Peritoneal dialysis (PD) at home

PD uses a catheter to introduce dialysis solution into a space in your abdomen to filter your blood through the peritoneal membrane. Haemodialysis (HD), on the other hand, filters your blood through a dialyser (artificial kidney) using an external machine, which requires needles to direct your blood into the machine. 

Doing peritoneal dialysis (PD) at home increases the flexibility and independence of your life on dialysis. It can save you frequent trips to the hospital or clinic and gives you more freedom to work or do the activities you enjoy.

For many chronic kidney disease (CKD) patients, remaining mobile and being able to travel is an important part of maintaining independence. As PD can be done in most places, it is possible for most dialysis patients to travel and continue their treatment while being away from home. While planning for your trip, you can discuss with your clinician to make the necessary arrangements for PD during your trip.

Even though no needles are involved in the PD process, the dialysis solution inside your abdomen may sometimes cause discomfort during your therapy. To relieve the discomfort, your clinician can suggest simple solutions such as the use of laxatives.

Some patients who are sensitive to the dialysis solution may also feel some stinging when the fluid enters the abdomen. Before starting dialysis, your clinician will discuss various ways to ensure your treatment is as comfortable as possible for you. You may always have a conversation with your PD doctor, who will be able to prescribe medication to reduce discomfort.

Sugar molecules are present in the dialysis fluid used during peritoneal dialysis, and some of them are absorbed by your body during dialysis. The absorbed sugar may cause weight gain in some PD patients.

If you are concerned about gaining weight, you will need to keep track of what you eat and engage in regular exercise. You can consult your doctor for professional advice on how to maintain a sustainable diet and exercise routine. Avoid following any extreme diet to lose weight in a brief time as it may disrupt your body's metabolism and cause you to fall very ill.

As peritoneal dialysis patients need to carry fluid in their peritoneal cavity throughout the day, you can have a noticeable abdominal bulge and may experience some bloating. These side effects may be more evident for patients who are prescribed dialysis solutions with higher glucose concentrations, as they need to drain a larger volume of fluid per exchange. Adhering to the daily fluid restriction recommended by your doctor can help to reduce the dialysate volume and make you feel less bloated when dialysing.

If the bloating persists, you can consult your doctor to modify your PD prescription.

Peritonitis happens when your peritoneum, a thin layer of tissue that lines the inside of your abdomen, is infected, usually with bacteria or fungi. It is critical to practise proper hygiene during your dialysis treatment. These include washing hands before dialysis, maintaining good exit site care and any other steps instructed by your healthcare team. 

Signs and symptoms of peritonitis can include:

• Pain
• Fever and chills
• Cloudy dialysis fluid after draining

You will be taught how to recognise the symptoms and signs of peritonitis during your training. Do consult your clinician immediately if you experience any of these symptoms. Early treatment of infection is vital.

Antibiotic injections in the PD solution are usually used to treat peritonitis. If the infection becomes severe or recurrent, you may need to have your catheter removed and switch either temporarily or permanently to haemodialysis.

Your exit site is the point on the abdomen where the PD catheter exits the skin. The exit site can get infected if you do not keep your exit site clean and dry. Therefore, you should always:

• Practice proper change of dressing as taught by your clinician
• Wash your hands thoroughly before exit site care
• Keep your catheter taped securely

Signs and symptoms of exit site infection can include:

• Redness
• Swelling
• Presence of pus
• Pain

Do consult your clinician immediately if you experience any of these symptoms. Early treatment of infection is vital.

A hernia occurs when an internal organ protrudes through the wall of the muscle or tissue that typically confines it. The presence of a lump in your abdomen (or an enlarged scrotum if you are a man) is the most common symptom of a hernia. It is possible that the lump is painless and will only be noticed during a routine check-up.

Peritoneal dialysis patients have a higher chance of getting a hernia. This is because keeping fluid in the peritoneal cavity for a long time can create a strain on the abdominal muscles.

Over time PD may become less effective. This is due to the additional work that PD places on the peritoneal membrane. This may lead to less waste product removal or less fluid removal on dialysis over time. This is measured regularly and assessed by your nursing team. The length of time your peritoneum will work varies from person to person but many people eventually have to switch to haemodialyis. Despite this PD remains an excellent first treatment for people with kidney failure.