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Peritoneal dialysis offers flexibility

Explore how peritoneal dialysis works and how treatment at home can let you maintain many of the activities you enjoy in your current lifestyle.

What is peritoneal dialysis?

Peritoneal dialysis (PD) is a type of treatment for kidney failure that filters wastes through a membrane in your belly (abdomen). This membrane in your belly, called the peritoneum, acts as a natural filter to remove toxins and extra fluid from your blood.

 

Explore the option that’s comfortable for you

One of the benefits of peritoneal dialysis at home is the flexibility it provides. You can set your own treatment schedule that suits your lifestyle.

There are two options for peritoneal dialysis at home. Talk to your care team about which one is right for you:

Continuous ambulatory peritoneal dialysis (CAPD) is done by hand. Tubing is attached to the PD catheter four times daily doing an exchange each time. After the exchange is completed, a cap is placed on the catheter and placed underneath the clothes. This process is repeated each time you connect for an exchange. Here are the specifics of CAPD:

  • Exchanges need to be done four times a day, every day.
  • Each exchange takes about 30–40 minutes.
  • This option can be done almost anywhere that is clean and dry.

Automated peritoneal dialysis (APD) can be done on your own schedule. Most people choose to do their treatment overnight while sleeping. During a treatment, your catheter tubing is connected to a machine called a cycler that delivers and drains fluid (exchanges) for you. Here are the specifics of APD:

  • The cycler does three-to-five fluid exchanges over an eight-to-ten-hour period.
  • You start each morning with fresh dialysate in your abdomen.
  • The cycler is small enough to fit on most bedside tables and is portable, so you can take it with you while traveling.
 
Person gets out of bed energetically while their partner looks on.
 

Peritoneal dialysis requirements

Starting dialysis is a big decision that can greatly benefit your kidney health. If you’re interested in peritoneal dialysis, you will need the following:

  • A trusted person to assist you on days you aren’t feeling well. One of the benefits of peritoneal dialysis is that you can do it on your own, but it’s nice to have someone to help you if needed.
  • One to two weeks for you and your dialysis partner, if you have one, to attend training. It’s important that you both know how to do exchanges, prevent infection, log your treatments and properly use the cycler. This is done in a dialysis center with a nurse.
  • A clean, dry, well-lit place for treatments and equipment storage. This area should remain off-limits to pets.

Getting started

Two to three weeks before starting treatment, you will need to undergo a minor surgery to place the catheter in your abdomen. Most people are able to go home the same day of surgery, but you will not be allowed to shower for 10 to 14 days. This is to keep your bandaged area clean and dry. You’ll also need to clean the area daily and take great care to prevent infection.

Even when the catheter is fully healed, you won’t be able to swim or soak in a tub, but it shouldn’t prevent you from most daily activities. It’s also easily hidden under your clothes since it’s only about the width of a pencil. 

 

Continuing treatment

Like all life changes, it can take some time to get used to being on peritoneal dialysis. Some people feel bloated in the beginning and a bit uncomfortable, as time goes on, you'll adjust to the feeling and you'll likely experience more energy. Another potential benefit is the possibility of relaxing some rules about eating and drinking. However, keep in mind that dialysate does contain extra calories, so you’ll still have to be mindful to avoid weight gain. But all in all, many people report that peritoneal dialysis allows them to continue to live, work and travel with relative ease.

Learn more about peritoneal dialysis, including how it works and pros and cons to be aware of.

Treatment at home offers more flexibility and, outside of a transplant, at-home dialysis may give you the most control."

 

In this video, you’ll learn the difference between hemodialysis and peritoneal dialysis and how both can be done in the comfort of your own home.

And because you can do dialysis at home more often than in a center, you can get important benefits like more energy to do the things you love, less fatigue, more flexibility in your schedule and diet, and generally a happier and healthier lifestyle.

You deserve options for your kidney health that fit your life. The phrase, “There’s no place like home,” hasn’t been truer than it is now.

Treatment at home offers more flexibility and, outside of a transplant, at-home dialysis may give you the most control over managing your health, your nutrition...

...and your schedule so you can live the life you want.

One type of dialysis is called hemodialysis. With home hemodialysis, you can receive treatment at home.

And since it’s done more often than in-center dialysis, it will clean your blood and get rid of toxins more frequently. The more frequent the treatment, the less fluid is removed each time which can cut down on headaches, nausea, muscle cramping and feeling tired after a treatment.

And you may start to feel much better as a result. You may be able to eliminate some medications, sleep better and have more energy to do the things you love to do.  

And most importantly, the more frequent and longer dialysis you have, the better quality of life you can enjoy.

You can even receive treatment while you sleep if that works best for your schedule.

Hemodialysis uses a machine to clean your blood. During dialysis, the blood flows out of your body, through the dialyzer filter and is then returned. But wastes and extra water that are small enough to pass through the filter are removed from your body.

But you’ll also need a way for your blood to move between your body and the dialyzer with hemodialysis, and that’s called a vascular access. This creates a connection between your blood vessels and the tubes leading to the dialyzer.  It’s usually placed in your arm.

There are three types of vascular access your doctor can discuss with you prior to receiving hemodialysis. Fistula, graft and catheter. Whichever one you and your doctor decide is best for you, will require a minor surgical procedure as much as six months before starting dialysis.

To make a fistula, a surgeon will connect an artery to a vein under your skin to make a bigger blood vessel for dialysis. It will take approximately one to four months for healing to complete.

If a fistula isn’t right for you, your surgeon may recommend a graft, where they’d use a piece of soft tube to join an artery and a vein in your arm. For a graft, you will need about two weeks to heal.

A catheter access is generally for temporary use, like if you needed to start dialysis and your fistula was still healing. A catheter is made by inserting a soft tube into a large vein in your neck or chest.

Both you and your doctor can decide which access is best suited for you, so you can benefit from optimal hemodialysis results at home. Your doctor will also advise you as to when to start planning for dialysis and how you need to prepare to start receiving it at home.

Not only does hemodialysis at home provide the comfort and security of being in your own place, but it offers a flexible schedule as well.

You and your doctor get to choose when you want to have your sessions. You don’t have to rely on what’s available or what isn’t at a center. You decide. There are two common schedules for home dialysis:

First, there are short daily dialysis sessions that are five to seven times a week, with each session lasting two to four hours while you’re awake.

Second, nocturnal home hemodialysis offers you a nightly schedule at four to seven nights a week, with each session lasting six to eight hours, all while you sleep!

You may do this every night or every other night, depending on what you and your doctor discuss. Many people find that this schedule boosts their overall energy level.

Home hemodialysis is a good fit for many people, but there are certain requirements.

A clean space about 15 square feet in your house will be needed for the home dialysis machine, equipment and supplies. And while it’s OK to have pets in the house, your dialysis area needs to be a pet-free zone.

A spouse, partner or close friend who can help you with each of your treatments must be available

You and your partner will need to complete a program that will teach you about the dialysis machine, supplies, how to do home dialysis treatments and how to record the treatments in a log.

You should know that most people learn how to do home dialysis correctly and comfortably.

Home hemodialysis will take some getting used to. But many people find that home hemodialysis gives them the flexibility and energy level to live their best lives.

Now that we talked about what home hemodialysis is and how it can be of great benefit to people with end stage renal disease, let’s talk about a different kind of home dialysis, peritoneal dialysis.

In hemodialysis, as you just saw, blood is drawn out of your body and cleaned by a machine that filters wastes and returned back to the body.

But with peritoneal dialysis, this process happens inside your belly, where your abdominal lining or peritoneum acts as a natural filter.

But of course, your doctor and care team will determine if home peritoneal dialysis is a good fit for you.

Peritoneal dialysis uses a fluid called dialysate to remove toxins and fluid from your blood. The dialysate is delivered to your abdomen through a catheter, a small soft tube that’s surgically inserted through your abdominal wall.

After several hours in your abdomen, called dwell time, the dialysate is drained back out through the catheter.

It’s then replaced by fresh dialysate. This cycle of filling and draining your abdomen with dialysate is called an exchange.

First, continuous ambulatory peritoneal dialysis means you do the dialysis by hand. By connecting an empty plastic bag to your catheter, you let gravity draw the fluid out. Then you remove the bag and attach a new bag of dialysate to flow into your abdomen.

The second way is automated peritoneal dialysis. This is done at night while you’re asleep.

Your catheter is connected to a machine called a cycler. The cycler delivers and drains the fluid for you, while you sleep. And it can fit on most bedside tables.

Just like home hemodialysis, home peritoneal treatment is done more often than in a center, so it cleans your blood more frequently allowing you more energy and more flexibility in your schedule. And like hemodialysis, you will need a dedicated space for the equipment and supplies, with the space being a pet-free zone even though it’s perfectly ok to have pets elsewhere in your home.

While you can do peritoneal dialysis on your own, it’s helpful to have a spouse, partner or close friend to assist you, especially on days when you aren’t feeling well.

You may also want to have someone who can help lift the bags of dialysate, which are usually five to six liters or one to two gallons.

You and your partner, if needed, will learn how to do exchanges, help prevent infection, log your vital signs and record your treatments, order your supplies to be delivered to your home monthly and use your cycler equipment.

If you’re planning to do automated peritoneal dialysis, the training program is held in a dialysis center with a nurse. Most people can learn how to do home peritoneal dialysis correctly in one to two weeks.

As stated, for peritoneal dialysis, you will need to have a catheter placed in your abdomen so minor surgery will be needed two to three weeks before you start.

After you start home peritoneal dialysis, you’ll need to clean your catheter area daily. A face mask and washing your hands before and after you do the cleaning will be required.

You won’t be able to swim or soak in a tub, but it shouldn’t get in the way of most everyday activities.

A catheter is about the width of a pencil, so you can easily keep it tucked away under your clothes.

Just like home hemodialysis, it can take time to get used to peritoneal dialysis. In the beginning, it’s normal to feel bloated or uncomfortable from the fluid in your abdomen. As a result, some people choose to wear looser clothing.

But the good news is, you’ll likely feel better and more energized. And with home peritoneal dialysis, many people find that it’s easier to work, travel and live the life they always saw themselves living.

You’ve learned about home hemodialysis and home peritoneal dialysis. We certainly hope that you found this video helpful and a path to feeling better.

However, we can’t say this enough: Be sure to talk with your doctor and/or care team to find out which one is best for your needs and optimal health benefits.

Whichever you and your doctor choose, you’ll reap the health benefits that both offer many people with chronic kidney disease.