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By Dr. Mark Shapiro
When chronic kidney disease (CKD) progresses to the point where kidneys are no longer able to function, it’s called end stage renal disease (ESRD), kidney failure or renal failure. When the kidneys stop working, toxins and fluid build up in the body and cannot be released. To stay alive, people with kidney failure will need to have dialysis treatments or a transplant to take over the job their kidneys can no longer do. One type of dialysis is a form of home dialysis called peritoneal dialysis (PD). Not all people with ESRD are able to choose PD. Your doctor will help you determine if you’re a good candidate for PD and, if not, will prescribe the treatment option that’s best for you.
What is PD?
PD uses the peritoneal cavity in the abdomen. Many people are familiar with hemodialysis, which takes blood out of the body, runs it through an artificial kidney that removes toxins and extra fluid, and then returns the cleaned blood back into the body. With PD, instead of cleaning the blood outside of the body, a membrane inside the abdomen, called the peritoneum, acts as a filter to remove toxins and fluid in place of the kidneys. A dialysis fluid, called dialysate, is placed into the peritoneal cavity to help pull toxins and fluid across the semipermeable membrane of the peritoneum. After a time, the dialysate is removed and replaced with fresh dialysate, so the process of removing toxins and fluids can be repeated.
How is PD done?
To perform PD, a patient must first have a catheter placed in their abdomen to allow the fluid to enter and drain. It’s inserted off to the side, below the belly button, and goes into the abdominal space called the peritoneal cavity. The catheter is placed into the body in the operating room by a surgeon or trained nephrologist, which is usually an outpatient procedure. The catheter remains permanently in the abdomen, and is taped down on the outside of the body so that it doesn’t interfere with everyday activities like work, exercise, recreation, showering or sexual activity.
After the catheter is in place and healed, the patient will visit the PD nurse and attend several training sessions over a one- to two-week period. Family members are encouraged to participate in training and provide support, although it’s not necessary to have a partner to perform PD. In addition to learning how to do peritoneal dialysis, information is given about diet, fluid management, good hygiene and medication management.
Home treatments usually begin two to three weeks after the catheter has been placed and training has been completed.
PD can be done manually during the day, or at night using a cycler machine
When someone chooses to do PD at home, they will consult with their doctor about which type of PD they will perform:
Most patients will start off doing CAPD,which involves between two and five daily fluid exchanges. The fluid exchange includes draining the dialysis solution from the abdomen, then filling it with fresh solution and letting the solution dwell in the abdomen for a period of time
Each drain and fill exchange takes about 15 to 20 minutes, and can be done in a clean area at home or at work. People who have significant function left in their kidneys can sometimes do well with only two to three exchanges per day. However, most patients need four to five exchanges per day in order to stay well.
In APD, larger bags of the dialysis solution are hung next to the bed, connected to the cycler machine and then attached to the PD catheter. The cycler is programmed to perform three to five fluid exchanges while the person sleeps in bed, usually over an eight- to 10-hour time period. In the morning, patients detach from the machine and put a small cap onto the end of their tubing. Depending on dialysis needs, some people may have to do a manual PD exchange during the day in addition to the cycler exchanges at night.
Advantages of PD
PD offers the freedom of doing dialysis at home or work rather than spending time in a dialysis center. PD allows a person to have more control over their schedule.
People on PD usually visit the dialysis clinic only once or twice each month.
Because PD is done each day, people on PD have fewer dietary limitations than those on hemodialysis who only go to dialysis three times a week.
Disadvantages of PD
Because the dialysis solution is made up of dextrose, or sugar, there can be some weight gain and problems with glucose control. If you have diabetes or are obese, ask your doctor if PD would be a good choice for you.
Some people feel that the abdominal catheter and fluid in the belly are unattractive.
There’s also a risk of infection of the catheter site and peritonitis — an infection in the abdomen — which can be painful and may require a stay in the hospital.
How can I find out more about peritoneal dialysis?
Ask your doctor about peritoneal dialysis. You can meet with a CKD educator, who can provide you with extensive education. The EMPOWER® professional educators can provide information about PD and hemodialysis. Call 1-888-MyKidney (1-888-695-4363), to find out more. You may schedule a visit to a peritoneal dialysis center. To arrange your tour at a DaVita® peritoneal dialysis center, call DaVita Guest Services at 1-866-801-6075.
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Dr. Shapiro is a nephrologist who practices in Escondido, CA. He did his undergraduate training at University of California, Los Angeles, obtained his medical degree at the University of Pittsburgh, and completed his residency training and nephrology fellowship at the University of California, San Diego.
Dr. Shapiro is an Assistant Professor of Medicine at University of California, San Diego, but also maintains an active private nephrology practice in the San Diego area. His primary area of medical interest is in peritoneal dialysis (PD).
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