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Peritoneal dialysis
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can no longer do the job. During peritoneal dialysis, blood vessels in your abdominal lining (peritoneum) fill in for your kidneys, with the help of a fluid (dialysate) washed in and out of the peritoneal space.
Peritoneal dialysis differs from hemodialysis, a more common blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments in the comfort of your own home, at work or while traveling. You may be able to use fewer medications and eat a less restrictive diet than you can with hemodialysis.
Peritoneal dialysis isn't an option for everyone with kidney failure. You need manual dexterity (or a reliable caregiver) and the ability to care for yourself at home.
Why it's done
Peritoneal dialysis is often done to manage kidney failure until a kidney transplant is possible. Kidney failure itself usually results from a long-term (chronic) disease that causes kidney damage over a number of years. Common causes of kidney failure include:
- Diabetes
- High blood pressure (hypertension)
- Kidney inflammation (glomerulonephritis)
- Blood vessel inflammation (vasculitis)
- Polycystic kidney disease (cysts in the kidney)
Your doctor will help you decide which type of dialysis will work best for you and when you should start, based on several factors:
- Your overall health
- Your kidney function (as measured by blood and urine tests)
- 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. In hemodialysis, your blood is pumped into a machine to be filtered and then returned to your body.
- You want to minimize the disruption of your daily activities and work or travel more easily.
Peritoneal dialysis might not work for you if:
- You have extensive surgical scars in your abdomen
- You have a limited ability to care for yourself or lack caregiving support at home
- You have inflammatory bowel disease or frequent bouts of diverticulitis
Risks
Most people who require dialysis face a variety of serious health problems, including diseases that cause kidney failure as well as kidney failure itself. Dialysis prolongs life for many people, but life expectancy for those who need the procedure is still much lower than that of the general population.
The main complications of peritoneal dialysis are:
- Infections. The most common problem for people receiving peritoneal dialysis is peritonitis, an infection of the abdominal cavity (peritoneum). An infection can also develop at the site where the tube (catheter) is inserted to carry the cleansing fluid into and out of your abdomen.
- Weight gain. The fluid used to clean your blood in peritoneal dialysis contains sugar (dextrose). You may take in several hundred calories each day by absorbing some of this fluid, known as dialysate. The extra calories can also lead to high blood sugar if you have diabetes.
- Weakening of the abdominal muscles (hernia). Holding fluid in your abdomen for long periods may strain your belly muscles.
Other complications that can stem from dialysis or the underlying kidney disease include:
- Anemia. Anemia — not having enough red blood cells in your bloodstream — is a common complication of kidney failure. Failing kidneys reduce their production of a hormone called erythropoietin, which stimulates formation of red blood cells.
- Bone diseases. If your damaged kidneys are no longer able to use vitamin D to absorb calcium, your bones may weaken. Overproduction of parathyroid hormone — a common complication of kidney failure — can strip calcium from your bones.
- High blood pressure (hypertension). High blood pressure is a leading cause of kidney failure. If you eat too much salt or drink too much fluid while being treated for kidney failure, your high blood pressure may get worse — which takes a toll on your remaining kidney function. Left untreated, high blood pressure can lead to a heart attack or stroke.
- Fluid overload. While holding the dialysis fluid in your abdomen for long periods, your body may absorb too much fluid. This can cause life-threatening complications, such as heart failure or fluid accumulation and swelling in your lungs (pulmonary edema).
- Amyloidosis. Dialysis-related amyloidosis develops when proteins in blood are deposited on joints and tendons, causing pain, stiffness and fluid in the joints. The condition is common in people who have been on dialysis for more than five years.
How you prepare
Before you start peritoneal dialysis, you and your family will receive training on what the procedure involves and how to use the equipment. You will need an operation to insert the catheter — the thin, soft plastic tube that carries the dialysis solution in and out of your abdomen. You may receive local or general anesthetics for the insertion procedure. Usually the surgeon places the tube near your bellybutton.
Your doctor will probably recommend waiting at least two weeks before starting treatment so that the catheter site has time to heal.
What you can expect
In peritoneal dialysis, a sterile cleansing solution (dialysate) flows through the catheter into your abdomen. The solution stays in your belly for a prescribed period of time, known as the dwell time. The lining of your abdominal cavity (peritoneum) acts as a membrane that allows waste, chemicals and extra fluid to pass from your blood into the dialysis solution. The solution contains a sugar that draws wastes and extra fluid through the tiny blood vessels in your peritoneum into your abdomen. Your belly may feel fuller than usual while the dialysis solution is there, but it's generally not uncomfortable.
When the dwell time is over, the solution, along with the waste products pulled from your blood and any excess fluid, drain into a sterile collection bag. The process of filling and draining your abdomen is called an exchange.
Different methods of peritoneal dialysis have different schedules of daily exchanges. The two main schedules are continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). Some people use a combination of both methods.
Continuous ambulatory peritoneal dialysis (CAPD)
With this form of peritoneal dialysis, you fill your abdomen with dialysis solution and later drain the fluid. Gravity moves the fluid through the tube and into and out of your belly.
Each exchange includes filling your abdomen with dialysate fluid, letting the fluid dwell in your abdomen, then draining the fluid. You may need three to four exchanges during the day and one with a longer dwell time while you sleep. You can do the exchanges at home, work or any clean place. You're free to go about your normal activities while the dialysis solution dwells in your abdomen between exchanges.
Continuous cycling peritoneal dialysis (CCPD)
With CCPD, a machine called an automated cycler performs three to five exchanges at night while you sleep. The cycler automatically fills your abdomen with dialysis solution, allows it to dwell there, and then drains it to a sterile drainage bag that you empty in the morning. This gives you more flexibility during the day, but you must remain attached to the machine for 10 to 12 hours at night. In the morning, you begin one exchange with a dwell time that lasts the entire day. You're not connected to the machine during the day.
Which form of peritoneal dialysis is best for you depends on your lifestyle, personal preferences and medical condition. You may also customize your program by combining the two forms. For instance, if you are using CCPD, you may do one extra exchange in the afternoon to remove more waste and prevent absorption of too much fluid.
Results
Many factors affect how well peritoneal dialysis works in removing wastes and extra fluid from your blood. These factors include:
- Your size
- How quickly your peritoneum filters waste (peritoneal transport rate)
- How much dialysis solution you use (fill volume)
- The number of daily exchanges
- Dwell times
- The concentration of sugar (dextrose) in the dialysis solution
Your health care team will perform several tests to check if your dialysis is removing enough waste products. These tests are especially important during the first weeks of dialysis to determine whether you're receiving an adequate amount, or dose.
- Peritoneal equilibration test (PET). This test measures how much sugar has been absorbed from a bag of used dialysis solution and how much of two waste products — urea and creatinine — have entered into the solution during a four-hour exchange.
- Clearance test. Samples of used dialysis solution and a blood sample are collected to compare the amount of urea in the used solution with the amount in the blood. If you still produce urine, your doctor may take a urine sample at the same time to measure its urea concentration.
If the test results show that your dialysis schedule is not removing enough wastes, your doctor may change your prescription. This might involve changing the number of exchanges, increasing the amount of solution you use for each exchange or using a dialysis solution with a higher concentration of dextrose, a type of sugar.
You can improve your dialysis results and your overall health by eating the right foods, including foods low in sodium and phosphorus and high in protein. Your dietitian will help you develop an individualized meal plan based on your weight, your personal preferences, your remaining kidney function and other medical conditions, such as diabetes or high blood pressure.
Taking your medications as prescribed also is important for achieving the best possible results. While you're receiving peritoneal dialysis, you'll likely need various medications to control your blood pressure, stimulate production of red blood cells, control the levels of certain nutrients in your blood and prevent the buildup of phosphorus in your blood.
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