Peritoneal Dialysis

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 products and excess fluid from the blood, this procedure takes over that job. A cleansing fluid called dialysate is introduced into the abdominal cavity through a soft tube called a catheter. The peritoneum (the thin membrane lining the inside of the abdomen) allows waste products and extra fluid to pass from the blood into the dialysate. After a set amount of time — called a dwell time — the used fluid is drained out and replaced with fresh dialysate. This cycle is repeated several times a day or overnight, depending on the method chosen.

Peritoneal dialysis is used when the kidneys have lost most or all of their ability to function, a state known as kidney failure or end-stage renal disease (ESRD). It is one of two main dialysis options — the other being haemodialysis (a machine-based blood-cleaning process). A nephrologist (kidney specialist) will assess which type is safer and more practical for each patient.

• Chronic kidney disease (CKD) that has progressed to end-stage, meaning the kidneys are working at very low capacity.
• Acute kidney injury (sudden loss of kidney function) when other treatments have not been sufficient.
• Fluid overload (dangerous build-up of fluid in the body) that the kidneys can no longer control.
• Dangerous levels of waste products such as urea or creatinine accumulating in the blood.
• Electrolyte imbalances (abnormal levels of minerals like potassium) that cannot be managed with medication alone.
• Patients who prefer a home-based treatment and have suitable living conditions.
• Patients for whom haemodialysis is difficult, for example those with poor blood-vessel access or certain heart conditions.

Peritoneal dialysis is NOT suitable for every patient. The care team will discuss alternative options if any of the following apply.

• Extensive scarring or adhesions (bands of scar tissue) inside the abdomen from previous surgeries or infections, which would prevent the dialysate from spreading properly.
• Active abdominal infections such as peritonitis (infection of the abdominal lining) at the time of planned treatment.
• Certain hernias (when an organ pushes through a weak spot in the abdominal wall) that cannot be repaired first.
• Severe inflammatory bowel disease or recent abdominal surgery that has not yet healed.
• Patients who cannot reliably perform the exchange procedure at home and have no caregiver support.

Peritoneal dialysis is generally well tolerated as a long-term therapy, but like any ongoing medical treatment it carries recognised risks that the care team will monitor closely.

• Peritonitis (infection of the peritoneum): the most common serious complication, usually caused by bacteria entering through the catheter during exchanges. Signs include cloudy drainage fluid, abdominal pain, and fever.
• Exit-site infection: redness, swelling, or discharge around the point on the skin where the catheter exits the body.
• Tunnel infection: infection along the path of the catheter beneath the skin, which can be harder to treat.
• Catheter blockage or malposition: the catheter tip may shift or become blocked, slowing or stopping drainage.
• Fluid leaks: dialysate can sometimes leak around the catheter site or into nearby tissues, causing swelling.
• Hernia: repeated filling of the abdomen with fluid increases pressure, which can push tissue through a weak spot in the abdominal wall.
• Inadequate dialysis: over time the peritoneum may become less effective as a filter, meaning waste is not cleared efficiently enough.
• Metabolic changes: the glucose (sugar) in dialysate can be absorbed into the body, potentially affecting blood sugar levels and contributing to weight gain over time.
• Low blood pressure or fluid imbalance if too much fluid is removed too quickly.
• Rare: damage to nearby organs during catheter insertion.

Preparation for peritoneal dialysis happens in two phases: getting ready for the catheter insertion surgery, and then learning how to carry out exchanges at home. Both phases require time and active participation from the patient and, where possible, a family member or caregiver.

Before catheter insertion, your care team will usually give the following instructions regarding lifestyle adjustments.

• Fasting (nothing to eat or drink) for a number of hours before the catheter insertion procedure — your surgical team will specify the exact duration.
• Certain medications, especially blood thinners and anti-inflammatory drugs, are usually paused for a period before surgery; the care team will advise which ones and for how long.
• Smoking slows wound healing and raises infection risk. Most teams advise stopping or reducing smoking before the procedure.
• Alcohol should be avoided in the days before surgery.

A series of tests is typically performed to make sure the patient is suitable for catheter insertion and to build a baseline picture of kidney function and overall health.

• Blood tests to measure kidney function markers (urea, creatinine), electrolyte levels, blood count, and clotting ability.
• Urine tests, if the kidneys are still producing any urine.
• Imaging such as ultrasound (USG) or CT scan of the abdomen to check for anatomical issues.
• Chest X-ray and heart tracing (EKG) to assess general fitness for the procedure.
• Nutritional assessment, since kidney failure often affects the body's nutrition balance.
• Training assessment to ensure the patient or caregiver can learn the exchange technique safely.

The catheter insertion itself is a surgical procedure performed in a hospital operating room or procedure suite. The steps below describe what typically happens, though the exact approach varies between hospitals and surgeons.

• 1. The patient receives anaesthesia (pain-blocking medication) — this may be general (fully asleep) or regional/local, depending on the surgeon's assessment.
• 2. The surgical site on the abdomen is cleaned and sterilised.
• 3. A small incision (cut) is made near the navel, and a soft, flexible catheter is guided into the peritoneal cavity (the space inside the abdomen).
• 4. The catheter is tunnelled under the skin so that one end sits inside the abdomen and the other end exits through a small hole in the skin called the exit site.
• 5. The catheter position is confirmed, and the incision is closed with sutures (stitches) or staples.
• 6. A short period of monitoring follows in a recovery area.
• 7. In most hospitals, a waiting or 'break-in' period of several weeks is allowed before regular dialysis exchanges begin, so the catheter can heal into place. Your nephrologist will advise on the timing.

After the catheter has healed, patients and caregivers attend a structured training programme — usually run by specialist dialysis nurses — to learn how to perform exchanges safely at home, recognise early signs of infection, and handle the equipment correctly.

Peritoneal dialysis is an ongoing therapy, not a single event, so aftercare is essentially the patient's new daily routine. After catheter insertion, most patients spend a short time in hospital for monitoring, then recover at home before starting regular exchanges. Once exchanges begin — whether done manually several times a day (CAPD, continuous ambulatory peritoneal dialysis) or by a machine overnight (APD, automated peritoneal dialysis) — the patient's lifestyle, diet, and follow-up schedule all adjust to support the treatment.

• Exit-site care: the area where the catheter exits the skin must be cleaned regularly using the technique taught during training. Keeping this area dry and protected helps prevent infection.
• Activity: most patients can return to light daily activities and, in many cases, work once they have recovered from catheter insertion and are comfortable with exchanges. Heavy lifting and strenuous exercise should be discussed with the care team.
• Bathing: showering is usually preferred over bathing or swimming until the exit site is fully healed. The catheter must be protected from contamination during washing.
• Diet: a kidney-friendly diet is usually recommended — this typically means adjusting intake of salt, potassium, phosphorus (a mineral found in many foods), and fluids. A renal dietitian (nutrition specialist for kidney patients) will provide personalised guidance.
• Fluid intake: the amount of fluid a patient can drink each day is usually limited, depending on how much urine the kidneys still produce and how much fluid is removed during exchanges.
• Medication: most patients continue to take medications for blood pressure, anaemia (low red blood cell levels), bone health, and other conditions related to kidney failure. The care team adjusts these over time.
• Follow-up appointments: regular clinic visits are essential to check dialysis adequacy (whether enough waste is being removed), blood test results, blood pressure, nutrition, and catheter condition. The frequency of visits is decided by the nephrologist.
• Watching for infection: patients are taught to check their drainage fluid every exchange for cloudiness, and to contact the dialysis team promptly if they notice cloudy fluid, abdominal pain, fever, or redness at the exit site.
• Travel: peritoneal dialysis can often be arranged while travelling, but advance planning with the dialysis team and the receiving facility is essential.
• Emotional wellbeing: living with a long-term dialysis routine can be demanding. Many centres offer access to social workers or counsellors, and connecting with patient support groups can also help.