Peritoneal Dialysis

Peritoneal Dialysis (PD) is a life-saving treatment option for patients with end-stage renal disease (ESRD) or severe chronic kidney disease (CKD). Unlike hemodialysis, which uses a machine to filter waste and excess fluids from the blood, peritoneal dialysis uses the body’s own peritoneal membrane as a natural filter.

What Is Peritoneal Dialysis?

Peritoneal dialysis is a form of renal replacement therapy that involves the infusion of a special dialysis solution into the peritoneal cavity, the space within the abdomen that houses organs like the intestines, liver, and stomach. The peritoneum—a thin, vascular membrane lining the abdominal cavity—acts as a semi-permeable membrane through which waste products and excess fluids pass from the blood into the dialysis fluid.

How Does Peritoneal Dialysis Work?

Catheter Insertion: A soft, flexible tube called a Tenckhoff catheter is surgically placed in the abdomen.
Filling: Dialysis fluid (dialysate) is introduced into peritoneal cavity through the catheter.
Dwell Time: The fluid remains in the abdomen for a prescribed period, allowing the peritoneal membrane to filter waste products and excess electrolytes from the bloodstream.
Draining: After the dwell time, the fluid—now containing waste and toxins—is drained out and replaced with fresh dialysate.

Types of Peritoneal Dialysis

1. Continuous Ambulatory Peritoneal Dialysis (CAPD)

Performed manually, without a machine.
Typically involves 3 to 5 exchanges per day.
Each exchange takes about 30–40 minutes, with dwell times of 4–6 hours.
Allows mobility and independence during the day.

2. Automated Peritoneal Dialysis (APD)

Uses machine called cycler to perform exchanges automatically.
Usually done at night while patient sleeps.
Each cycle lasts 1 to 2 hours, totaling 8–10 hours.
Ideal for patients who prefer fewer interruptions during the day.

Who Is a Candidate for Peritoneal Dialysis?

PD is suitable for many patients, especially those who:

Prefer a home-based treatment option.
Live far from dialysis centers.
Wish to maintain work or school routines.
Have vascular access issues making hemodialysis difficult.

However, it may not be ideal for patients with:

Abdominal scarring or multiple previous surgeries.
Hernias or poor peritoneal membrane function.
Cognitive impairments that affect self-care.

Advantages of Peritoneal Dialysis

Greater independence and flexibility.
Gentler filtration, making it suitable for patients with cardiovascular issues.
Fewer dietary restrictions compared to hemodialysis.
No need for regular hospital visits.
Better preservation of residual kidney function.

Potential Risks and Complications

Peritonitis: Infection of the peritoneal cavity, usually presenting with abdominal pain, fever, and cloudy drainage.
Exit-site or tunnel infections around the catheter.
Hernias due to increased intra-abdominal pressure.
Weight gain or fluid imbalance.
Catheter malfunction or blockage.

Living with Peritoneal Dialysis

Follow strict hygiene protocols to avoid infection.
Monitor for signs of complications.
Adhere to fluid and dietary guidelines.
Attend regular follow-ups for lab monitoring and assessment.