Overview

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't adequately do the job any longer. This procedure filters the blood in a different way than does the more common blood-filtering procedure called hemodialysis.

During peritoneal dialysis, a cleansing fluid flows through a tube (catheter) into part of your abdomen. The lining of your abdomen (peritoneum) acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded.

These treatments can be done at home, at work or while traveling. But 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 you need a reliable caregiver.

Why it's done

You need dialysis if your kidneys no longer function well enough. Kidney damage generally progresses over a number of years as a result of long-term conditions, such as:

• Diabetes
• High blood pressure
• Kidney inflammation (glomerulonephritis)
• Multiple cysts in the kidneys (polycystic kidney disease)

In hemodialysis, blood is removed from the body, filtered through a machine and then the filtered blood is returned to the body. Hemodialysis is typically done in a health care setting, such as a dialysis center or hospital, though it can sometimes be done at home.

Although both types of dialysis can effectively filter your blood, the benefits of peritoneal dialysis compared with hemodialysis include:

• Diabetes
• High blood pressure
• Kidney inflammation (glomerulonephritis)
• Multiple cysts in the kidneys (polycystic kidney disease)

In hemodialysis, blood is removed from the body, filtered through a machine and then the filtered blood is returned to the body. Hemodialysis is typically done in a health care setting, such as a dialysis center or hospital, though it can sometimes be done at home.

Although both types of dialysis can effectively filter your blood, the benefits of peritoneal dialysis compared with hemodialysis include:

• Greater lifestyle flexibility and independence. These can be especially important if you work, travel or live far from a hemodialysis center.
• A less restricted diet. Peritoneal dialysis is done more continuously than hemodialysis, resulting in less accumulation of potassium, sodium and fluid. This allows you to have a more flexible diet than you could have on hemodialysis.
• Longer lasting residual kidney function. People who use peritoneal dialysis might retain kidney function slightly longer than people who use hemodialysis.

Talk with your doctor about which type of dialysis might be best for you. Factors to consider include:

• Your kidney function
• Your overall health
• Your personal preferences
• Your home situation
• Your lifestyle

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
• Want to 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

It's also likely that people using peritoneal dialysis will eventually have a decline in kidney function that requires hemodialysis or a 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 hundreds of extra calories daily, 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.