Peritoneal dialysis duration stages how it is performed and its risks

Peritoneal dialysis is one of the most important treatments for chronic kidney failure. It helps the body safely and easily eliminate toxins and excess fluids, and it can be performed at home. Its main advantage is that it gives patients more freedom and flexibility compared to hemodialysis, making it a preferred choice for many people.In this Dalili Medical article, we will explore the duration of peritoneal dialysis, its main stages, the most common side effects, and how to know if the dialysis is working effectively while maintaining your health during treatment.

What is Peritoneal Dialysis?
Peritoneal dialysis is a type of dialysis used when the kidneys are no longer able to perform their natural function of filtering blood and removing excess toxins and fluids. The kidneys are a vital part of the urinary system, responsible for filtering blood and producing urine.

In cases of kidney failure, waste products and toxins, such as urea, accumulate in the body, which can lead to serious complications if left untreated.

In peritoneal dialysis, the internal lining of the abdomen (the peritoneum) acts as a natural filter instead of the kidneys. A thin, flexible tube called a catheter is inserted into the abdomen through a minor procedure. A special dialysis solution is introduced through the catheter to absorb excess toxins and fluids from the blood. The used solution is then drained, and fresh solution is added to start the process again.

The major advantage of this method is that it can be performed easily at home, either during the day or at night, giving the patient more freedom and flexibility compared to traditional hemodialysis.

What is Automated Peritoneal Dialysis (APD)?
Automated peritoneal dialysis is an advanced type of peritoneal dialysis that uses a machine called a “cycler.”
The device automatically exchanges dialysis fluids according to a schedule set by the doctor, making the process easier and more precise.
APD is usually performed overnight while the patient sleeps, with each session lasting 8 to 12 hours. This type is very convenient as it saves time and effort, allowing the patient to maintain normal daily activities.

Can I Travel While on Peritoneal Dialysis?
Yes, traveling is possible with peritoneal dialysis, but it requires proper planning.
It is recommended to prepare the necessary fluids and medical supplies in advance, especially for patients using manual peritoneal dialysis (CAPD). You can also coordinate with a dialysis center near your travel destination in case medical assistance is needed.

Is Peritoneal Dialysis Suitable for All Kidney Failure Patients?
Not all patients are suitable for peritoneal dialysis.
The doctor determines suitability based on the health of the peritoneal membrane, previous abdominal infections, or past surgeries that might affect dialysis efficiency. Therefore, a thorough medical evaluation is essential before starting treatment.

How Often Does a Patient Need to Change Dialysis Solution?

In manual peritoneal dialysis (CAPD), the solution is usually changed 3–5 times a day.
In automated nighttime peritoneal dialysis (APD), the machine performs automatic exchanges during sleep.
The doctor determines the appropriate number of exchanges based on the patient’s condition and lab results.

Can I Exercise While on Peritoneal Dialysis?
Yes, light exercises like walking or stretching are safe.
However, avoid heavy or high-impact activities that could affect the catheter or cause complications.

Do I Need Medication While on Peritoneal Dialysis?
Sometimes, patients may need medications to control blood pressure, phosphate levels, or blood sugar.
The doctor prescribes the type and dose based on regular lab tests.

Does Peritoneal Dialysis Fully Replace Kidney Function?
Peritoneal dialysis helps remove toxins and excess fluids, but it does not completely replace the natural function of the kidneys.
Patients require regular lab tests to monitor dialysis effectiveness and must follow a prescribed diet and medications to maintain body balance.

Is There an Age Limit for Starting Peritoneal Dialysis?
No, peritoneal dialysis is suitable for both children and adults, provided a thorough medical evaluation is done to ensure safe dialysis.
The doctor determines the best method based on the patient’s age and health condition.

Does Peritoneal Dialysis Affect Pregnancy or Fertility?
Peritoneal dialysis can be used during pregnancy, but it requires close monitoring by both a nephrologist and an obstetrician.
Fluid volumes and medications are adjusted according to the patient’s needs to prevent complications.
With proper medical supervision, women can safely conceive and carry a pregnancy.

What Should I Do During Power Outages or While Traveling with an APD Machine?
In case of a power outage or while traveling, contact your doctor immediately.
The doctor may advise temporarily switching to manual dialysis (CAPD) until the situation is resolved.
Advance planning helps avoid unexpected interruptions in treatment.

Are There Psychological Effects of Peritoneal Dialysis?
Some patients may experience anxiety or stress due to the daily dialysis routine or lifestyle changes.
Psychological support from family, medical counseling, and participation in support groups can help patients adapt better and maintain mental health.

When is Peritoneal Dialysis Started?
Peritoneal dialysis is typically initiated in two main scenarios:

End-stage chronic kidney disease:
When kidney function drops to 10–15% of normal capacity. In this case, dialysis continues for life unless a kidney transplant is performed.
Acute kidney failure:
Often due to a sudden illness or severe injury, dialysis may be temporary until kidney function recovers.

What Happens if a Dialysis Session is Missed?
Skipping or missing a dialysis session can lead to toxin and fluid buildup in the body, causing severe fatigue or serious complications over time.
Repeatedly missing sessions can also affect the peritoneal membrane’s efficiency, so it’s crucial to follow the dialysis schedule as instructed by your doctor.

How Long Can a Person Live on Peritoneal Dialysis?
The average life expectancy after starting peritoneal dialysis ranges from 5 to 10 years, but some patients live 20–30 years or more without major problems.
Regular medical follow-up, adherence to diet, and medications improve quality of life and longevity.

Recovery Time After Catheter Placement
Recovery from catheter placement surgery usually takes 2–3 weeks.
Patients can then start dialysis gradually. Some notice improvement within the first week, while others may take a month or longer. Recovery varies depending on overall health and peritoneal membrane condition.

When Can I Return to Work or School?
Many patients can return to work or school while on peritoneal dialysis.

Patients using APD can perform dialysis overnight, which does not interfere with daily activities.
Manual CAPD can be done during the day in a clean, safe environment.

How Long Does Peritoneal Dialysis Take?

Manual peritoneal dialysis (CAPD): Each exchange takes 30–40 minutes, 3–5 times a day.
Automated peritoneal dialysis (APD): Sessions last 8–12 hours, usually overnight.

What Happens After a Dialysis Session?
After dialysis, the drainage bag is removed and the catheter site is cleaned thoroughly.
Maintaining hygiene reduces the risk of infection and ensures treatment effectiveness.

Is Peritoneal Dialysis Painful?
Peritoneal dialysis is not painful.
Some patients may feel mild bloating or fullness in the abdomen while the solution is in place, which is normal and improves as the body adjusts.

Does Urination Continue During Peritoneal Dialysis?
This varies between individuals. Most patients continue producing some urine after starting dialysis, but the amount may gradually decrease over time. Regular monitoring with the doctor helps adjust fluid management.

What Conditions Does Peritoneal Dialysis Treat?
Peritoneal dialysis is used to treat chronic or acute kidney failure when the kidneys cannot filter blood and remove excess toxins and fluids.
It is an effective method that helps the body maintain balance and prevents waste accumulation that could lead to serious complications.

How Common is Peritoneal Dialysis?
Peritoneal dialysis is less common than hemodialysis, with only about 10% of kidney failure patients worldwide using it.
Despite this, it is an excellent option for many patients because it offers greater freedom and flexibility and can be performed at home.

Why Isn’t Peritoneal Dialysis Very Popular?
Several factors contribute to its lower popularity compared to hemodialysis:

Lack of awareness: Many patients are unaware that peritoneal dialysis is a safe and available option.
Limited specialized staff: Fewer doctors and nurses are trained in peritoneal dialysis compared to hemodialysis.
Difficulty in assistance: Some patients need help during dialysis, which is not always available.
Emergency starts: In cases of sudden kidney failure, it may be difficult to place a catheter quickly, so patients often start with hemodialysis instead.

How to Prepare for Peritoneal Dialysis
Before starting dialysis (usually 2–3 weeks in advance), a surgeon places a permanent catheter in the abdomen near the navel through a minor procedure.
The medical team will then teach you essential steps, including:

Proper use of dialysis equipment.
Safe connection of dialysate bags.
Care for the catheter site to prevent infection.

After recovery, dialysis sessions gradually begin at home under the doctor’s supervision.

Components of a Peritoneal Dialysis System

1️⃣ Peritoneal Catheter
A thin tube inserted into the abdomen that allows dialysis fluid to flow in and out.
It remains in place throughout treatment and requires regular cleaning to prevent infection.

2️⃣ Dialysate Bags
Contain a special solution that absorbs excess toxins and fluids through the peritoneal membrane.
The volume and composition are customized based on the patient’s condition.

3️⃣ Tubing/Lines
Connect the fluid bags to the catheter.
In manual dialysis, the patient changes them themselves. In automated dialysis, the cycler machine handles the exchanges.

4️⃣ Connectors & Valves
Control fluid flow, prevent leaks, and ensure safety during dialysis.

5️⃣ Cycler Machine – for Nighttime APD
Automatically exchanges dialysate during sleep.
Includes a pump, timer, and sensors to monitor fluid pressure and exchange volume.

6️⃣ Monitoring Devices
Some advanced machines have digital displays showing fluid volume, exchange duration, and peritoneal pressure to ensure safe and effective sessions.

Types of Peritoneal Dialysis

1️⃣ Continuous Ambulatory Peritoneal Dialysis (CAPD)

Method: The patient manually exchanges dialysate 3–5 times daily.
Duration: Each exchange takes 30–40 minutes, with the fluid remaining in the abdomen for 4–6 hours.
Advantages: No machine required; can be done anywhere.
Disadvantages: Requires strict hygiene and schedule adherence; infection risk if instructions aren’t followed.

2️⃣ Automated Peritoneal Dialysis (APD)

Method: Performed with a cycler machine overnight while the patient sleeps.
Duration: 8–10 hours, with automatic fluid exchanges.
Advantages: Convenient for busy patients; less manual effort.
Disadvantages: Requires electricity; can be affected by power outages or travel.

What Happens During Dialysis

In CAPD, the patient connects the solution bag to the catheter, leaves it in the abdomen for a set time, then exchanges it with fresh solution according to the doctor’s instructions.
In APD, the machine automatically fills and drains the abdomen multiple times overnight.
Hygiene is crucial in both methods to prevent infection.

Signs of Ineffective Peritoneal Dialysis

⚠️ Symptoms of reduced efficiency:

Fluid buildup (swelling in feet, hands, or abdomen).
High blood pressure or difficulty controlling it.
Elevated toxins in the blood (urea, creatinine).
Fatigue, loss of appetite, nausea, or repeated vomiting.
Weight gain between dialysis sessions due to fluid retention.

⚠️ Possible Causes:

Catheter blockage or leaks.
Peritoneal infections (peritonitis).
Incorrect solution concentration or volume.
Changes in peritoneal membrane properties over time.
Skipping exchanges or not following the dialysis schedule.

⚠️ Ways to Improve Dialysis Efficiency:

Catheter cleaning or adjusting the solution type/concentration.
Treat infections with appropriate antibiotics.
Increase daily exchanges or dwell time.
Switch to hemodialysis if necessary.
Work with a renal dietitian to maintain proper nutrition and electrolyte balance.

Common Drawbacks and Complications of Peritoneal Dialysis

⚠️ Main Drawbacks:

Must be done daily.
Permanent catheter in the abdomen.
Not suitable for all patients (e.g., previous abdominal surgery or high body weight).

⚠️ Potential Complications:

Peritonitis: Bacterial infection of the peritoneum, often within the first two years.
Hernia: Due to increased abdominal pressure.
Peritoneal scarring: Can reduce filtration efficiency over time.
Malnutrition: Loss of some nutrients during dialysis.
Weight gain: From sugar (dextrose) in the solution.
Ultrafiltration failure: Inability to remove excess fluids.
Catheter issues: Blockage or displacement.
Reduced long-term effectiveness: Some patients may need to switch to hemodialysis after several years.

Peritoneal Dialysis vs. Hemodialysis

Feature	Peritoneal Dialysis (PD)	Hemodialysis (HD)
Filtration Method	Uses peritoneal membrane in the abdomen	Uses a machine and filter to clean blood directly
Frequency	Usually daily or as prescribed	Typically 3 times/week, 3–5 hours each
Location	At home or convenient place	Usually at a dialysis center or hospital
Equipment	Catheter + dialysate bags	Vascular access + machine + cannula
Flexibility	High; patient controls timing	Less flexible; fixed schedule
Daily Activity	Can maintain normal lifestyle	Daily activity affected on dialysis days
Common Risks	Peritonitis, catheter blockage	Low blood pressure, vascular issues, access site infection
Comfort	Relatively comfortable; can sleep/work during APD	Less comfortable; must stay at center

Monitoring Dialysis Effectiveness

1️⃣ Routine Blood Tests:

Urea & creatinine for toxin removal.
Electrolytes (Na, K, Ca, Phosphate) for mineral balance.
Albumin & proteins for nutrition and muscle protection.

2️⃣ Dialysate Fluid Check:

Observe fluid color: should be clear; any changes may indicate infection.
Measure waste and protein levels to assess efficiency.

3️⃣ Weight and Fluid Monitoring:

Track weight before and after dialysis to measure fluid removal.
Assess swelling in limbs or fluid retention.

4️⃣ Blood Pressure and Heart Indicators:

Changes in BP may signal fluid removal problems.
Watch for shortness of breath or pulmonary swelling.

5️⃣ Process Quality Indicators:

Adherence to the daily/nightly dialysis schedule.
No repeated catheter blockage or infection.
Patient satisfaction with comfort and activity levels.

Home Peritoneal Dialysis Guidelines

1️⃣ Cleanliness & Sterilization:

Wash hands before handling catheter or fluids.
Use sterile pads or disinfectant around catheter site.
Choose a clean area away from dust and pets.

2️⃣ Handling the Catheter:

Avoid pulling or sharply bending it.
Secure it properly before starting.
Keep it covered with a clean, dry dressing.

3️⃣ Preparing Fluids:

Check dialysate bags for clarity and expiration.
Warm bags to room temperature before use.

4️⃣ Flow Monitoring:

Watch fluid entering and exiting the abdomen.
Stop dialysis and contact the doctor if blockage or leaks occur.

5️⃣ Health Monitoring:

Daily weight tracking.
Observe BP, limb swelling, abdominal pain, nausea, or changes in fluid color.

6️⃣ Disposal of Used Fluids:

Follow doctor’s instructions for safe disposal.

7️⃣ Schedule Adherence:

Keep a record of each exchange: time, volume, and notes.

How Peritoneal Dialysis Affects Lifestyle

1️⃣ Freedom & Flexibility:

Can be done at home or while traveling (especially CAPD).
Nighttime APD allows normal daytime activities.

2️⃣ Daily Activities:

Most patients maintain normal work, study, and social life.
Adhering to exchange schedules is essential.

3️⃣ Diet & Fluids:

More flexible than hemodialysis, but fluid and electrolyte intake must be monitored.
Daily weight checks prevent fluid retention.

4️⃣ Travel & Mobility:

Easier than hemodialysis as no dialysis center is needed.
APD requires reliable electricity for the machine overnight.

5️⃣ Health Monitoring:

Daily tracking of weight, BP, and abdominal symptoms.
Any catheter problems or infection signs require immediate medical attention.

6️⃣ Psychological & Social Impact:

Provides more independence than center-based hemodialysis.
Requires hygiene discipline and schedule adherence, which may cause initial anxiety for some patients.