At a glance
Peritoneal dialysis is a kidney replacement therapy that cleans the blood by using the lining of the patient's own abdomen as a natural filter.
When the kidneys can no longer remove waste and excess fluid from the blood, a cleansing fluid called dialysate is introduced into the abdominal cavity through a small tube. The peritoneum (the thin membrane lining the inside of the belly) acts like a filter: waste products and extra fluid pass from the blood into the dialysate, which is then drained out and discarded. This exchange is repeated several times a day or overnight, depending on the method your care team chooses.
Medical Condition
Peritoneal dialysis is used when the kidneys have lost most of their ability to function and the body can no longer manage waste or fluid on its own. It is one of two main forms of long-term dialysis, the other being haemodialysis (where blood is filtered through a machine outside the body).
- End-stage renal disease (ESRD), where the kidneys are working at a very low level and cannot sustain life without support.
- Chronic kidney disease (CKD) that has progressed to the point where the kidneys can no longer compensate.
- Acute kidney injury in selected patients when rapid fluid removal is needed and haemodialysis is not available or suitable.
- Patients who prefer a home-based therapy that allows more flexibility in daily schedule.
- Patients who live far from a dialysis centre and cannot attend three sessions per week.
- Children with kidney failure, where peritoneal dialysis is often preferred because it is gentler on the body.
Peritoneal dialysis is not suitable for everyone. A nephrologist (kidney specialist) will assess each patient's anatomy, lifestyle, and other health conditions before recommending it.
- Previous major abdominal surgery that has left extensive scar tissue inside the belly, which can block the filter membrane.
- Active infection of the abdominal wall or intestines.
- Inflammatory bowel disease or other conditions that damage the peritoneal membrane.
- Very large body size combined with very poor remaining kidney function, which may mean the membrane cannot filter enough waste.
- Inability to perform the exchanges at home safely, whether due to vision problems, dexterity issues, or lack of a suitable caregiver.
Risks & Complications
Peritoneal dialysis is generally well tolerated, but like any ongoing medical treatment it carries recognised risks that the care team monitors for throughout therapy.
- Peritonitis: infection of the peritoneal membrane, the most common serious complication, usually caused by bacteria entering through the catheter during exchanges.
- Exit-site or tunnel infection: infection around the point where the catheter exits the skin, or along the path of the tube under the skin.
- Catheter blockage or displacement: the tube shifts position or becomes blocked, reducing the flow of dialysate.
- Fluid imbalance: too much or too little fluid is removed, causing swelling or low blood pressure.
- Hernias (a bulge where an organ or tissue pushes through a weak spot): the pressure of fluid in the abdomen can push through a weakness in the abdominal wall.
- Blood sugar changes: dialysate contains glucose (a type of sugar), which is absorbed and can raise blood sugar, especially in patients with diabetes.
- Protein loss: some protein passes out of the body with the used dialysate, which may require dietary adjustments.
- Membrane failure over time: after several years, the peritoneal membrane may become less effective at filtering, and a switch to haemodialysis may be needed.
- Shoulder tip pain: absorbed dialysate can irritate the diaphragm (the breathing muscle below the lungs) and cause referred pain in the shoulder.
Preparation & Procedure
Preparation for peritoneal dialysis happens in two stages: getting ready for the catheter insertion surgery, and then completing training before starting regular exchanges at home.
Before the catheter is placed, the medical team will usually ask the patient to stop blood thinners and some other regular medications for a set number of days. Patients are typically asked to stop eating and drinking for at least six hours before the procedure. Smoking slows healing, so the surgical team will advise stopping as early as possible. A bowel preparation (clearing the intestines) may be prescribed so the intestines are not full during surgery, making it easier to position the catheter.
Several tests are normally run before the catheter is placed and before dialysis begins. These help confirm the patient is safe for surgery and establish a baseline for monitoring.
- Blood tests to check kidney function, electrolyte (mineral) levels, blood count, and clotting ability.
- Urine tests to check what kidney function remains.
- An abdominal ultrasound (USG) or CT scan to map the abdominal anatomy and check for previous scarring.
- Chest X-ray and ECG (a tracing of the heart's electrical activity) to assess overall health before surgery.
- Nutritional assessment, as patients starting dialysis often need dietary guidance from the beginning.
The catheter insertion itself is usually done as follows, though exact steps vary between hospitals and surgical approaches.
- The patient receives either a local anaesthetic (numbing medicine) with sedation, or a general anaesthetic (fully asleep), depending on the technique and the patient's health.
- The surgeon makes one or more small cuts near the navel (belly button).
- A soft, flexible tube (the Tenckhoff catheter) is guided into the peritoneal cavity and positioned near the pelvis.
- A cuff (a small felt collar on the tube) is anchored under the skin to hold the catheter in place and reduce the risk of infection.
- The outer end of the catheter is brought through the skin at a separate exit site, usually on the lower abdomen.
- The wound is closed and a dressing is applied. The catheter is usually left to heal for two to four weeks before dialysis exchanges begin.
- During this waiting period, the care team provides training in how to perform the exchanges safely at home.
Aftercare
After catheter placement, most patients go home within one to two days and enter a training period before starting full dialysis. Once exchanges begin, peritoneal dialysis is an ongoing therapy, not a one-time procedure, so aftercare continues for as long as the patient is on dialysis.
- Catheter exit-site care: the area where the tube exits the skin is cleaned daily using the technique taught during training. Keeping it dry and clean is the main way to prevent infection.
- Recognising infection early: patients are taught to watch for signs of peritonitis, including cloudy drained fluid, abdominal pain, and fever, and to contact the dialysis team immediately if these appear.
- Activity restrictions after surgery: heavy lifting and strenuous exercise are usually avoided for several weeks after catheter placement while the wound heals.
- Swimming and immersion baths are generally avoided throughout peritoneal dialysis because of the infection risk at the exit site. Showering is usually fine.
- Diet and fluid management: a dietitian (nutrition specialist) guides the patient on limiting potassium, phosphorus, and sometimes fluid intake. The glucose in dialysate adds calories, so weight is monitored closely.
- Blood sugar monitoring for patients with diabetes, as the glucose in dialysate can affect blood sugar levels.
- Regular clinic follow-up: blood tests, dialysis adequacy tests (checks that enough waste is being removed), and blood pressure checks are scheduled at regular intervals.
- Medication review: blood pressure medicines, phosphate binders (medicines that reduce mineral build-up), and other drugs are adjusted as kidney function changes.
- Machine-assisted dialysis (APD): some patients switch to an automated cycler machine that performs exchanges overnight while they sleep. The care team will explain if and when this is appropriate.
- Kidney transplant assessment: peritoneal dialysis is often used as a bridge while the patient waits for a kidney transplant, and the transplant evaluation may run in parallel.
Cost & What Determines It
The cost of peritoneal dialysis varies widely because it is not a single event but an ongoing treatment that involves a surgical procedure, months or years of consumables, regular clinic visits, and a support system around the patient at home.
- Disease stage and remaining kidney function: patients who still produce some urine may need fewer exchanges, reducing the volume of dialysate bags used each month.
- Type of dialysis chosen: continuous ambulatory peritoneal dialysis (CAPD, done manually several times a day) and automated peritoneal dialysis (APD, done by a machine overnight) have different ongoing supply costs.
- Hospital class and country: the surgical fee for catheter placement, the training programme, and clinic follow-up fees differ greatly between public hospitals, private hospitals, and internationally accredited centres in different countries.
- Length of initial admission: patients who develop early complications after catheter placement may stay longer, adding to the hospital bill.
- Monthly dialysate supply: dialysate bags are a recurring cost and may be purchased locally or imported, affecting the long-term price significantly.
- APD machine rental or purchase: if automated dialysis is used, the cycler machine itself may be rented or bought, and this cost varies by country and supplier.
- Medications: blood pressure medicines, phosphate binders, anaemia treatments, and vitamins are ongoing costs separate from dialysis supplies.
- Additional tests: regular blood tests, peritoneal equilibration tests (tests that measure how well the membrane filters), and imaging studies add to the total cost over time.
- Nurse or technician home visits: some programmes include periodic home checks; others bill for these separately.
A hospital package for the catheter insertion surgery typically includes the operating theatre fee, the catheter itself, the anaesthetist's fee, nursing care during admission, and the initial training programme. What is usually billed separately includes ongoing monthly dialysate bags, medications, outpatient clinic consultations, blood tests, and any APD machine costs.
BPJS Kesehatan and most Indonesian private insurance policies do not cover treatment received abroad, which means patients who choose to have this procedure in another country usually pay out of pocket or rely on international private health insurance. Because dialysis is a long-term commitment with monthly supply costs, the total financial picture is larger than the initial catheter surgery alone. Asking the hospital for a detailed written estimate that covers both the surgical stay and the projected ongoing monthly costs before travelling is the most reliable way to plan and avoid unexpected bills.
Frequently Asked Questions
How many sessions of peritoneal dialysis will I need?
Peritoneal dialysis is not a short course of treatment but an ongoing therapy that runs every day, usually for as long as your kidneys remain unable to filter your blood adequately. Most people do four to five exchanges per day, or one longer overnight exchange using a machine called a cycler. Your nephrologist (kidney specialist) will set a schedule based on how much kidney function you still have and how your body responds.
What does peritoneal dialysis feel like, and will it hurt?
Most people feel mild fullness or pressure in the belly when the fluid is inside, but the process is not usually painful once you are used to it. The catheter (a soft tube placed through the abdomen to allow fluid in and out) may cause some soreness in the first days after it is inserted. If you ever feel sharp pain, fever, or notice cloudy fluid draining out, let your care team know straight away because those can be warning signs of infection.
How soon will peritoneal dialysis start working?
Dialysis begins filtering waste from your blood from the very first exchange, so relief from symptoms like swelling and fatigue can start within days. Feeling noticeably better usually takes one to two weeks as your body adjusts to the new routine. Full benefit depends on sticking to the prescribed schedule, following your diet plan, and attending regular check-ups with your kidney specialist.
How much does peritoneal dialysis cost?
The cost depends on several factors: whether you use manual exchanges or an overnight cycler machine, the ongoing supply of sterile dialysis fluid (which is needed every day), the class of hospital or clinic managing your care, and any additional medicines or tests required along the way. Because this is a daily long-term therapy, pricing is often quoted monthly or annually rather than per session. Requesting a written cost estimate from the hospital is the most reliable way to understand the full ongoing expense.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
