Kidney Disease Clinic

📑 Contents

What is PD? PD catheter Types of PD How exchanges work Schedule & duration Complications Diet & fluids Living with PD

🧬 What is peritoneal dialysis?

Peritoneal dialysis uses the lining of your abdomen (peritoneum) as a natural filter. A sterile cleansing fluid (dialysate) is introduced into your abdominal cavity through a soft, flexible tube (catheter). Waste products and excess fluid pass from tiny blood vessels in the peritoneum into the dialysate, which is then drained out.

💡 Key advantage: PD is done at home, often while you sleep, allowing more independence and fewer dietary/fluid restrictions than haemodialysis.

📌 The PD catheter – your access

A soft silicone or polyurethane tube surgically placed into your abdomen (usually below the belly button). It exits through a small hole in the skin. Catheters are typically placed 2‑4 weeks before starting PD to allow healing.

Types: Tenckhoff (most common), coiled or straight tip.
Exit site care: Daily cleaning with antiseptic, keep dry, check for redness or discharge.
Once healed, the catheter is permanently implanted – you can swim, bathe, and exercise after healing (with precautions).

⚠️ Never pull, twist, or put tension on the catheter. Secure it with a belt or tape. Report any exit site infection immediately.

🔄 Types of peritoneal dialysis

🕛 Continuous Ambulatory PD (CAPD)

Manual exchanges, 4‑5 times per day, each taking 20‑30 minutes. No machine needed. You walk around with dialysate in your abdomen between exchanges.

🌙 Automated PD (APD) / Cyclers

A machine (cycler) performs 3‑6 exchanges automatically while you sleep – usually 8‑10 hours. Most common form, preferred by working patients.

Your nephrologist will help choose based on lifestyle, residual kidney function, and peritoneal membrane characteristics.

🔄 The PD exchange – step by step

Prepare – wash hands, wear a mask, clean the work surface.
Drain – open the catheter and drain used fluid into a bag (waste).
Flush – fresh dialysate bag is connected briefly to remove air.
Fill – fresh dialysate flows into your abdomen (10‑20 minutes).
Dwell – fluid remains inside (hours for CAPD, shorter for APD).
Repeat – for multiple cycles.

Using sterile technique (“aseptic”) is critical to prevent peritonitis (infection inside the abdomen).

⏰ Typical schedule

CAPD: 4 exchanges daily, e.g. 8am, 12pm, 5pm, 10pm. Each exchange takes ~30 minutes, with dwell time 4‑6 hours. You can go about normal activities between exchanges.
APD: 8‑10 hours overnight, 3‑6 cycles. A final “day dwell” exchange may be needed if you are a high transporter.
Some patients combine both (APD at night, one manual exchange during the day).

⚠️ Possible complications & how to avoid

🦠 Peritonitis
Abdominal pain, cloudy fluid, fever. Prevent with strict aseptic technique. Treat with intra‑peritoneal antibiotics.

🩹 Exit site infection
Redness, crusting, discharge. Daily cleaning with antibiotic ointment if prescribed.

💧 Hernia
Increased abdominal pressure. Avoid heavy lifting; surgical repair if needed.

🥛 Dialysate leak
Fluid leaking around catheter. Reduce fill volume and rest.

🩺 Sclerosing peritonitis
Rare, long‑term complication. Use biocompatible fluids and avoid prolonged glucose exposure.

🚨 Call your dialysis unit immediately if: you have abdominal pain, cloudy effluent, fever, or redness at exit site.

🥗 Diet & fluid management on PD

PD is more flexible than haemodialysis because it works continuously. However, some restrictions apply:

Fluids: Less strict than HD, but monitor weight. Daily weight gain >1 kg may need fluid restriction.
Sodium: Limit salt to reduce thirst and fluid retention.
Potassium: Usually less restrictive because PD removes potassium, but still avoid extremes.
Phosphorus: Similar to HD – limit dairy, nuts, cola. Use phosphate binders.
Protein: PD loses protein into dialysate. High protein intake (1.2‑1.5 g/kg/day) is essential. Egg whites, chicken, fish, meat.
Carbohydrates: Dialysate contains glucose (sugar). Monitor blood sugar if diabetic; may need insulin adjustment.

🍽️ Work with a renal dietitian – PD patients often need higher protein and sometimes calorie restriction if gaining weight from glucose absorption.

❤️ Living well with peritoneal dialysis

Travel: PD is ideal for travel – supplies can be shipped ahead. Many patients travel freely using CAPD.
Work: CAPD allows daytime exchanges at work; APD works overnight, leaving days free.
Exercise: Light to moderate activity (walking, swimming after exit site healed) is encouraged. Avoid heavy lifting that could cause hernia.
Bathing & swimming: After catheter heals, you can shower daily. Swimming in clean pools or sea is allowed with waterproof dressing and immediate exit site care after.
Sleeping: APD patients sleep connected to cycler – most adapt quickly.

🌟 Reality: Many people remain on PD for 5‑10 years or more. It preserves residual kidney function better than haemodialysis and offers transplant flexibility.

🩻 Peritoneal Dialysis (PD): A Complete Guide