Peritoneal dialysis is a treatment option for kidney failure. It uses the lining of the abdomen, or peritoneum, to filter blood inside the body.
A person can perform peritoneal dialysis at home, making it an option for those who do not wish to regularly visit a dialysis clinic.
This article will look at what peritoneal dialysis is, including types, catheter placement, and common complications.
Peritoneal dialysis is a treatment for kidney failure. It can act as an artificial kidney and help rid the body of waste products while maintaining fluid balance. It uses the lining of the abdomen to filter blood inside a person’s body.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a healthcare professional places a catheter, which is a soft tube, in the abdomen, or belly. A few weeks later, a person will put a special solution called dialysate into the belly through the catheter.
When this is done, a person can disconnect the bag, place a cap on the catheter, and resume normal activities. After a few hours, they use the catheter to drain the fluid. This is called an exchange.
A person engaging in peritoneal dialysis exchanges may do so 4–6 times a day.
Does it hurt?
The process should not cause pain. People can expect to feel normal or bloated when the solution is in the belly.
Because of this, people may be more comfortable wearing larger clothing sizes.
The National Kidney Foundation state that there are two types of peritoneal dialysis.
One type is called continuous ambulatory peritoneal dialysis (CAPD). This is a continuous and machine-free method.
A person will place two quarts of the fluid into the belly and drain it later. They will need to do this 4–5 times over 24 hours. Each exchange can take 30–40 minutes.
Some people prefer to do exchanges at bedtime and mealtimes.
Another type is called automated peritoneal dialysis (APD). This involves attaching the dialysis catheter to an automated machine that will exchange the dialysis solution while a person sleeps.
The machine will often fill a person’s stomach with the dialysate for the beginning of the day, and a person may perform an exchange during the day. Another name for this approach is continuous cycling peritoneal dialysis, or CCPD.
A person can discuss their options with a healthcare professional to decide which method is best for them.
A doctor can place a peritoneal dialysis catheter using local anesthesia.
Some people prefer a doctor place the catheter under general anesthesia where a person is asleep and unaware of the procedure.
How to prepare
A doctor will usually recommend that a person not eat or drink anything after midnight before getting a peritoneal dialysis catheter. This is especially true if the person is going under general anesthesia for the catheter placement.
A person may also need to arrange for travel home after the procedure.
They should talk to a healthcare professional about the materials they will need to care for the catheter insertion site.
During the surgery
The procedure may vary based on the approach a doctor takes.
However, the general steps are:
- A surgeon will clean the abdominal area before making an incision.
- The surgeon will make an incision in the belly, usually slightly below, and to the right or left of, the belly button.
- A surgeon will guide the peritoneal dialysis catheter to the peritoneal cavity.
The NIDDK notes that, if possible, a person should plan to have this procedure 3 weeks before the first exchange, and the catheter will work better if it has approximately 10–20 days to heal before the first use.
A person will need to undergo training to perform either type of peritoneal dialysis at home. A dialysis nurse will train a person for 1–2 weeks. They will learn how to prepare the cycler, place the drain tube, and connect the dialysis bags.
A person has the option to bring a friend or family member to the training.
Even if a person uses APD, they must learn how to perform exchanges without a machine in case a power outage or machine failure occurs.
Infection prevention is very important in peritoneal dialysis, so a person using it must train well in sterile measures.
To perform an exchange, a person should wash their hands thoroughly and use a face mask before accessing the dialysis catheter.
They should then use a special connector called a transfer set to act as a connection between the catheter and the dialysis bag.
To perform a hand exchange, a person will need to warm the dialysis bag up to body temperature. A person can do this:
- using an electric blanket
- allowing the bag to sit in warm water
- using a microwave, if the bag comes with a protective outer layer
They should then hang the bag on a pole and connect it to the transfer tubing to allow the solution to enter their body.
If they are using APD, the machine will warm the bag. A person can program the machine to deliver a certain amount of cycles at night.
Both processes involve using the catheter to empty the fluid in the abdomen. Those using APD may have a longer transfer set that empties into a toilet, bathtub, or other container at night.
The amount and type of dialysis solution depends upon a person’s individual health and the doctor’s prescription.
A doctor will usually recommend a person using this type of dialysis make dietary changes.
The NIDDK note that these may involve changes in the amount of sodium, phosphorus, and potassium in a person’s diet. Each is an electrolyte the kidneys filter.
Those on dialysis may need to take nutritional supplements to replace those they lack as a result of avoiding high-potassium foods.
Peritoneal dialysis removes protein. As a result, a person may need to consume higher amounts of protein.
A person may also require fluid restrictions. Because the kidneys cannot filter fluids, a person is more prone to building up excess fluid in their body. As a result, a doctor may recommend they limit fluids to a specific amount every day.
One complication associated with peritoneal dialysis is a condition called peritonitis. This condition involves infection of the peritoneum, or the tissue lining of the inner wall of the abdomen. It happens
According to a 2018 article in the
Peritonitis causes symptoms such as abdominal pain, fever, and a cloudy look to the liquid leaving the body and passing into the discard bag. A person should seek care immediately if they suspect peritonitis so a doctor can treat them with antibiotics.
Other complications can occur from peritoneal dialysis. These include:
- hernia, or weakened area in the abdominal muscles due to the insertion of the peritoneal dialysis catheter and the pressure the fluid puts on the abdomen
- infection at the catheter site
- hypotension, or low blood pressure, which can occur if a person loses too much fluid from the exchanges
- weight gain, due to the dialysis fluid containing dextrose, which contains calories
A doctor will monitor a person on peritoneal dialysis for these and other complications.
Medicare may cover some of the cost of peritoneal dialysis. Those who participate in peritoneal dialysis can start receiving Medicare benefits as early as the first month of their dialysis course treatments.
The out-of-pocket costs depend upon if a person chooses original Medicare or Medicare Advantage. If a person has original Medicare, they will usually pay a 20% co-payment for services, medications, and medical supplies related to their dialysis treatments.
For those without insurance
According to the NIDDK, Medicaid may help to provide low-cost or free coverage for peritoneal dialysis.
Additionally, a person may be able to get advice and financial help from charities and foundations. One example is the National Kidney Foundation.
Both hemodialysis and peritoneal dialysis are effective treatment methods for kidney failure.
Peritoneal dialysis exchanges fluids and wastes via the peritoneum. Hemodialysis exchanges fluids and wastes via the blood.
To undergo hemodialysis, a person must go to a dialysis clinic to receive treatments. Instead of a catheter in their peritoneum, they will have a catheter in the arm.
Some doctors advocate for peritoneal dialysis because a person can perform it at home, and it eliminates the need to routinely travel to a clinic.
However, a 2017 systematic review of studies comparing hemodialysis and peritoneal dialysis did not conclusively determine whether those who use peritoneal dialysis have a higher quality of life.
For some, peritoneal dialysis is not an appropriate treatment option. This is the case for those who have obesity and scarring on the belly due to multiple previous abdominal surgeries.
Both in-person and online support groups are available through a number of national organizations. These include:
- American Association of Kidney Patients
- Kidney & Urology Foundation of America
- National Kidney Foundation
- Renal Support Network
A person can also ask a kidney doctor, called a nephrologist, about local support groups.
Peritoneal dialysis is a form of treatment for kidney failure. It uses the abdominal lining to help filter the blood inside the body.
Once trained, a person can perform this procedure at home, eliminating the need to make regular trips to a dialysis clinic.
A person will need to make changes to their diet to help improve their kidney function.