Peritoneal dialysis for chronic kidney disease

Unlike hemodialysis, peritoneal dialysis does not clean your blood outside of the body, but rather inside the abdominal cavity (the hollow space surrounding the organs in the abdomen). You are then given a special catheter called a peritoneal dialysis (PD) catheter. It is used to pass about two liters of dialysis fluid into the abdominal cavity several times a day, where it remains for four to five hours each time. During this time, harmful substances move through the peritoneum from the blood into the dialysis fluid. When that fluid is removed from the body, these substances go with it. Then fresh dialysis is transported into the abdominal cavity and the process repeats.

If testing has shown that your kidneys are very weak and will probably fail completely soon, preparations for peritoneal dialysis should be started. This requires a surgical procedure to install the catheter in your abdominal cavity and attached to the abdominal wall. It can be used for peritoneal dialysis after a healing period of two to four weeks.

Before the dialysis treatment can start, you also need to be trained by specialists in catheter hygiene. After that they will continue to offer you support and you will have check-ups with your doctor every four to six weeks.

You can do peritoneal dialysis at home and even when you are traveling. Many people appreciate having this freedom and like the fact that their everyday life needs to change less than it would for hemodialysis.

There are a number of different ways to do peritoneal dialysis. The standard method is called continuous ambulatory peritoneal dialysis (CAPD). In this method, the fluid is manually exchanged two to four times per day, and no machine is needed. This means that your abdomen is always “full.” But there is also an option to skip CAPD on some days. Then your abdomen remains empty of the fluid. You can also use a special fluid that is able to remain inside your abdominal cavity for a longer time, for example overnight. Then fewer exchanges are needed.

If you don’t want to exchange the fluid during the day or if you don't have the opportunity – because you’re at work, for example – you can use automated peritoneal dialysis (APD) every night instead. Here, the catheter is connected to a device called a cycler that regularly exchanges the dialysis fluid. During the day you have either no dialysis fluid in your abdomen, or a special fluid that is suited for remaining in the body for a longer time.

Which of the two methods is more suitable will also depend on the specific properties of the peritoneum (the lining of the abdominal cavity): So CAPD may be more suitable for some people, but APD might be a better option for others.

Like hemodialysis, there are certain recommendations for eating and drinking for peritoneal dialysis therapy as well. But they are not quite as strict as the ones for hemodialysis.

In peritoneal dialysis, fresh exchange fluid typically needs to be transported into the abdominal cavity several times per day, and the used fluid needs to be disposed of, for example in a sink. That means that you need to be very familiar with handling the equipment, and know the hygiene rules and follow them closely. Each exchange takes about 20 to 30 minutes. The bags with the fresh dialysis fluid need to be stored at home and new ones need to be ordered in time. Some people need help with all this and have a family member help them, for instance. If you use APD with a cycler, you will need enough space in your bedroom for it. At night you are connected to the machine.

The possible complications of peritoneal dialysis are related to the catheter:

• If bacteria enter the abdomen, they can cause inflammation of the peritoneum (peritonitis).
• The tip of the tube may result in painful irritation of the mucous membranes lining the inside of the abdomen.
• In rare cases, the tube gets bent or the opening of the tube is blocked. That can make dialysis more difficult or impossible.
• The opening in the abdominal wall where the tube goes in may become infected.

Most dialysis fluids contain sugar to help remove excess fluid from the body. Experts believe that the sugar may be released into the bloodstream over time and cause people to become overweight in isolated cases. In people with diabetes, blood-sugar-lowering treatments then need to be adjusted accordingly.

If your individual situation or personal needs change, you may no longer be satisfied with the type of dialysis you chose. It is possible to switch to hemodialysis (or back to peritoneal dialysis) if you are having too much difficulty managing it.

Some people make a general decision not to have dialysis (or they decide that later on). Possible reasons might include old age or other health problems that they have. Making this decision means letting your life come to an end. It is often difficult for friends and family to accept a decision like that – so it's important to discuss it with them.