Peritoneal dialysis (PD) is a home-based renal replacement therapy (RTT) used to treat advanced chronic kidney disease (CKD), i.e kidney failure (Stage 5 CKD).
Unlike haemodialysis (HD), peritoneal dialysis uses the body’s own peritoneal membrane as a natural filter to remove waste products, excess fluid, and toxins from the blood.
This article explains what peritoneal dialysis is, how it works, how a PD catheter is inserted, and the potential complications, with a focus on practical and clinical understanding for informed patients.
Peritoneal dialysis is a form of dialysis that cleans the blood through the peritoneum, a thin membrane lining the abdominal cavity. This membrane contains a rich network of blood vessels that allow waste products and excess electrolytes to move from the bloodstream into a special glucose-based dialysis fluid (or dialysate).
PD is performed at home, offers greater lifestyle flexibility, and allows continuous gentle dialysis, which closely mimics natural kidney function.
Like HD, it provides about 5% of the function of 2 kidneys.
The process of peritoneal dialysis involves three key steps:
Fill. A sterile dialysis solution (dialysate) is infused into the abdominal cavity through a permanent PD catheter.
Dwell. The dialysate remains in the abdomen for a prescribed period. During this time:
Urea, creatinine, and other waste products diffuse across the peritoneal membrane
Excess fluid is removed through osmotic forces (mainly via glucose in the solution)
Drain. The used dialysis fluid, now containing waste products and excess water, is drained out and replaced with fresh solution.
This cycle is repeated several times daily or overnight, depending on the PD modality.
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Automated Peritoneal Dialysis (APD)
Both methods are equally effective when prescribed appropriately.
A peritoneal dialysis catheter is a soft, flexible silicone tube that provides access to the peritoneal cavity. Proper catheter placement and care are critical for successful long-term peritoneal dialysis.
Pre-procedure Preparation
Catheter Insertion Techniques
PD catheters can be placed using one of the following methods:
1. Surgical (Open or Laparoscopic)
2. Percutaneous (Bedside or Radiological)
The catheter tip is positioned in the pelvis, and cuffs are embedded in the abdominal wall to reduce infection risk.
After catheter insertion:
While PD is generally safe, complications can occur. Understanding them allows early recognition and prompt treatment.
Peritonitis
Exit-Site and Tunnel Infections
Note. If any of these infections do not improve in 3-4 days, catheter removal may be needed.
Advantages
Limitations
Peritoneal dialysis is an excellent option for many patients with kidney failure, especially those who value independence and home-based care. The decision should be made collaboratively with a nephrology team, considering medical suitability, lifestyle factors, and personal preference.
Peritoneal dialysis is a well-established, effective renal replacement therapy that empowers patients to manage kidney disease outside the hospital setting.
Understanding how PD works, how the catheter is placed, and what complications to watch for is essential for long-term success and safety.
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