Peritoneal Dialysis: At-home Treatment for Kidney Failure

About 37 million people in the United States today have chronic kidney disease. More than 450,000 of those patients require some form of renal replacement therapy (RRT).

RRT refers to treatment methods that help the body filter waste from the blood when the kidneys can't. Very often, people using RRT can live long, productive lives.

“Kidney transplantation is the most optimal form of renal replacement, but there aren't enough kidneys to go around, so most patients rely, in the short term, on one of the means of dialysis,” explains John Kevin Tucker, MD.

Dr. Tucker is the vice president for education at Mass General Brigham and a nephrologist at Brigham and Women's Hospital. Below, he explains peritoneal dialysis at home and discusses its benefits for patients who qualify.

What is peritoneal dialysis?

When patients start dialysis, they are often able to choose between one of two major therapies: hemodialysis or peritoneal dialysis. Most patients can do either therapy as the outcomes are similar. "It often depends upon personal choice, lifestyle, life situation, change in employment, or a change in school status," says Dr. Tucker.

Hemodialysis involves an artificial kidney machine that filters the patient's blood. Patients often need to come into the clinic for treatment around 3 times each week. This can be a challenge, depending on the patient's lifestyle and work or school schedules.

Patients often prefer peritoneal dialysis to hemodialysis. That’s because they can do it at home on their own schedule, and it doesn’t involve blood.

"The reason it's called peritoneal dialysis is that it uses the peritoneum, which is the lining around all of the organs in the abdomen, as a filter," explains Dr. Tucker.

Peritoneal dialysis uses a process called an exchange. During an exchange, the patient connects a soft, hollow tube (called a catheter) in their abdomen to an IV bag filled with dialysis solution. The solution enters their stomach and helps filter waste. Later, they drain the used solution into an empty bag and replace it with new solution.  

Performing peritoneal dialysis at home

Patients who choose treatment at home for kidney failure have a full care team. The whole team supports and trains the patient in understanding all the aspects of dialysis care. Care team members include:

• A kidney doctor (nephrologist)
• A dialysis nurse
• A social worker 
• A dietitian 

To start, a surgeon places a catheter into a patient’s abdomen. Once the abdomen heals around the catheter, a nurse trains the patient to do peritoneal dialysis. This takes 1 to 2 weeks, depending on the patient's schedule.

By law, a patient must have a home visit before they can begin peritoneal dialysis. Usually, a dialysis nurse visits the patient's home to make sure that the environment is safe for at-home dialysis treatment. The dialysis clinic continues to support the patient by ordering supplies and delivering them to their home.

Patients have two choices when exploring treatment at home for kidney failure. 

1. Continuous ambulatory peritoneal dialysis (CAPD)

With continuous ambulatory peritoneal dialysis, the patient hangs a bag of fluid off an IV pole and connects it to their catheter. IV fluid flows through the catheter into their abdomen. When it’s time for an exchange, the patient drains their used fluid into an empty bag and connects fresh solution to their abdomen. 

In CAPD, exchanges take about an hour from start to finish. This includes time to gather supplies, ensure a sterile work area, drain the old solution, and install the fresh solution. Patients treated with CAPD can go around 4 to 6 hours between exchanges and do 3 or 4 exchanges a day.

2. Continuous cycling peritoneal dialysis (CCPD)

Patients may choose continuous cycling peritoneal dialysis, especially if they prefer to do dialysis overnight.

In CCPD, the patient hooks themselves up to a small cycler machine that does several cycles or exchanges automatically, usually while they sleep. The fluid drains through tubing connected to the patient's toilet.

While this process takes 8 to 9 hours, the patient sleeps through most of this therapy. So, this is often the most convenient option for those with full schedules. And setup is relatively easy as well, taking the patient 30 minutes to set up and 15 minutes to disconnect.

Can older patients do peritoneal dialysis?

According to Dr. Tucker, there is a myth that older patients shouldn’t do peritoneal dialysis.

"In fact, most older patients prefer it,” he says. “It's difficult for my elderly patients to get out of their homes to come into a clinic 3 times per week for in-center hemodialysis."

As long as a patient can learn how to do peritoneal dialysis and can perform the exchanges themselves, they can use peritoneal dialysis at any age.