Peritoneal Dialysis (PD) is a treatment used for patients with advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD). Unlike hemodialysis, which filters blood outside the body using a machine, peritoneal dialysis uses the lining of the abdominal cavity — the peritoneum — as a natural filter.
This technique allows patients to manage kidney failure at home, offering flexibility and independence compared to hospital-based hemodialysis. It is especially important in improving quality of life, managing symptoms, and prolonging survival in individuals whose kidneys no longer function adequately.
The peritoneum is a thin, highly vascular membrane lining the abdominal cavity and covering abdominal organs. Its large surface area and rich blood supply make it an effective semipermeable membrane.
In peritoneal dialysis:
A sterile dialysis solution (dialysate) is introduced into the abdominal cavity through a catheter.
Waste products (urea, creatinine) and excess electrolytes and fluids move from the bloodstream into the dialysate through diffusion and osmosis.
After a set “dwell time,” the fluid is drained, removing toxins from the body.
This continuous or intermittent process substitutes kidney function while maintaining electrolyte and fluid balance.
Peritoneal dialysis is indicated for patients with end-stage kidney disease, which develops when kidney function drops below 10–15%. Common causes of kidney failure include:
Diabetes mellitus – the leading cause of ESRD worldwide.
Hypertension (high blood pressure) – damages small vessels in the kidneys over time.
Glomerulonephritis – inflammation of kidney filtering units.
Polycystic kidney disease – inherited condition leading to cyst formation and kidney damage.
Autoimmune diseases – e.g., lupus nephritis.
Obstructive uropathy – prolonged blockage due to stones, tumors, or prostate enlargement.
Acute kidney injury (AKI) – in selected cases where temporary support is required.
Patients requiring peritoneal dialysis usually present with signs of kidney failure, such as:
Fluid retention – swelling in ankles, legs, or around the eyes.
Fatigue and weakness – due to toxin buildup or anemia.
Shortness of breath – from fluid accumulation in the lungs.
Nausea, vomiting, or loss of appetite – linked to uremia.
Itchy skin – caused by accumulation of waste products.
Confusion or difficulty concentrating – when toxins affect the brain.
Starting dialysis often improves these symptoms significantly.
The decision to initiate dialysis, including PD, is based on clinical and laboratory findings:
Blood tests: Elevated creatinine and blood urea nitrogen (BUN), abnormal potassium, calcium, or phosphate levels.
Glomerular filtration rate (GFR): Dialysis is usually initiated when GFR falls below 15 mL/min/1.73m².
Urine output: Markedly reduced urine production.
Symptoms of uremia: Nausea, confusion, uncontrolled fluid overload, or electrolyte imbalance.
Imaging: Ultrasound may show shrunken, scarred kidneys in CKD.
Treatment of ESRD includes:
Medical management: Controlling blood pressure, diabetes, diet, and anemia.
Dialysis options:
Hemodialysis – external blood filtration using a machine.
Peritoneal dialysis – home-based option using the peritoneum.
Kidney transplantation: The best long-term solution when available.
Peritoneal dialysis is particularly beneficial for children, elderly patients, or those who prefer independence and home-based care.
Peritoneal dialysis requires the placement of a peritoneal dialysis catheter into the abdominal cavity.
Catheter insertion:
A soft silicone catheter is surgically placed through the abdominal wall, usually below the navel.
The tip lies within the peritoneal cavity.
Dialysis exchange:
A sterile bag of dialysis solution is connected to the catheter.
Fluid flows into the abdomen by gravity.
Dwell time:
The dialysate remains in the abdomen for several hours, allowing waste and fluid exchange.
Drain phase:
The used dialysate, now containing toxins and extra fluid, is drained out into a separate sterile bag.
Continuous Ambulatory Peritoneal Dialysis (CAPD):
Performed manually, typically 3–5 times daily.
Automated Peritoneal Dialysis (APD):
Done overnight using a machine (cycler) that performs multiple exchanges while the patient sleeps.
After catheter placement and initiation of PD:
Training: Patients and caregivers are trained in sterile techniques, fluid exchanges, and catheter care.
Diet: Restrictions on fluid, salt, potassium, and phosphorus intake. Adequate protein is encouraged.
Activity: Patients can continue most daily activities, including work and travel, with adjustments.
Catheter care: The exit site must be kept clean and dry to prevent infection.
Regular follow-up: Includes blood tests to monitor electrolyte balance, adequacy of dialysis, and signs of complications.
Peritoneal dialysis is generally safe, but possible complications include:
Peritonitis (infection of the abdominal cavity): Presents with fever, abdominal pain, and cloudy dialysis fluid.
Exit-site or tunnel infections: Redness, swelling, or discharge around the catheter.
Hernias: Due to increased abdominal pressure.
Dialysate leaks: Around the catheter site.
Metabolic issues: Weight gain, high blood sugar (from glucose in dialysate), or altered lipid levels.
Inadequate dialysis: May occur if exchanges are insufficient or catheter function is impaired.
With proper training and adherence, peritoneal dialysis is effective in maintaining quality of life and prolonging survival in patients with kidney failure. Many patients can remain on PD for years before switching to hemodialysis or receiving a kidney transplant.
Survival outcomes are comparable to hemodialysis, especially in the early years of therapy. The long-term prognosis depends on age, underlying health conditions, and adherence to treatment.
Patients on peritoneal dialysis should seek medical attention if they experience:
Fever, chills, or abdominal pain.
Cloudy or foul-smelling dialysis fluid.
Redness, swelling, or pus around the catheter site.
Sudden weight gain, swelling, or breathing difficulty.
Severe nausea, vomiting, or confusion.
Early recognition of complications ensures prompt treatment and prevents serious outcomes.
Peritoneal Dialysis is a safe, effective, and flexible treatment for patients with end-stage kidney disease. By using the peritoneum as a natural filter, it allows patients to manage their condition at home while maintaining independence and quality of life.
Although it carries some risks, such as infection, with proper training, strict hygiene, and regular follow-up, many patients thrive on PD for years. For long-term management, kidney transplantation remains the best solution, but until then, peritoneal dialysis plays a vital role in sustaining life.
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