The phrase “peritoneal hemodialysis” is commonly used in online searches, but medically, peritoneal dialysis and hemodialysis are two different dialysis modalities.

Both treatments are used to replace some of the functions of failing kidneys by removing waste products and excess fluid from the body.

• Hemodialysis (HD) filters blood using a dialysis machine and an external dialyzer.

• Peritoneal dialysis (PD) uses the lining of the abdomen, called the peritoneum, as the filtering membrane.

Both are established treatment options for kidney failure. The appropriate choice depends on the patient's medical condition, lifestyle, home circumstances, preferences and suitability for the treatment.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized evaluation and kidney-failure treatment planning, including dialysis-related care.

How Does Peritoneal Dialysis Work?

Peritoneal dialysis uses the patient's abdominal lining to help remove waste and excess fluid.

A soft catheter is surgically placed into the abdomen. Special dialysis fluid is introduced through the catheter and remains inside the abdominal cavity for a prescribed period.

During this time, waste products and excess fluid move across the peritoneal membrane into the dialysis solution.

The used solution is then drained and replaced with fresh solution.

Unlike hemodialysis, the blood does not have to circulate through an external dialysis machine during conventional peritoneal dialysis.

Why Is the Peritoneum Used for Dialysis?

The peritoneum is a thin membrane lining the abdominal cavity.

It contains a network of blood vessels. During peritoneal dialysis, the membrane acts as a natural filtering surface.

Dialysis fluid placed inside the abdomen allows waste products and excess fluid to move from the blood across the peritoneal membrane into the dialysis solution.

The used fluid is subsequently drained.

This makes it possible to perform peritoneal dialysis without using the same external blood-filtering circuit required for conventional hemodialysis.

What Are the Main Types of Peritoneal Dialysis?

There are two commonly used approaches.

Continuous Ambulatory Peritoneal Dialysis

Continuous ambulatory peritoneal dialysis (CAPD) is performed manually.

The patient connects the catheter to dialysis bags and allows the solution to flow into and out of the abdomen.

After a prescribed dwell period, the used solution is drained and replaced with fresh solution.

CAPD does not require a dialysis machine for each exchange.

Automated Peritoneal Dialysis

Automated peritoneal dialysis (APD) uses a machine called a cycler to perform multiple exchanges, usually during sleep.

The machine controls the filling, dwell and drainage cycles according to the prescribed treatment.

The exact schedule varies between patients.

How Is Hemodialysis Different?

Hemodialysis works through a different mechanism.

Blood is removed from the body through vascular access and passed through a dialyzer, which acts as an artificial filter.

Waste products and excess fluid are removed before the blood is returned to the patient.

Hemodialysis can be performed:

• In a dialysis center

• At home in selected patients

The frequency and duration depend on the prescribed dialysis program.

Peritoneal Dialysis vs Hemodialysis

Feature	Peritoneal Dialysis	Hemodialysis
Filtering membrane	Peritoneum inside the abdomen	External dialyzer
Blood outside the body	Not routinely circulated through a machine	Yes
Access	Peritoneal catheter	Vascular access
Location	Commonly performed at home	Center or home, depending on modality
Machine requirement	CAPD does not require a cycler; APD uses one	Requires dialysis equipment
Treatment pattern	Usually performed continuously or through repeated exchanges	Schedule depends on the dialysis prescription
Major infection concern	Peritonitis and catheter-site infection	Vascular-access infection
Diet and fluid needs	Individualized	Individualized

Neither treatment is automatically suitable for every patient. A nephrologist should assess the individual's medical and practical circumstances before a modality is selected.

Who May Need Peritoneal Dialysis?

Peritoneal dialysis may be considered for people with kidney failure who require kidney replacement therapy.

The decision does not depend only on one creatinine value.

Doctors consider:

• Kidney function

• Symptoms

• Fluid balance

• Electrolyte abnormalities

• Acid-base disturbances

• Overall health

• Other medical conditions

• Ability to perform treatment safely

• Home environment

• Patient preference

• Availability of caregiver support when required

Kidney failure generally refers to kidney function falling below approximately 15% of normal, but the timing of dialysis initiation depends on the overall clinical situation.

Can Peritoneal Dialysis Be Done at Home?

Yes.

One of the important features of peritoneal dialysis is that it can generally be performed at home after appropriate training.

Patients learn how to:

• Connect dialysis bags or equipment

• Perform exchanges safely

• Maintain catheter hygiene

• Store dialysis supplies

• Identify possible complications

• Follow the prescribed treatment schedule

Home dialysis requires careful training and adherence to infection-control procedures.

The healthcare team should ensure that the patient or caregiver is comfortable with the technique before treatment is performed independently.

What Is a Peritoneal Dialysis Catheter?

A peritoneal dialysis catheter is a soft tube placed through the abdominal wall.

It provides access to the peritoneal cavity so dialysis fluid can be introduced and drained.

Catheter placement is usually planned before regular peritoneal dialysis begins.

Proper catheter care is essential because infection around the catheter can lead to more serious complications.

NIDDK notes that peritoneal dialysis generally requires minor surgery for catheter placement before treatment begins.

What Happens During a Peritoneal Dialysis Exchange?

A typical exchange involves three basic stages:

1. Fill

Fresh dialysis solution enters the abdominal cavity through the catheter.

2. Dwell

The solution remains inside the abdomen for a prescribed period.

Waste products and excess fluid move into the dialysis solution.

3. Drain

The used dialysis solution is drained from the abdomen and replaced with fresh solution.

The exact volume, dwell time and number of exchanges are prescribed according to the patient's dialysis needs.

What Are the Potential Benefits of Peritoneal Dialysis?

Depending on the individual, peritoneal dialysis may offer several practical advantages.

Home-Based Treatment

Many patients appreciate the ability to perform treatment at home.

Greater Scheduling Flexibility

CAPD and APD can provide different scheduling possibilities compared with conventional in-center hemodialysis.

No Routine Vascular Access

Peritoneal dialysis uses an abdominal catheter rather than an AV fistula or other vascular access.

Continuous Waste Removal

Because PD is generally performed continuously or through repeated daily exchanges, there may be less time for waste and fluid to accumulate between treatments compared with intermittent treatment schedules.

However, these potential advantages must be balanced against the responsibilities and risks of PD.

What Are the Possible Problems With Peritoneal Dialysis?

Peritoneal dialysis is an established treatment, but it is not free of complications.

Possible problems include:

• Peritonitis

• Catheter-site infection

• Hernia

• Catheter malfunction

• Fluid leakage

• Abdominal discomfort

• Weight gain

• Other treatment-related complications

Peritonitis is one of the most important complications because infection can occur inside the abdominal cavity.

What Are the Warning Signs of Peritonitis?

A patient receiving peritoneal dialysis should know the symptoms that require prompt medical attention.

Possible warning signs include:

• Abdominal pain

• Fever

• Nausea or vomiting

• Cloudy dialysis fluid

• Abdominal tenderness

• Feeling unusually unwell

Redness, swelling, pus or pain around the catheter exit site may indicate an exit-site infection.

These symptoms should be reported promptly to the dialysis team.

How Is Peritoneal Dialysis Kept Safe?

Infection prevention is a major part of PD training.

Patients are generally taught to:

• Wash hands carefully

• Use clean technique as instructed

• Keep the catheter exit site clean

• Follow exchange procedures precisely

• Inspect dialysis fluid

• Store supplies appropriately

• Contact the dialysis team when abnormalities occur

The exact technique should be taught by the patient's dialysis team rather than learned from online instructions alone.

Does Peritoneal Dialysis Require a Special Diet?

Yes, but dietary requirements are individualized.

People on peritoneal dialysis may need to manage:

• Sodium

• Fluid

• Potassium

• Phosphorus

• Protein

• Calories

Peritoneal dialysis can remove more protein than hemodialysis, so adequate protein intake is often important. The dialysis diet should therefore be planned with a nephrologist and renal dietitian.

The diet may also need to account for calories absorbed from glucose-containing dialysis solution.

Is Fluid Restriction Necessary During Peritoneal Dialysis?

Not necessarily to the same degree for every patient.

Fluid requirements depend on:

• Residual kidney function

• Urine output

• Dialysis prescription

• Fluid removal

• Sodium intake

• Heart function

• Blood pressure

• Presence of swelling

Some patients may require fluid restriction, while others may need adequate additional fluid intake if dialysis removes substantial amounts of fluid.

Never change your fluid allowance without discussing it with your dialysis team.

Is Peritoneal Dialysis Better Than Hemodialysis?

There is no single dialysis method that is better for every patient.

Peritoneal dialysis may suit people who prefer home treatment and can safely manage the required exchanges.

Hemodialysis may be appropriate for patients who prefer or require treatment in a dialysis center, or for whom PD is unsuitable.

Medical factors, lifestyle, home circumstances and patient preference all contribute to modality selection.

Can a Patient Switch From Peritoneal Dialysis to Hemodialysis?

In some situations, a patient may transition from one dialysis modality to another.

Reasons can include:

• Peritoneal membrane problems

• Recurrent or severe peritonitis

• Catheter complications

• Changes in medical condition

• Inadequate dialysis

• Patient preference

• Changes in home circumstances

The decision should be made with the treating nephrology team.

Can Someone Switch From Hemodialysis to Peritoneal Dialysis?

Selected patients may be able to move from hemodialysis to peritoneal dialysis.

Before changing modalities, the healthcare team will consider:

• Abdominal suitability

• Previous abdominal surgery

• Infection history

• Residual kidney function

• Medical stability

• Ability to perform PD

• Home environment

• Patient preference

A peritoneal catheter must generally be placed and allowed to become ready for use according to the clinical plan.

Peritoneal Dialysis and Kidney Transplantation

Dialysis is not the only kidney replacement option.

For appropriately selected patients with kidney failure, kidney transplantation may provide an alternative to ongoing dialysis.

Some patients receive dialysis while waiting for transplantation, while selected patients may undergo transplant evaluation before dialysis becomes necessary.

Transplant eligibility requires comprehensive assessment of medical and surgical factors.

NIDDK identifies kidney transplantation, hemodialysis and peritoneal dialysis as major kidney-failure treatment options, alongside conservative management in selected patients.

How Is Peritoneal Dialysis Planned Before Kidney Failure?

If kidney function is progressively declining, early education can help patients understand their treatment choices.

Planning may include:

• Learning about PD

• Learning about hemodialysis

• Discussing transplantation

• Assessing home circumstances

• Planning catheter placement if PD is selected

• Discussing vascular access if HD is selected

• Reviewing nutrition

• Medication management

• Planning emergency support

Early preparation can help avoid an unplanned dialysis start and give patients more time to understand their options.

What Happens If Peritoneal Dialysis Is Not Suitable?

If PD is unsuitable or becomes ineffective, other kidney replacement options can be considered.

These may include:

• Hemodialysis

• Home hemodialysis

• Kidney transplantation

• Conservative kidney management in selected patients

The appropriate approach depends on the patient's medical condition and treatment goals.

Is Peritoneal Dialysis a Permanent Treatment?

Not necessarily.

The duration of dialysis depends on the underlying kidney condition.

For some people with acute kidney injury, dialysis may be temporary if kidney function subsequently recovers.

For established kidney failure, dialysis may continue long term unless a kidney transplant or another appropriate change in treatment occurs.

Therefore, starting peritoneal dialysis does not by itself determine how long a patient will need dialysis.

Peritoneal Dialysis Care at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized evaluation and treatment planning for patients with advanced kidney disease and kidney failure.

Depending on the patient's condition, kidney-care services may include:

• Assessment of kidney function

• Evaluation of dialysis requirements

• Discussion of peritoneal dialysis and hemodialysis

• Dialysis modality planning

• Management of CKD complications

• Fluid and electrolyte management

• Nutrition-related kidney care

• Dialysis-related medical supervision

• Kidney transplant evaluation and coordination when appropriate

• Follow-up of patients receiving kidney replacement therapy

Treatment decisions are individualized according to kidney function, medical conditions, lifestyle, treatment preferences and overall health.

Frequently Asked Questions

Is peritoneal hemodialysis the same as peritoneal dialysis?

The terms are often used together in online searches, but they describe different dialysis methods. Peritoneal dialysis uses the abdominal lining as the filtering membrane, whereas hemodialysis uses an external dialyzer to filter blood.

Is peritoneal dialysis done at home?

Yes. Peritoneal dialysis is generally designed as a home-based treatment after appropriate training.

What is the difference between CAPD and APD?

CAPD involves manual exchanges of dialysis fluid, while APD uses a machine or cycler to perform exchanges, commonly during sleep.

Does peritoneal dialysis require a machine?

CAPD does not require a dialysis machine for the exchanges. Automated peritoneal dialysis uses a cycler to manage the treatment cycles.

Is peritoneal dialysis painful?

The procedure should not normally be painful, although some patients can experience abdominal discomfort, fullness or catheter-related problems. New or severe abdominal pain should be assessed promptly, especially if accompanied by fever or cloudy dialysis fluid.

Can peritoneal dialysis remove excess fluid?

Yes. Peritoneal dialysis is designed to remove waste products and excess fluid from the body. The amount removed depends on the dialysis prescription and the patient's residual kidney function.

What is the biggest risk of peritoneal dialysis?

One important complication is peritonitis, an infection involving the peritoneal cavity. Prompt recognition and treatment are important.

Can a person on peritoneal dialysis drink water?

Fluid intake varies between patients. Some require fluid limits, while others may need adequate fluid intake depending on urine output and the amount of fluid removed during PD.

Can peritoneal dialysis be stopped after a kidney transplant?

If a successful kidney transplant provides sufficient kidney function, dialysis may no longer be required. The transplant team determines this based on the functioning of the transplanted kidney.

Conclusion

The search term “peritoneal hemodialysis” commonly refers to questions about dialysis options, but it is important to distinguish peritoneal dialysis (PD) from hemodialysis (HD).

Peritoneal dialysis uses the lining of the abdomen to remove waste products and excess fluid, while hemodialysis filters blood through an external dialyzer. Both can be used to treat kidney failure, and each has different practical requirements, potential benefits and possible complications.

Peritoneal dialysis can be performed at home through CAPD or automated peritoneal dialysis. Careful catheter management and infection prevention are essential, particularly because peritonitis can be a serious complication.

The decision between peritoneal dialysis, hemodialysis, transplantation or other kidney-failure management should be individualized after discussion with a nephrologist.

For specialist kidney-failure evaluation and dialysis treatment planning, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is intended for general educational and informational purposes only and is not a substitute for medical diagnosis, treatment or individualized medical advice. “Peritoneal hemodialysis” is not the standard medical name for a single dialysis modality; peritoneal dialysis and hemodialysis are distinct treatments. The appropriate dialysis option depends on kidney function, symptoms, medical conditions, residual kidney function, home circumstances, treatment preferences and other clinical factors. Do not start, stop or change dialysis, fluid intake, medicines or diet without guidance from your nephrologist and dialysis team. Patients receiving peritoneal dialysis should seek prompt medical attention for abdominal pain, fever, cloudy dialysis fluid, catheter-site redness, swelling or discharge, or other signs of infection. Consult Dr. Sandip Prabhakar Bhurke or another qualified nephrologist for personalized kidney-care advice.