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Key points

Peritoneal dialysis (PD) and haemodialysis are both treatments for kidney failure. Throughout the UK the number of people on each treatment is about equal. People often ask, “which type of dialysis is the best?”. The answer is neither – different treatments suit different people.

On PD you manage your own care, compared to hospital haemodialysis, and this gives you independence and flexibility. On PD you tend to spend around 1-2 hours each day draining dialysis fluid in and out of your tummy, and the rest of the time you get on with your life while the dialysis happens inside your body. For haemodialysis you need to be connected to a machine which cleans your blood. This takes around 3-5 hours, 2-3 times each week.

Expect changes to be made in your PD or haemodialysis prescription. Regular check ups are performed to make sure your blood results stay as close to the target levels as possible.

Everyone is different, and their body will react according to the lifestyle and circumstances of that individual. There are solutions to problems, and people who care and can give information, help and support.

What is peritoneal dialysis?

Peritoneal dialysis (PD) is one of the two types of dialysis (removal of waste and excess water from the blood) that is used to treat people with kidney failure. In PD, the process of dialysis takes place inside the body. The abdomen (tummy) has a lining called the peritoneal membrane, which can be used as a filter to remove excess waste and water. A tube (catheter) is inserted into the abdomen during an operation. Special dialysis fluid is drained into the abdomen. Excess waste and water pass from the blood into the fluid and after a few hours the fluid is drained out.

Can anyone do PD?

PD is a suitable treatment for most people with end stage renal failure (ESRF). People who have had several major abdominal operations may not be able to have PD. People who are blind or have problems with their fingers such as arthritis can usually do PD, with the help of a special system and devices. PD requires a lot of commitment from kidney patients and their families. People on PD are usually responsible for their own dialysis, in their own homes. For this reason, PD may not be suitable for some people who have no support at home. Elderly people, living in Nursing Homes can sometimes get help to carry out their PD.

Are there different types of PD?

There are two main types of PD. The most commonly used type is known as Continuous Ambulatory Peritoneal Dialysis (CAPD). In this form of PD, patients have fluid in their abdomen 24 hours a day. At the end of each period of dialysis, they have to change the dialysis fluid themselves. The other type is known as Automated Peritoneal Dialysis (APD). ‘Automated’ means that a machine changes the dialysis fluid for the person, usually at night.

How will I know if PD is working well?

Most people, who have been on PD for a few weeks, start to feel quite well again. When you first start PD you may still be passing urine and this will help clear some waste and fluid from your body. Over the first two years on PD your urine output may decline, and your PD prescription may need to be changed. Symptoms such as feeling weak and tired, nausea and lack of appetite may be a sign that you are not receiving enough dialysis. A number of different blood and PD fluid tests can be carried out to assess how well your dialysis is working

What problems can happen on PD?

PD is not always entirely trouble free. Generally speaking one third of people experience no problems on PD, a third have occasional problems, and a third have repeated problems and feel PD is a disaster! Problems with PD tend to fall into 4 categories:

• Psychological problems
• Infections
• Problems with the PD tube, such as drainage problems
• Physical problems such as pain, itching, or cramps

How long can people remain on PD?

Once a person’s kidneys have failed, they will need dialysis indefinitely. Some people may go on to have a kidney transplant, or may change from PD to haemodialysis. Others have been successfully treated with PD for over 10 years. The availability of new PD fluids and a wide range of prescriptions on CAPD and APD will mean that more people who choose to stay on PD can do so.

Will I be able to lead a normal life on PD?

Many people on PD do all or most of the things that they did before they started on PD. Important aspects of life; (family life, work, holidays, sport and exercise, and sexual relationships), are limited in some ways, though often less of a problem on PD than people might expect. Some people cope more easily than others do with life on PD.

Will I need to take medications on PD?

Everyone on PD will need to take prescribed medications. The most common types of medicines are those used to help;

• Prevent constipation
• Reduce bone disease
• Prevent anaemia (low blood count)
• Control blood pressure

Will I need to be on a special diet or fluid restriction?

Many people on PD are able to enjoy a normal diet without too many restrictions, but may need to moderate certain types of food. This is because PD can only ever replace a small amount of the work done by healthy kidneys. People on PD may have a poor appetite because of the dialysis fluid in their abdomen, which can make them feel bloated, or if they are not having enough dialysis. People are often asked to restrict the amount of fluid that they drink particularly when they start to pass less urine than they used to.

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The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.