Peritoneal dialysis uses the lining of your own abdomen as the filter. It is done at home, by you, on your schedule — and for many patients it is the better choice.
How it works
A soft catheter is placed through the abdominal wall. Sterile fluid flows in and dwells there. The peritoneum — a membrane richly supplied with blood vessels — lets waste products and excess fluid diffuse out of the blood and into that fluid. After a few hours, it drains, and fresh fluid goes in.
No needles. No machine filtering your blood. No three-times-a-week trip to a center.
Two ways to do it
Continuous ambulatory peritoneal dialysis (CAPD). You perform four or five exchanges yourself across the day, each taking about thirty minutes. No machine. Nothing to plug in.
Automated peritoneal dialysis (APD). A cycler machine performs the exchanges while you sleep. You connect at night and disconnect in the morning. Your days are free.
| Type | How it works |
|---|---|
| Continuous (CAPD) | You exchange fluid by hand a few times a day, no machine |
| Automated (APD) | A machine does the exchanges overnight while you sleep |
Why patients choose it
It happens at home. Nobody drives you anywhere. Your schedule stays yours.
Fluid and solutes come off gradually rather than in a four-hour surge, which is gentler on the heart and easier on blood pressure. Patients often report feeling steadier between treatments than they did on hemodialysis.
Diet is generally less restrictive. Residual kidney function — the small amount of urine you still make — tends to be preserved longer, and that matters more than most people realize.
Travel is easier. Supplies ship to your destination.
Where it falls short
Peritonitis is the principal risk. Infection of the peritoneum, usually from a break in sterile technique during an exchange. It is treatable, but repeated episodes scar the membrane and can end peritoneal dialysis as an option.
The membrane also changes over years of exposure to dialysis fluid. Many patients eventually transition to hemodialysis for this reason, and that is an expected part of the course rather than a failure.
Abdominal surgery, extensive scarring, and large hernias can make peritoneal dialysis impossible. Severe obesity complicates it. And it requires that you or someone at home can perform the exchanges reliably and cleanly, every day, without exception.
Getting started
The catheter is placed and then left to heal for two weeks before use. Training takes one to two weeks.
That is the whole timeline. It is short — far shorter than the three to six months a fistula requires — which is one reason peritoneal dialysis is often the right answer for a patient who needs to start dialysis sooner than a fistula can be ready.