If you have end-stage kidney disease and your kidneys have failed, you will be unable to get rid of waste products or control your body’s fluid balance without dialysis. Peritoneal dialysis offers an alternative to haemodialysis that is becoming increasingly popular; around 5,000 people in the UK are having peritoneal dialysis on a regular basis.

Peritoneal dialysis is when waste products and excess fluid are moved out of the blood through the peritoneum (the thin membrane that surrounds your abdominal organs) and into dialysis fluid, which has been poured into the space around your peritoneum.  This dialysis fluid and waste is then drained. 

Types of peritoneal dialysis

There are two types of peritoneal dialysis:

  • Continuous ambulatory peritoneal dialysis (CAPD): this takes place through the day as you continue with your normal activities.
  • Continuous cycler-assisted peritoneal dialysis (CCPD): this is also known as automated peritoneal dialysis (APD) and it takes place overnight as you sleep.

Peritoneal dialysis at The London Clinic

Should you require peritoneal dialysis here at The London Clinic, our multidisciplinary team can provide the preferred peritoneal dialysis service, whether you have CAPD or APD. We use the Baxter HomeChoice® machine for patients who need APD.

On arrival, your line may be changed so that we can make all connections compatible but, otherwise, your treatment will continue according to your normal routine as far as possible. Should any problems arise, whether due to your condition or your treatment, we are also able to provide a haemodialysis service.

How peritoneal dialysis works

Peritoneal dialysis uses the same basic principles as haemodialysis, except that the blood remains within the body and the peritoneal membrane acts as the filter through which waste products pass before they are removed from the body.

The peritoneal membrane is like a bag that encloses the major internal organs within the abdomen and also lines the abdominal cavity. At the start of a peritoneal dialysis session, this area, the peritoneal cavity, is filled with between 1.5 to 3 litres of dialysis fluid. This takes about 40 minutes and is then left in place for several hours.  You are then free to move around and get on with your normal daily routine.

During this time, toxins, waste products and water from the blood vessels in the membrane are drawn into the fluid across the peritoneal lining. The fluid is then exchanged by draining it and replacing it with fresh fluid.

Peritoneal dialysis fluid consists of water with dissolved glucose and salts to encourage the right exchange of waste products and water. It comes in 3 strengths, depending on the amount of water that needs to be removed from the blood. You may need to use a mix of different strengths through the day to achieve the right balance of body fluids.

The access point for peritoneal dialysis

To allow for peritoneal dialysis, permanent access must be made to the peritoneal membrane. This is achieved by introducing a Tenckhoff catheter, which consists of a thin flexible tube that runs from inside the peritoneal membrane to around 10 cm outside the skin. This is sealed when not in use.

Pros and cons of peritoneal dialysis

The major advantage of peritoneal dialysis is that you are not required to attend the renal unit several times per week for four hours per session, as you would be with haemodialysis. Peritoneal dialysis can take place either throughout the day, with fluid exchanges taking around half an hour, four times a day or overnight, with no interruption to your daily routine.

Peritoneal dialysis can also be more effective, as the constant cleansing of the blood more closely mimics the natural purification process of the kidneys. This means that there are fewer restrictions on diet and drinking than there are with haemodialysis.
Peritoneal dialysis also gives you more freedom, as the equipment is portable and can be taken away with you when you travel.  Automated peritoneal dialysis equipment is about the size of a small suitcase.

The main disadvantage of peritoneal dialysis is the high risk of infection. These may occur at the entry site of the catheter and within the body cavity itself (peritonitis), although these can be easily managed by including antibiotics in the peritoneal dialysis fluid.
In some cases, the membrane of the peritoneal membrane can thicken over time, making the process less effective.