Peritoneal dialysis is a treatment option for kidney failure that involves the use of a person’s abdomen lining. It also uses a cleaning solution, which is called dialysate, to help clean the blood of waste products that build up and extra fluids. The peritoneum serves as a filter for this process.
Unlike other forms of dialysis, peritoneal dialysis is not performed at an outpatient center unless that’s what the patient wants to do. Anyone can take advantage of this treatment option as long as the place is clean and dry. That means individuals have more freedom to travel, work, and enjoy the regular activities of life because there isn’t the same need to schedule appointments at a local provider.
There are two forms of peritoneal dialysis that are practiced today: continuous ambulatory PD and continuous cycler-assisted PD. The patient’s doctor will help them to decide which option will create the best possible results.
If your doctor is recommending peritoneal dialysis for your kidney failure as part of the overall treatment plan, then these are the pros and cons to consider with the procedures.
List of the Pros of Peritoneal Dialysis
1. This option gives you the opportunity to benefit from continuous dialysis.
Because you are using a continuous process with peritoneal dialysis, it is easier to manage the fluid levels in your body when compared to other kidney failure treatment options. This benefit may place less pressure on your heart, arteries, and other components of your circulatory system. PD also gives you the opportunity to eat more often, use fewer medications, and perform more of your daily activities without appointment interruptions.
2. Most people have minimal out-of-pocket costs for this treatment option.
Any form of dialysis is expensive. If you had to pay for it privately, then the cost would be tens of thousands of dollars every year. In the United States, the federal government now typically pays for 80% of the charges, according to information published by the National Kidney Foundation. If you have private insurance, then it will cover the remainder of the charges in most circumstances. You might have a deductible or a copay to manage, but that is typically the extent of the costs.
3. It can be accomplished with or without a machine.
Some people benefit from a machine-less peritoneal dialysis option, performing a manual process throughout the day that helps to clean the blood. You would fill your abdomen with a dialysis solution, and then drain the fluid later in the day. Gravity helps to move it through the tube, and then into or out of the abdomen. You might need 3-4 exchanges throughout the day, and then a longer dwelling time at night to cover your sleeping time.
Some patients do better with an automated cycling machine that performs up to five exchanges during the night while you sleep. The equipment fills the abdomen with solution, lets it dwell there, and then drains it into a sterile drainage bag to be discarded upon waking.
4. There are fewer unwanted side effects with peritoneal dialysis.
When your doctor decides that either version of peritoneal dialysis is a suitable solution for your health needs, then most patients experience far fewer adverse side effects with their treatments when compared to other forms of dialysis. Most people experience less nausea, cramping, and vomiting when using this option when compared to hemodialysis. There are also fewer issues with unwanted weight gain with PD.
Part of the reason why this benefit exists is because you are receiving a treatment option that is similar to what the kidneys provide for the body. You receive continuous therapy instead of following an appointment schedule, so there is less stress placed on the body.
5. You don’t need to worry about needles with this treatment option.
Although you will be using a catheter with peritoneal dialysis treatments, you don’t need to worry about constant circulatory system access through the use of needles. That means you don’t need to worry about problems with finding an appropriate vessel to start your treatment. All you need to do is connect the bags to your catheter tube so that the fluid can go into or out of your abdomen to provide the necessary therapy.
Because you don’t need to go to the doctor’s office to receive your therapy, most patients can have their peritoneal dialysis supplies shipped directly to your home. You can even have them sent to your travel destination if you plan to be away from your house for an extended time.
6. There are fewer dietary restrictions to worry about with peritoneal dialysis.
You will find that there are fewer dietary and fluid restrictions that you’ll need to worry about if your doctor decides that peritoneal dialysis is a viable option. Although everyone is a little different, DaVita Kidney Care notes that you will want to increase the levels of fiber and protein that you receive each day while limiting potassium and calcium consumption. You will also need to limit phosphorus as it tends to build up in the blood when the kidneys are not working as they should.
Your doctor may also want you to limit the amount of salt that you receive. When you receive peritoneal dialysis, some of your calories will come from the dialysate solution since the cleansing fluid contains dextrose. You’ll naturally want to eat fewer carbs with this option compared to the experiences with hemodialysis.
7. Some people can perform dialysis at work with peritoneal dialysis.
If your doctor decides that continuous ambulatory peritoneal dialysis is a suitable choice for your treatment needs, then the equipment you receive is highly portable. That means you have a lot more freedom to manage your schedule, including the option to take your equipment to work. You’ll still need to spend at least two hours performing dialysis with this option, but you aren’t as tied to your bedroom for treatment options for extended periods either.
List of the Cons of Peritoneal Dialysis
1. There is a higher risk of peritonitis with this procedure.
Because you are using the lining inside of your abdomen as a filter, there is a higher risk of peritonitis with peritoneal dialysis. It is the most common problem that patients encounter when using this treatment option. This issue occurs when bacteria gets into the abdomen through the catheter incision where the tube for circulation comes into the body. It can happen when disconnecting the dialysate bags as well. This disadvantage is even possible if the catheter tube s in the chest.
You can avoid this issue by washing your hands thoroughly before touching the catheter. Clean the incision every day and use an antibiotic spray. Wear a mask while performing exchanges, and then make sure your supplies stay in a clean and dry area.
2. Some individuals are not good candidates for PD.
When your doctor looks at peritoneal dialysis, then the viability of accessing the abdominal lining will help to determine if you are an excellent candidate for this procedure. Although most people are, there are some individuals who cannot receive treatment in this way. Anyone with a BMI over 40 may be excluded because being that overweight can interfere with the quality of treatment that is possible. Individuals with multiple abdominal surgeries in the past may also not benefit from this option.
You will also need to perform treatments with CAPD every 4-6 hours, which may be problematic for some individuals. Since your abdomen is always full of fluid, it is not unusual to see an increase in the size of the belly, which is another issue that can exclude some patients from this procedure.
3. You may need up to 12 hours of machine time each night.
If your doctor recommends that you use the continuous cycling version of peritoneal dialysis, then you will need to stay hooked up to the machine for up to 12 hours each night while you sleep. Then you will need to begin one exchange with a dwell time that can last through the entire day. You will have more flexibility during the daytime hours with this option, but it also means that you are tied to your bedroom at night so that the equipment can do its work.
When you choose peritoneal dialysis, then you are scheduling this treatment into your daily routine. It is not something that you can skip, and there are no appointment-free days – even if you get to do everything at home.
4. It requires the use of a permanent catheter.
If you are experiencing kidney failure and an organ transplant is not an immediate option, then peritoneal dialysis requires the placement of a permanent catheter. That means you must go through a surgical procedure, usually outpatient, that will place the components necessary for the therapy that you need. Because there will be equipment that exists outside of the body, you may find that there are some lifestyle adjustments you might need to make.
You might need to sleep in a different position based on where the catheter placement occurs when you need peritoneal dialysis. There may be changes to your clothing that need to happen. You might also gain weight still with this option, especially around the waist, because of the fluid exchanges that occur.
5. You will need plenty of space in your home for your PD supplies.
The number of supplies that are necessary for peritoneal dialysis are significant, which means your home must have adequate storage space. You may need to keep the equipment and supplies in an area with specific temperature and humidity levels as well, which means you might need to have indoor environment upgrades for your room to purchase.
There is also the need to have extra space in your bedroom for the equipment that you need to use. If you are given a cycler machine to help you manage this process while sleeping, then there needs to be space for it to work next to your bed as well.
6. It is not an immediate treatment option that you can start.
Before you begin your peritoneal dialysis treatments, you will need an operation to insert the catheter. Children receive this option while under general anesthesia. Adults typically receive a local anesthetic, but complex procedures may require a more significant surgery for successful placement. Then you will need to allow the placement area to heal completely before you can begin the therapy you require. This process can take several weeks to heal before your dialysis can begin.
Then you will go through an extensive series of trainings on how to use the equipment in a safe way. It helps to have a family member trained with you in case you may be unable to perform the work for some reason. There will also be new fluid and dietary restrictions that you will need to follow as part of this treatment process.
7. There might be changes to your peritoneum.
Although this disadvantage is rare, there are times when your peritoneum may gradually thicken because of the filtering action that occurs with peritoneal dialysis. Some patients even experience scarring with their abdominal lining, which means some people may need to switch to hemodialysis anyway after a few years to prevent this issue or encourage the body to heal. When you combine this disadvantage with the lack of protein that can occur, and you may experience much lower energy levels than you’re used to experiencing – especially during the first days of your treatment process.
Verdict on the Pros and Cons of Peritoneal Dialysis
This treatment option may not be for everyone who experiences kidney failure. The abdomen of some patients, especially those who are severely obese or subject to multiple past surgeries, may make this choice difficult, if not impossible, to complete. You must keep your home very clean to ensure there is no bacteria buildup or another health concern that develops. Then your doctor might ask about the storage space you have.
If you do qualify for peritoneal dialysis, then this daily therapy works in a similar way to how the kidneys help to process waste and extra fluids in the body. You may also experience fewer adverse side effects with this option.
The pros and cons of peritoneal dialysis look at your current health status to see if your treatment plan can benefit from this option. Only your doctor and treatment team can decide if this option will serve your needs if you experience kidney failure. Use this guide to discuss the key points of this treatment during your appointment to see if it could be a viable choice for your needs.