Content written on and updated on June 3, 2020 - Medically reviewed by Frances E. Ashe-Goins, RN, MPH, FAAN, Orlando Gutierrez, MD

Peritoneal dialysis (PD) is one type of dialysis treatment for kidney failure. It uses a fluid that is put in your belly and then removed to clean your blood.

What happens during PD?

During PD, you fill an area of your belly with a cleaning fluid called dialysate. The dialysate uses the lining that covers most of the organs in your belly, called the peritoneum, to serve as a filter for the dialysis process.

You have to let the dialysate sit in your belly for a period of time while it cleans your blood. This time is called a dwell time. Then, you will drain the used dialysate out of your belly and refill your belly with fresh dialysate. This process of draining used dialysate and refilling with fresh dialysate is called an exchange. Each exchange (drain and refill) usually takes 30–40 minutes. You may do these exchanges yourself or with the help of a machine. Your doctor will tell you how many exchanges you should do.

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What is dialysate?

Dialysate has a sugar in it that pulls fluid and waste from your blood into the dialysate. PD uses your peritoneum as a filter. The dialysate holds on to the waste and fluid and removes them from your body when you do an exchange.

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How does dialysate flow in and out of my belly?

Before you can begin PD, you will need minor surgery to have a soft, flexible tube called a catheter put into your belly or chest. The end of the catheter will come out through your skin. You will use this tube to do your exchanges.

To get your catheter, you may have surgery under general anesthesia or with a local anesthetic. General anesthesia is a medicine that makes you go to sleep and not feel any pain. Local anesthesia is a medicine that keeps you from feeling pain in the area where the surgery is happening while you stay awake.

It is best to wait 2–3 weeks after the surgery for your incision site to heal before using the new catheter. This is why doctors recommend getting your catheter 3 weeks before your first peritoneal dialysis session.  In some cases, you can use your catheter can be used right after surgery.  Your doctor will discuss with you when is the best time to start using the catheter.

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How do I care for my belly to prevent infection?

An infection in your belly, called peritonitis, is the most common problem that happens in people who do PD. If you do not clean the area where your catheter goes into your body, bacteria may get into your belly. Bacteria may also get into your catheter while you connect or disconnect from your dialysate bags.

You will need to take good care of your catheter and safely do your exchanges to prevent an infection. To help prevent peritonitis:

  • Wash your hands very well before touching your catheter
  • Clean the area where your catheter goes into your body every day
  • Use an antibiotic spray on the area where your catheter goes into your body
  • Keep your catheter dry at all times
  • Store your PD supplies in a clean, dry area
  • Wear a mask while you do exchanges
  • Only do exchanges in clean, dry places
  • Watch for signs of infection, including:
    • Fever
    • Redness or pain around the catheter
    • Dialysate that looks cloudy or off-color when you drain it from your belly

If you notice any signs of infection, contact your doctor or nurse right away. Sometimes, you can get a catheter in your chest to reduce your chances of an infection.

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What are the types of PD?

The 2 most common types of PD are continuous cycler-assisted peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD). Your doctor can help you decide which fits best with your life and schedule. You may choose to do one or the other, or both.

This table will help you compare the 2 types of PD:

Continuous cycler-assisted PD (CCPD)Continuous ambulatory PD (CAPD)
How does it work?

CCPD uses a machine called a cycler to do your exchanges. When you connect your catheter to tubes going in to the cycler, it will:

  • Fill your belly with dialysate
  • Wait for the correct dwell time
  • Drain the used dialysate from your belly into a bag
  • Refill your belly with clean dialysate and begin the process again to do 3–5 exchanges overnight

CAPD uses gravity to help you do the exchanges by hand, called manual exchanges. Gravity helps fill your belly with dialysate and drain it.

To fill your belly with dialysate:

  • You will sit in a chair, with a tube attached to a bag of dialysate that is hanging above you
  • Gravity will pull the dialysate down from the bag, through the tube into your belly
  • To drain the used dialysate, you will attach a tube to your catheter, and let gravity pull the dialysate out of your belly, through the tube and into a bag below you
  • You will refill your belly with clean dialysate and begin the process again



How often?

CCPD is usually done at night, while you sleep. It must be done every night.

Every morning, the machine will fill your belly with dialysate for the last time. This time, the dialysate will sit in your belly for the whole day, until you go to bed and begin your nightly CCPD treatment again.

Your doctor may tell you to do exchanges during the day if:

  • Your body is holding on to too much of the dialysate during the long daytime dwell time
  • You weigh over 175 pounds
  • You need to have more waste removed from your blood than what can be done during your CCPD overnight treatments

CAPD must be done during the day because you need to do each exchange yourself. It must be done every day.

Most people do 4 exchanges each day. Between exchanges, you will let the dialysate sit in your belly for the dwell time. At the end of each day, you will fill your belly one last time, and the dialysate will sit in your belly all night long. In the morning, you will begin doing exchanges again.

Your doctor may tell you to use a minicycler (a smaller version of the cycler machine used in CCPD) to do some exchanges at night while you sleep if:

  • Your body is holding on to too much of the dialysate during the long nighttime dwell time
  • You weigh over 175 pounds
  • You need to have more waste removed from your blood than what can be done during your CAPD daytime treatments

How long does it take? Usually, the cycler does 3–5 exchanges overnight, which takes about 9 hours.

Your doctor will tell you how many exchanges you should do and how long your dwell times should be. Your dialysis nurse or technician will show you how to set up the cycler machine to give you the right treatment.
It usually takes between –30–40 minutes to drain and refill your belly with dialysate for each exchange.

Your doctor will tell you how many exchanges you should do each day and how long your dwell times should be.

Where is it done? You will likely do PD in your bedroom. Most people do their PD exchanges at home, but you can do them any place that is clean and dry. You can choose any room in your home, workplace, or other space where you spend your time. Most people do their PD exchanges at home, but you can do them any place that is clean and dry.

If you do your PD exchanges at work, your social worker may be able to help you work with your employer to provide a space for your treatment.

What else should I know? No matter which type of PD you choose, your doctor will ask you to have some tests during the first few weeks of your treatment. These tests will help your doctor figure out if you are getting the right amount of dialysis. Based on your test results, your doctor might tell you to change:
  • How often you do exchanges
  • The type of dialysate you use
  • The amount of dialysate you use

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How can I prepare my home for PD?

You will need a space in your home that is kept clean and dry. The room must be free of pets and plants.

You will also need a large area in your home where you can store your treatment supplies. This storage space should be clean, dry, and easy for you to get to. Supplies are usually delivered to your home once a month. Each delivery might include many large, heavy boxes. If you are unable to lift heavy boxes, make sure you have someone who can help you on your delivery day.

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Can I continue my usual activities, work, and travel?

PD can offer a lot of flexibility. If you do PD at night, you will have more time for other activities during the day, but there are some limits on what you can do. Your catheter area should not get wet, so you should avoid swimming or using hot tubs. If your doctor knows about the activities you enjoy, they might be able to recommend a treatment plan that lets you continue those activities.

Work
People who are on PD often have a more flexible treatment schedule than people who do in-center dialysis. PD may mean you can keep your regular schedule for work, school or other activities. But you must follow your doctor’s instructions on when and how many PD exchanges you do each day. It is important to not miss treatments.

Travel
Usually, your PD supplies can be shipped to your travel destinations, and you can do your exchanges in clean, dry spaces on your trip.

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Is it okay to have pets at home while on PD?

For most of us, pets are family. Bringing dialysis treatments home does not mean you have to find a new home for your animal buddy. Here are some tips for pet lovers to stay safe while doing dialysis at home.

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Questions to ask your doctor

Talk to your doctor about your life and the activities you enjoy. Here are some questions you may want to ask your doctor:

  • Would it be best for me to have a catheter in my chest or belly?
  • How do I need to take care of my catheter?
  • How will I do my exchanges?
    • How often?
    • How many?
    • How much and what type of dialysate?
  • What type of PD is best for me, given my travel, work, and the activities I enjoy?
  • Can I continue my usual activities?
  • What should I expect when my supplies are delivered?

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