Peritoneal dialysis

If you have kidney failure, your treatment options may include:

• a kidney transplant
• dialysis (haemodialysis or peritoneal dialysis)
• supportive medicines and care only

This page is on peritoneal dialysis. To understand your other options, see our pages on Kidney transplants in ADPKD and an introduction to dialysis.

If you choose to have peritoneal dialysis, the first step is a home visit to check you have all the facilities needed at home.

You’ll need a surgical procedure at least 2 weeks before starting peritoneal dialysis. A medical nephrologist or surgeon will fix a tube called a catheter through the skin below your belly button into your abdomen (tummy).

The catheter will go into your peritoneum, which is a membrane that surrounds your organs and bowels. You’ll have the catheter long term (unless you stop having peritoneal dialysis). It has a cap on it.

You’ll have a local or general anaesthetic before the surgical procedure to fit the catheter. The procedure can usually be done in one day (meaning you won’t need to stay at hospital overnight). You’ll be given antibiotics to reduce your chance of getting an infection.

The nursing team will teach you about peritoneal dialysis before you get started.

Once you start peritoneal dialysis you’ll have dialysis fluid (dialysate) in your abdomen most of the time. Over a few hours, waste and fluid in your blood will travel through tiny blood vessels in your peritoneum into the dialysis fluid.

You, a relative, caregiver or visiting technician will drain out the old dialysis fluid and replace it with fresh fluid using your catheter (see picture).

There are two ways of refreshing dialysis fluid:

• Automated peritoneal dialysis: You’ll use a machine to automatically swap the fluids during the night while you sleep.
• Continuous ambulatory peritoneal dialysis: You, a relative, caregiver or technician will do a fluid swap about 4 times a day. It takes about 30–45 minutes each time.

Experts think these two types of peritoneal dialysis work equally well, although there’s not been much research comparing them. Automated peritoneal dialysis is the more common choice.

Your dialysis team will be on hand for advice and care when you need.

Peritoneal dialysis can make you feel tired and sick. It can also lead to low blood pressure that can make you feel dizzy or lightheaded. Some people find it uncomfortable to have a peritoneal catheter, to have fluid in their abdomen or to do the fluid swaps.

Let your nursing team know if you get any of these problems as changes to your dialysis schedule or the fluid ingredients can help.

You’ll probably need to take laxatives daily to prevent constipation (difficulty pooing). This is because constipation can move or squash your catheter, stopping it working well. Laxatives make your poo softer and you might need the toilet more urgently.

If you have peritoneal dialysis, there’s a risk of:

• getting an infection around your catheter or in your peritoneum (known as peritonitis)
• getting a hernia, meaning part of your bowel bulges through your tummy muscles under the skin
• the catheter becoming blocked, not draining well or leaking
• changes to your peritoneum that require treatment

You’ll need to keep your catheter clean to reduce the chance of infection. Your dialysis team will explain the signs of infection to look out for. If you have diverticular disease and use peritoneal dialysis, you might be more likely to get peritonitis.

If you get an infection, you’ll need antibiotics either at home or in hospital. If the infection doesn’t clear, you might need a procedure to adjust or replace parts of your catheter. A nurse can do this for you. You might need to have haemodialysis until the infection clears.

If you get a hernia, you may need surgery to correct this.

If your catheter becomes blocked, a nurse can usually unblock it for you. If it keeps leaking, a radiologist can use scans to see why. Some leaks get better on their own — you might need to swap to haemodialysis while it settles. If the leak continues, your catheter might need adjusting or replacing.

Some people having peritoneal dialysis get a thicker or harder peritoneum covered in calcium. This is called encapsulating peritoneal sclerosis and can make you unwell. You’re likely to need nutritional supplements by mouth or into a vein until you’re well enough to eat again.

Encapsulating peritoneal sclerosis can be hard to treat so you may need to switch to having haemodialysis.

You’ll have regular monitoring (usually at least every 6 months) to check peritoneal dialysis is working well to clean your blood. You might need check-ups more often if your kidney function is very low. You’ll also have check-ups of your peritoneum.

Check-ups are a chance for you and your dialysis team to review any side effects and discuss how dialysis is impacting your life. They might be able to suggest changes, treatments or support to help.

You might be able to do some of these check-ups over the phone or on video call rather than visiting the clinic.

You can do your fluid swaps anywhere clean and light with a sink to wash your hands. You can go on holiday or overnight stays — just take enough supplies and follow your dialysis routine.

For more information, see Kidney Care UK’s guide Dialysis Away From Base. You can get help organizing dialysis away from home through their free service called Dialysis Freedom.