Peritoneal Dialysis

The peritoneum is a thin membrane that lines the inside of the abdomen and covers the organs, with a rich network of small blood vessels. In peritoneal dialysis this membrane acts as the filter. A PD catheter, a soft, flexible tube about the thickness of a pencil, is placed through the lower abdominal wall so that one end lies inside the abdomen and the other comes out through the skin. About two litres of sterile dialysate are run into the abdomen. Over several hours, waste products such as urea and creatinine and extra salts pass from the blood into the fluid, and the glucose draws extra water across the membrane. The used fluid is then drained and replaced with fresh fluid, a cycle called an exchange. In continuous ambulatory peritoneal dialysis (CAPD), you do the exchanges by hand during the day; in automated peritoneal dialysis (APD), a machine called a cycler does them while you sleep.

Peritoneal dialysis is one of the main options when chronic kidney disease reaches kidney failure and dialysis is needed. It suits many people who want to dialyse at home, keep working or studying, avoid needles, or live far from a dialysis unit. It is often favoured for people who still have some kidney function, which PD may help to preserve. It may be less suitable after major abdominal surgery with extensive scarring, with certain hernias or bowel conditions, or when someone cannot carry out exchanges and has no helper. For travellers already on PD, the question is how to keep treatment going while away, which is usually simpler than travelling on hemodialysis because no unit booking is needed. People who travel for another treatment, such as surgery, need a hospital whose kidney team can support PD or arrange temporary hemodialysis if the abdomen cannot be used for a while.

Treatment starts with catheter insertion, done by a surgeon or nephrologist under local anaesthesia with sedation or under general anaesthesia, through a small cut below the navel or by keyhole surgery, usually as a day case or with one night in hospital. The catheter is ideally left to heal for about two weeks before regular use. Training follows, usually over about one to two weeks with a PD nurse, covering hand hygiene, connecting and disconnecting, checking the drained fluid, caring for the exit site and recognising problems. In CAPD, each exchange takes about 30 to 40 minutes: you drain the used fluid into a bag, run fresh fluid in and go about your day, typically four times daily. In APD, you connect to the cycler at bedtime and it performs several exchanges over about 8 to 10 hours, sometimes with one extra exchange in the day.

Candidates are people with kidney failure who can perform exchanges themselves or with a helper, have a clean, dry space to store supplies and do exchanges, and have no abdominal problem that stops the fluid from working. Before catheter insertion, the team reviews previous surgery, hernias and bowel function, and treats constipation, which can interfere with drainage; a hernia may be repaired at the same time. For travel on PD, plan about six to eight weeks ahead: ask your PD unit and supplier whether they can deliver fluid and disposables to your destination, and confirm that a local kidney unit can help in an emergency. Bring a letter describing your prescription, recent blood results and, if your unit advises it, a supply of antibiotics. If you are travelling for surgery or another treatment, share your PD details early, because an abdominal operation may require a temporary switch to hemodialysis.

After catheter insertion, mild discomfort around the cut settles within days, and most people go home the same day or the next. Avoid heavy lifting and straining while the catheter heals, usually for a few weeks, and keep the exit site dry until the team advises otherwise. Once you are trained and established, there is no recovery between sessions: exchanges fit around daily life. If the catheter is placed abroad, plan to stay about a week so that the wound and catheter function can be checked, and agree in advance where training and the start of dialysis will happen, ideally with the PD unit that will look after you in the long term. When travelling on PD, carry a few days of supplies in your hand luggage in case deliveries are delayed, and set up a clean place for exchanges. Ask your unit before swimming, and use a waterproof dressing over the exit site.

Peritoneal dialysis is a well-established treatment, and many people use it safely for years. The main risk is peritonitis, an infection of the abdominal lining that usually follows a break in sterile technique; it causes cloudy drained fluid, abdominal pain or fever and needs urgent treatment, usually with antibiotics added to the dialysis fluid. Exit-site and tunnel infections around the catheter cause redness, discharge or tenderness and are treated early to protect the catheter. The catheter can become blocked or move out of place, sometimes because of constipation, and may need repositioning. Hernias and fluid leaks can occur because of the fluid pressure in the abdomen. The glucose in the fluid adds calories and can affect blood sugar and weight. Over many years the membrane can become less efficient, and some people then move to hemodialysis. Results are measured by blood tests, clearance tests, fluid balance and how well you feel. PD treats kidney failure but does not cure it.