Peritoneal Dialysis (CAPD and APD)

Peritoneal dialysis (PD) is a home-based form of dialysis that uses the lining of your own abdomen to filter waste and extra fluid from the blood. For many people with kidney failure it offers flexibility, independence and fewer hospital visits. Dr. Satarupa Deb, Consultant Nephrologist at Bombay Hospital, South Mumbai, helps patients decide whether PD is right for them and supports them through long-term care.

How Peritoneal Dialysis Works

The inside of the abdomen is lined by a thin membrane called the peritoneum, which has many small blood vessels. In PD, a sterile solution called dialysate is run into the abdomen through a soft, permanent tube (PD catheter). Waste products and excess fluid pass from the blood into this fluid. After a set time, known as the dwell, the used fluid is drained out and replaced with fresh fluid. Each drain-and-fill cycle is called an exchange.

The PD catheter is placed through a small procedure, and it is usually allowed to heal for some time before regular dialysis begins.

CAPD and APD: The Two Main Types

Continuous Ambulatory Peritoneal Dialysis (CAPD) is done manually, without a machine. Most people perform around three to four exchanges during the day, each taking roughly 30 to 40 minutes, and go about their normal activities in between.

Automated Peritoneal Dialysis (APD) uses a small machine called a cycler, which performs exchanges automatically overnight while you sleep. This leaves the day largely free, which some working people and students prefer. Your nephrologist will help decide which type suits your health needs and lifestyle.

Who May Benefit From Peritoneal Dialysis

PD may be a good option for many, but not all, patients with kidney failure.

• People who value independence and wish to dialyse at home
• Those who live far from a hemodialysis centre or travel frequently
• Patients who may have difficulty with fistula creation or vascular access
• People with some remaining kidney function, which PD may help preserve for longer
• Those who are motivated and able to perform exchanges, or have a trained family member to help

Training, Hygiene and Infection Prevention

Before starting PD at home, patients and caregivers receive training on performing exchanges, caring for the catheter exit site and recognising problems. Good hygiene is essential, because the most important complication of PD is peritonitis, an infection of the abdominal lining.

• Always wash and dry hands thoroughly before handling the catheter or bags
• Perform exchanges in a clean, closed, dust-free area with fans switched off
• Care for the exit site daily as taught
• Check that drained fluid is clear; cloudy fluid, abdominal pain or fever needs urgent medical attention
• Keep a daily record of weight, blood pressure and fluid balance

Follow-Up and What to Expect

Regular clinic reviews allow your nephrologist to check dialysis adequacy, fluid balance, blood pressure, nutrition, anaemia and bone health, and to adjust the prescription as needed. Periodic tests of the peritoneal membrane may be advised to tailor the dialysis schedule.

Dr. Satarupa Deb (MD Medicine, DM Nephrology, KEM Hospital, Mumbai) discusses all dialysis options openly, including hemodialysis and kidney transplantation, so that each patient can choose the approach that fits their life best.

This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.