanges independently.

Manual Exchange Process (CAPD)

Each CAPD exchange begins with meticulous hand hygiene. Wash your hands thoroughly with soap and water for at least 20 seconds, then apply hand sanitizer. This step is absolutely critical—most cases of peritonitis (infection of the peritoneal cavity) result from bacteria being introduced during exchanges due to improper hand hygiene or technique.

Gather your supplies in a clean area: a fresh bag of dialysis solution at the prescribed concentration, an empty drainage bag, and any necessary connecting equipment. Warm the fresh solution bag if needed—many patients prefer body-temperature solution as cold fluid can be uncomfortable and may affect the efficiency of the exchange.

Connect your catheter to the drainage bag and open the clamp to allow the used solution to flow out by gravity. This drain phase typically takes 10-20 minutes. The used fluid will be yellowish and should be clear—cloudy fluid is a warning sign of infection. Once the drain is complete, close that line and connect to the fresh solution bag. Open the clamp to allow the fresh solution to flow into your abdomen, which takes another 10-15 minutes.

After the fill is complete, disconnect, cap your catheter using sterile technique, and secure it in its holder. Dispose of the used supplies according to your local guidelines. The fresh solution now dwells in your abdomen for the prescribed time—usually 4-6 hours—during which you can go about your normal activities.

Automated Exchange Process (APD)

With APD, you set up the cycler machine each evening before bed. Connect the solution bags and drainage bag to the machine, then connect your catheter to the machine's tubing. Program the machine with your prescribed settings if they aren't already saved, and start the treatment.

Throughout the night, the machine automatically cycles through fill, dwell, and drain phases multiple times. Each cycle typically lasts 40-60 minutes, with the machine controlling the precise volumes and timing. You'll sleep through most of this—the machine operates quietly, and most patients quickly become accustomed to sleeping while connected.

If there's an issue—such as a kink in the tubing or a drain alarm—the machine will alert you with a gentle alarm. Most alarms are easily resolved by changing position or checking the tubing. In the morning, you disconnect from the machine, which usually leaves a final fill in your abdomen to provide continuous dialysis during the day.

How Will I Feel After Starting Peritoneal Dialysis?

Most patients feel significantly better within a few weeks of starting peritoneal dialysis, as the treatment removes accumulated toxins and excess fluid. Initial discomfort from the catheter and having fluid in the abdomen typically resolves as your body adjusts. Many patients report improved energy, appetite, and overall well-being.

Beginning dialysis treatment is often a turning point for people who have been suffering from the effects of advanced kidney disease. In the weeks and months leading up to starting dialysis, you may have experienced symptoms like fatigue, poor appetite, nausea, itching, and difficulty concentrating—all caused by the buildup of waste products in your blood. As dialysis begins removing these toxins, many patients notice gradual improvement in these symptoms.

The initial adjustment period varies from person to person. Some patients feel an immediate improvement, while others need several weeks to notice significant benefits. During this time, your dialysis prescription may be adjusted based on blood tests and how you're feeling, optimizing the treatment for your individual needs.

Adapting to the Physical Sensation

Having two liters of fluid in your abdomen can feel strange at first. Some patients describe a feeling of fullness, mild bloating, or slight pressure. These sensations typically diminish significantly within the first few weeks as your body adapts. The peritoneum is remarkably flexible, and most patients find that they quickly become unaware of the fluid once they're accustomed to it.

Patients sometimes worry that the fluid will be uncomfortable or restrictive, but most find they can perform nearly all their normal activities—including exercise, intimacy, and physical work—without difficulty. The fluid doesn't prevent movement or cause pain; it's more of a subtle awareness that fades with time.

Can I Perform Peritoneal Dialysis Myself?

Yes, most people can learn to perform both CAPD and APD independently after receiving proper training. You'll be taught by specialized nurses and won't start home treatment until you demonstrate competence. Strict hand hygiene using soap, water, and hand sanitizer is essential to prevent bacterial contamination and infection.

Self-care is one of the great advantages of peritoneal dialysis. The vast majority of PD patients perform their own treatment, either entirely independently or with minimal assistance. This self-reliance gives you control over your treatment schedule and reduces dependence on healthcare facilities, preserving your independence and quality of life.

Training for home peritoneal dialysis is comprehensive and individualized. Specialized dialysis nurses will work with you over several sessions—typically 1-2 weeks—teaching you every aspect of the treatment. You'll learn the underlying principles of dialysis, proper sterile technique, how to perform exchanges step by step, how to recognize and respond to problems, and when to seek medical help. You won't be sent home to perform dialysis alone until you and your training nurses are confident in your abilities.

The most critical skill you'll learn is infection prevention. Peritonitis is the most common serious complication of peritoneal dialysis, and it's almost entirely preventable with proper technique. The cornerstone is hand hygiene: thorough hand washing with soap and water, followed by hand sanitizer, before every exchange. You'll also learn sterile connection and disconnection techniques that minimize the risk of introducing bacteria into your peritoneal cavity.

Getting Assistance When Needed

If you're unable to perform peritoneal dialysis independently due to illness, physical limitations, or other factors, assisted peritoneal dialysis is available. This involves having a trained caregiver—a family member, visiting nurse, or home health aide—perform or assist with your exchanges. Many patients who begin with assisted dialysis eventually transition to self-care as their confidence grows, while others prefer to continue with assistance.

What Is It Like to Live with Peritoneal Dialysis?

Living with peritoneal dialysis requires adapting to a treatment schedule and carrying supplies, but most patients maintain active, fulfilling lives. You can work, travel, exercise, and enjoy social activities. Many patients report that PD offers more freedom than hemodialysis, as treatments are done at home on your own schedule.

Peritoneal dialysis becomes part of your daily routine, but it doesn't have to define your life. Many PD patients continue working full-time, raising families, traveling, and pursuing hobbies and interests. The key is finding a rhythm that works for you and maintaining that consistency while remaining flexible when life requires it.

Planning becomes more important than before. You'll need to ensure you have adequate supplies, arrange delivery to your home on a regular schedule, and think ahead when traveling or changing your routine. But these considerations become second nature over time, and the freedom of home-based treatment often far outweighs the organizational effort required.

Work and Daily Activities

Many peritoneal dialysis patients continue working, either at their previous jobs or in adapted roles. CAPD patients can often perform a midday exchange at work if they have access to a clean, private space. APD patients have their days completely free since treatment occurs overnight. Your employer may be willing to make reasonable accommodations, and discussing your needs with human resources can be helpful.

Physical activity is encouraged for dialysis patients. Regular exercise helps maintain strength, improves cardiovascular health, and enhances overall well-being. Most activities are safe with peritoneal dialysis, though you may need to modify some based on your catheter placement. Contact sports and activities with high risk of abdominal injury may be restricted. Swimming in pools or natural bodies of water is generally discouraged due to infection risk, though some patients swim with waterproof catheter coverings.

Diet and Nutrition

Peritoneal dialysis patients typically have fewer dietary restrictions than hemodialysis patients because PD provides continuous treatment rather than intermittent sessions. However, you'll still need to follow dietary guidelines to optimize your health. You'll work with a dietitian who specializes in kidney disease to develop a nutrition plan that maintains adequate protein intake (important because some protein is lost in the dialysis fluid), manages phosphorus and potassium levels, and controls fluid intake as needed.

Eating a healthy, balanced diet with adequate energy and nutrients is important for maintaining strength and preventing malnutrition, which is a concern for many dialysis patients. Your dietitian will provide specific recommendations based on your blood test results and individual needs.

Emotional and Social Support

Starting dialysis is a major life change that can bring emotional challenges including anxiety, depression, and feelings of loss. These reactions are normal and common. Support is available through counselors and social workers at your dialysis center, patient support groups where you can connect with others in similar situations, and kidney disease patient organizations that provide resources and community.

Family members and close friends may also need support as they adjust to your treatment needs. Many dialysis centers offer education sessions for family members and can connect caregivers with support resources.

Travel and Vacation

Traveling with peritoneal dialysis requires planning but is definitely possible. For domestic travel, you can arrange to have supplies delivered to your destination ahead of your arrival. Many patients travel frequently and successfully with their PD equipment. The APD machine fits in a wheeled carrying case suitable for most transportation, and CAPD supplies can be packed in regular luggage.

For international travel, additional coordination is needed to arrange supply delivery across borders and identify local medical resources in case of problems. Your dialysis center can help you plan international trips and may be able to connect you with dialysis services at your destination.

When Is Peritoneal Dialysis Not Suitable?

Peritoneal dialysis may not be suitable for patients with extensive abdominal adhesions from previous surgeries, active inflammatory bowel disease (Crohn's disease or ulcerative colitis), diaphragmatic hernia, or certain other abdominal conditions. Patients with inguinal hernias may need surgical repair before starting PD.

While peritoneal dialysis is an excellent treatment option for most kidney failure patients, certain medical conditions may make it less suitable or require modifications. Your nephrologist will carefully evaluate whether PD is appropriate for you based on your complete medical history.

Extensive abdominal adhesions—bands of scar tissue that form after abdominal surgeries—can prevent the free flow of dialysis solution and reduce the effectiveness of treatment. If you've had multiple abdominal surgeries, imaging studies may be needed to assess whether your peritoneal cavity is suitable for dialysis.

Active inflammatory bowel disease, such as Crohn's disease or ulcerative colitis, increases the risk of peritonitis and other complications. Patients with well-controlled IBD may still be candidates for PD after careful evaluation. Similarly, certain hernias—particularly inguinal (groin) hernias—may need to be surgically repaired before starting PD, as the increased abdominal pressure from dialysis fluid can worsen them.

Some patients may have medical conditions that don't rule out PD but require additional monitoring or modifications to the treatment. Your nephrologist will discuss these considerations with you if they apply to your situation.

What Are the Possible Complications of Peritoneal Dialysis?

The main complications of peritoneal dialysis include peritonitis (infection of the abdominal cavity), catheter-related infections, and hernias. Warning signs include cloudy dialysis fluid, abdominal pain, fever, and redness at the catheter site. Most complications are preventable with proper technique and treatable when caught early.

Understanding potential complications helps you prevent them and recognize warning signs early. With proper training, good technique, and prompt attention to any problems, most peritoneal dialysis patients experience few complications. Many patients successfully use PD for years without any serious problems.

Peritonitis

Peritonitis—infection of the peritoneal cavity—is the most important complication to understand and prevent. It occurs when bacteria enter the abdominal cavity, usually during exchanges due to breaks in sterile technique. Symptoms include cloudy dialysis drainage fluid (the most common early sign), abdominal pain or tenderness, fever, nausea or vomiting, and general malaise.

If you notice any of these symptoms, especially cloudy fluid, contact your dialysis center immediately. Peritonitis requires prompt treatment with antibiotics, which are usually given through the dialysis fluid. Most episodes resolve completely with appropriate treatment, but delays can lead to more serious illness and sometimes require catheter removal.

The good news is that peritonitis rates have decreased significantly over the years thanks to improved training and connection systems. Following proper hand hygiene and sterile technique consistently is your best protection.

Catheter-Related Problems

The dialysis catheter can sometimes develop problems including exit site infections (redness, swelling, or discharge where the catheter exits your skin), tunnel infections (infection along the path of the catheter under your skin), and mechanical problems (catheter migration, blockage, or leakage).

Exit site infections are usually treated with antibiotics and improved exit site care. More serious infections may require catheter replacement. Mechanical problems sometimes resolve on their own—for example, a catheter that has shifted position may move back to a functional position—but may require intervention if they persist.

Hernias

The increased pressure in your abdomen from dialysis fluid can increase the risk of developing or worsening hernias, particularly inguinal (groin) hernias. If you notice a bulge in your groin or abdomen that worsens with standing or straining, notify your healthcare team. Hernias related to PD usually require surgical repair, after which you may need to temporarily switch to hemodialysis while healing.

How Can I Be Involved in My Care?

Active participation in your care leads to better outcomes. Ask questions, understand your treatment prescription, learn to interpret your blood test results, report concerns promptly, and communicate openly with your healthcare team. You have the right to understand your treatment and participate in decisions about your care.

Being an active, informed participant in your care is one of the most important things you can do to achieve the best possible outcomes with peritoneal dialysis. Understanding your treatment, monitoring your own health, and communicating effectively with your healthcare team puts you in the best position to maintain your health and quality of life.

Don't hesitate to ask questions—there are no silly questions when it comes to your health. If something is unclear, ask for explanation. If you're concerned about a symptom or a trend in your test results, bring it up. Your observations and concerns are valuable information for your healthcare team.

Keep track of your daily dialysis records, including drainage volumes, fluid appearance, and any problems or symptoms. This information helps your team optimize your treatment. Many centers now offer patient portals where you can view your lab results online—learning to understand these results helps you become a more informed partner in your care.

Children and adolescents on peritoneal dialysis should be involved in their care to the extent appropriate for their age and maturity. As young patients grow, they can take on increasing responsibility for their treatment, building skills for independent self-care as adults.