Peritoneal dialysis (per-ih-toe-NEE-ul die-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can no longer do the job adequately.
A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste products from your blood. After a prescribed period of time, the fluid with filtered waste products flows out of your abdomen and is discarded.
Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling.
Peritoneal dialysis isn't an option for everyone with kidney failure. You need manual dexterity and the ability to care for yourself at home, or a reliable caregiver.
Why it's done
Dialysis is required if your kidneys don't function adequately on their own. Kidney damage generally progresses over a number of years as a result of long-term conditions, such as:
- Diabetes
- High blood pressure (hypertension)
- Kidney inflammation (glomerulonephritis)
- Multiple cysts in the kidneys (polycystic kidney disease)
The benefits of peritoneal dialysis compared with hemodialysis can include:
- Greater lifestyle flexibility and independence. These can be especially important if you work, travel or live far from a hemodialysis center.
- More flexible dietary guidelines. Peritoneal dialysis is done more continuously than hemodialysis, resulting in less accumulation of potassium, sodium and fluid.
- More stable blood chemistry and body hydration. Peritoneal dialysis doesn't require intravenous (IV) access, which can disrupt your circulation and fluid levels.
- Longer lasting residual kidney function. People who use peritoneal dialysis might retain kidney function slightly longer than people who use hemodialysis.
Your doctor will discuss with you the type of dialysis that's best for you. Factors to consider include:
- Your kidney function, as measured by blood and urine tests
- Your overall health
- Your personal preferences
- Your home situation
Peritoneal dialysis may be the better option if you:
- Can't tolerate the rapid changes of fluid balance associated with hemodialysis
- Want to minimize the disruption of your daily activities, and work or travel more easily
- Have some residual kidney function
Peritoneal dialysis might not work if you have:
- Extensive surgical scars in your abdomen
- A large area of weakened abdominal muscle (hernia)
- Limited ability to care for yourself, or a lack of caregiving support
- Inflammatory bowel disease or frequent bouts of diverticulitis
- Protein malnutrition
- Critical illness
Most people who start dialysis with peritoneal dialysis will eventually experience a decline in kidney function and will need hemodialysis or kidney transplant.
Risks
Complications of peritoneal dialysis can include:
- Infections.An infection of the abdominal lining (peritonitis) is a common complication of peritoneal dialysis. An infection can also develop at the site where the catheter is inserted to carry the cleansing fluid (dialysate) into and out of your abdomen. The risk of infection is greater if the person doing the dialysis isn't adequately trained.
- Weight gain.The dialysate contains sugar (dextrose). Absorbing some of the dialysate might cause you to take in several hundred extra calories a day, leading to weight gain. The extra calories can also cause high blood sugar, especially if you have diabetes.
- Hernia.Holding fluid in your abdomen for long periods may strain your muscles.
- Inadequate dialysis.Peritoneal dialysis can become ineffective after several years. You might need to switch to hemodialysis.
If you have peritoneal dialysis, you'll need to avoid:
- Certain prescription and over-the-counter medications that can damage your kidneys, including nonsteroidal anti-inflammatory drugs.
- Soaking in a bath or hot tub, or swimming in a lake, pond, river or nonchlorinated pool — which increases the risk of infection. Showers and swimming in a chlorinated pool are generally acceptable.
How you prepares
You'll receive training on what peritoneal dialysis involves and how to use the equipment. You'll also need an operation to insert the catheter that carries the dialysate in and out of your abdomen. The insertion might be done under local or general anesthesia. The tube is usually inserted near your bellybutton.
After the tube is inserted, your doctor will probably recommend waiting at least two weeks before starting peritoneal dialysis treatments to give the catheter site time to heal. Complete healing of the catheter site can take up to two months.