Peritoneal dialysis
A home-based treatment for kidney failure that uses the lining of your own tummy, and a soft tube, to clean your blood without a dialysis machine filtering it directly.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- PD uses the lining of your own tummy and a soft tube to clean your blood at home, rather than a machine filtering it directly.
- It supports failing kidneys but does not cure them; transplant and other dialysis options are usually discussed alongside it.
- Infection of the tummy lining (peritonitis) is the main risk, and careful, clean technique is central to safe PD.
- It offers flexibility and independence, but means a daily routine and a permanent tube in your tummy.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can be done at home, offering independence and flexibility
Significant previous tummy surgery, scarring or adhesions can make PD difficult or unsafe.
Some soreness around the tube is normal for a few days. The site is usually left to heal for a few weeks before PD starts, so the catheter beds in.
Thorough training with refreshers and a clear clean technique
Some soreness around the tube is normal for a few days. The site is usually left to heal for a few weeks before PD...
Over several sessions you learn to do exchanges safely, recognise infection, and look after the exit site, until...
You settle into a daily routine, your fluid and blood tests are monitored, and the team adjusts the prescription...
Regular clinic reviews check how well dialysis is working, the catheter site and your overall health, and discuss...
What is peritoneal dialysis?
Peritoneal dialysis (PD) is a treatment for kidney failure that you do yourself at home. Instead of a machine filtering your blood directly, it uses the thin lining inside your tummy, called the peritoneum, as a natural filter. This lining is rich in tiny blood vessels.
A soft tube (a Tenckhoff catheter) is placed into your tummy in a small operation. A special fluid is run in through the tube and left for a few hours, during which waste products and extra water pass from your blood into the fluid. The used fluid is then drained out and replaced with fresh fluid. This is called an exchange, and it is repeated through the day, or overnight using a machine.
PD helps control the symptoms and blood-test changes of kidney failure and can fit around work and daily life. It supports failing kidneys but does not cure them, and most people on PD are also considered for a kidney transplant or may move to other forms of dialysis over time.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Peritoneal dialysis vs haemodialysis
| Feature | Peritoneal dialysis | Haemodialysis |
|---|---|---|
| Where it is done | Usually at home | Often in a unit, sometimes at home |
| How blood is cleaned | Through the tummy lining | Through a machine and filter |
| Schedule | Daily (day or overnight) | Usually 3 sessions a week |
| Main access | Tube in the tummy | Fistula or neck line in a blood vessel |
| Main infection risk | Peritonitis (tummy lining) | Bloodstream and access-site infection |
Neither is simply better; the right choice depends on your health, lifestyle and preferences, and many people switch over time.
Preparing for your treatment
- Talk through all your options, including haemodialysis, transplant and conservative (non-dialysis) care, so the choice fits your life and health.
- Have the catheter inserted, ideally a few weeks before starting, so the site can heal and settle.
- Complete training with the home dialysis team so you can do exchanges safely and recognise problems.
- Set up a clean, suitable space at home for exchanges and for storing the fluid and supplies.
- Learn the signs of infection, especially cloudy fluid, tummy pain or fever, and what to do.
- Plan how PD will fit around work, travel and family life, including arranging deliveries of supplies.
- Tell the team about any previous tummy surgery, hernias or bowel problems, which can affect suitability.
What happens
Before PD can start, a soft tube (Tenckhoff catheter) is placed into your tummy. This is done under local or general anaesthetic, often through small cuts, and the tube is tunnelled under the skin so it sits securely. It is usually left to heal for a few weeks before use.
The home dialysis team then trains you, over a series of sessions, to do exchanges safely using a careful, clean technique. With CAPD you run fluid in and out by hand several times a day; with APD a machine does this overnight while you sleep. Each exchange involves draining out the used fluid and running in fresh fluid through the tube.
Once trained, you do PD at home as part of your daily routine, with regular clinic reviews and blood tests. The team checks how well dialysis is working, looks after the catheter site, and supports you if problems such as infection arise.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Significant previous tummy surgery, scarring or adhesions can make PD difficult or unsafe.
- Some hernias, bowel problems or inability to manage the technique (without assisted PD) may make PD unsuitable.
- Severe lung disease can be worsened by fluid in the tummy in some people.
- PD does not suit everyone, and haemodialysis or conservative care may be a better fit depending on your health and circumstances.
Delay or rearrange if…
- There is an active infection that needs treating first.
- The catheter exit site has not yet healed after insertion.
- A hernia or other abdominal problem needs repair or assessment before starting.
- Your home setup or training is not yet ready to do PD safely.
- You are acutely unwell and need stabilising before a home dialysis routine begins.
Alternatives to discuss
- Haemodialysis, in a unit or at home
- Kidney transplant, where suitable, which can avoid or end the need for dialysis
- Conservative (non-dialysis) kidney care focused on symptoms and quality of life
- Assisted PD, where a carer or nurse helps, if managing alone is the only barrier
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Can be done at home, offering independence and flexibility
- Fits around work, study and family life, especially the overnight (APD) option
- Avoids regular trips to a dialysis unit for many people
- Needles are not required for the exchanges themselves
- Often allows a gentler, more continuous control of fluid and waste than some other schedules
- Can make travel more manageable with planning and supplies
Risks & complications
- Infection of the tummy lining (peritonitis), usually treatable but needing prompt attention
- Infection or irritation where the tube leaves the skin (exit-site infection)
- A feeling of fullness, bloating or changes to appetite from the fluid in the tummy
- Weight gain or higher blood sugar from the sugar in some dialysis fluids
- Hernias, because of the extra pressure in the tummy
- Leaking of fluid around the tube or into nearby tissues
- Problems with the tube draining or becoming blocked or displaced
- Constipation affecting how well the fluid drains
- Severe peritonitis leading to sepsis, or needing the tube removed and a switch to another form of dialysis
- Scarring or thickening of the tummy lining over many years that reduces how well PD works
- Serious complications around the catheter operation
The main risk is peritonitis, an infection of the tummy lining, most often caused by germs entering during an exchange or through the tube site. Careful, clean technique greatly reduces this, and prompt treatment usually controls it, but repeated or severe infections can mean stopping PD. Ask how your unit supports good technique, what its infection rates are, and exactly what to do if your fluid turns cloudy or you develop tummy pain or fever.
Published figures to discuss
The main measurable risk in PD is peritonitis, and units track this as an infection rate per patient-year. Targets exist, but actual rates vary between units and individuals depending on technique, training and personal factors. The figures below are quality targets and standards rather than your personal risk, which your team can discuss in light of your circumstances.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Peritonitis (infection of the tummy lining) | International (ISPD 2022) targets aim for no more than around 0.40 episodes per patient-year; older UK standards cited around one episode every 18 months (about 0.67 per year) | These are unit-level targets, not individual risk; good technique and prompt treatment matter most. Ask your unit for its own rate. | ISPD peritonitis guideline recommendations: 2022 updatejournals.sagepub.comSource-linked context |
| Catheter infection or exit-site infection | Recognised | Redness, pain, discharge or fever around the catheter needs prompt dialysis-unit advice. | ISPD peritonitis guideline recommendations: 2022 updatejournals.sagepub.comSource-linked context |
| Technique failure or need to switch to haemodialysis | Patient- and time-dependent | Peritonitis, membrane changes, hernias, leaks or inadequate dialysis can lead to modality change. | ISPD peritonitis guideline recommendations: 2022 updatejournals.sagepub.comSource-linked context |
| Fluid overload or inadequate clearance | Monitoring-dependent | Weight, swelling, breathlessness, blood tests and adequacy checks guide prescription changes. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is a short recovery from the operation to insert the tube, then PD becomes part of daily life. 'Recovery' afterwards is really about settling into a safe routine and watching for problems.
- Soreness around the tube for a few days after the operation
- A feeling of fullness or bloating from fluid in the tummy
- Taking time to get used to a daily exchange routine
- Regular clinic visits and blood tests as part of ongoing care
Aftercare
- Follow your clean technique exactly at every exchange to reduce the risk of infection.
- Care for the exit site as taught, and keep it clean and dry.
- Check your drained fluid each time, and contact the team urgently if it is cloudy.
- Watch for tummy pain, fever or feeling unwell, and report these promptly.
- Keep up your fluid, salt and dietary advice, and take prescribed medicines.
- Avoid constipation, as it can affect drainage, and follow advice on staying active.
- Attend all clinic reviews and blood tests so dialysis can be monitored and adjusted.
- Clean, suitable space at home for exchanges and supplies
- Training completed and clean technique understood
- Knowing the signs of peritonitis and exit-site infection
- The unit's urgent contact number saved
- Plan for supply deliveries and for travel
- Understanding of fluid, salt and dietary advice
Scars and how they heal
There are small scars where the tube is inserted, usually near the belly button and the hip, and a permanent soft tube exits through the skin of your tummy. The exit site needs ongoing care to keep it clean and reduce infection. The catheter can be removed if PD is stopped, for example after a transplant.
⚠ Get urgent help if…
- Cloudy drained fluid, especially with tummy pain — a key sign of peritonitis; contact your unit straight away
- Tummy pain, fever, chills or feeling generally unwell
- Redness, swelling, pain or discharge where the tube leaves the skin
- Fluid not draining properly, or pain on running fluid in or out
- Leaking of fluid around the tube or a new bulge suggesting a hernia
- Blood-stained drainage fluid that is new or persistent
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
When PD is working well, it controls the symptoms and blood-test changes of kidney failure, helps manage fluid and keeps you feeling as well as possible, while fitting around your life. The team monitors how effectively dialysis is clearing waste and removing fluid, and adjusts your prescription accordingly.
PD supports failing kidneys but does not restore kidney function or cure kidney disease. Over time, the lining of the tummy can become less effective, or repeated problems may mean changing treatment, so PD is often part of a longer journey that includes considering a transplant or moving to haemodialysis.
PD can work well for some years, but the tummy lining can gradually become less effective at filtering, and some people develop repeated infections or other problems. Many people on PD eventually move to haemodialysis, receive a kidney transplant, or change their plan as their health and circumstances change. Your team reviews how well PD is working and discusses options over time.
Related tests, treatments or support
PD is part of wider kidney care that includes medicines for blood pressure, anaemia, bone health and fluid balance, and dietary advice. It is usually discussed alongside the possibility of a kidney transplant and other forms of dialysis. The right combination and the timing of any change are decided with your kidney team.
Follow-up & long-term care
People on PD have regular clinic reviews and blood tests to check how well dialysis is working, look after the catheter exit site, manage related medicines, and watch for complications. The team also reviews suitability for transplant and discusses changing treatment if PD becomes less effective or problems arise. There is usually a route to contact the unit urgently if you become unwell.
- Lifelong clean technique at every exchange to reduce infection
- Ongoing exit-site care to keep the tube site healthy
- Regular blood tests and clinic reviews to monitor how well dialysis is working
- Managing related medicines for blood pressure, anaemia and bone health
- Following fluid, salt and dietary advice
- Ongoing discussion of transplant and other dialysis options
Repeat, follow-on and what comes next
- The catheter can become blocked or displaced and may need adjusting or replacing.
- Repeated or severe peritonitis can mean removing the tube and switching to another form of dialysis.
- The tummy lining can become less effective over years, requiring a change in prescription or treatment.
- Many people on PD eventually move to haemodialysis or receive a transplant.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Thorough training with refreshers and a clear clean technique
- A named contact and an urgent route for suspected infection
- Regular monitoring of how well dialysis is working, with prescription adjustments
- Proactive exit-site care and prompt treatment of infections
- Ongoing review of transplant suitability and other treatment options
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The type of PD (manual CAPD or machine-based APD) and the dialysis fluid prescription
- The operation to insert the catheter and any related imaging or anaesthetic
- Training provided by the home dialysis team
- Ongoing supplies, fluid deliveries and any home adaptations
- Regular clinic reviews, blood tests and treatment of complications such as infection
- Related medicines for blood pressure, anaemia, bone health and fluid balance
- Whether care is NHS-funded or, unusually, private, and exactly what is included
- The catheter insertion procedure, anaesthetic and facility fees
- Training and ongoing support from the home dialysis team
- Cost and arrangements for dialysis fluid, machine (for APD) and supply deliveries
- Clinic reviews, blood tests and how complications such as peritonitis are managed and charged
- Related medicines and dietetic support
- What happens, and who is responsible, if you need to switch to another form of dialysis
On the NHS? Peritoneal dialysis is a standard NHS treatment for kidney failure, with training and supplies provided; private dialysis provision is uncommon in the UK.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining that PD supports but does not cure the kidneys
- Underplaying the daily commitment and the importance of clean technique
- Not making clear what to do, urgently, if the fluid turns cloudy
- Failing to discuss transplant and other dialysis options alongside PD
- Not setting out that PD may need to change over time as the tummy lining tires
Marketing red flags
- Presenting any dialysis as a cure for kidney failure
- Downplaying infection risk or the need for strict technique
- Not discussing alternatives such as haemodialysis, transplant or conservative care
- Overstating how little a home dialysis routine will affect daily life
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Is PD a good fit for me given my health, home and lifestyle, compared with haemodialysis or transplant?
- What are your unit's peritonitis and infection rates, and how do you support good technique?
- What exactly should I do if my fluid is cloudy or I get tummy pain or fever?
- How will we know if PD is working well enough, and when might I need to change treatment?
- Am I suitable for a kidney transplant, and how does that fit with starting PD?
- What support is available if I struggle with the routine or have problems with the tube?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is peritoneal dialysis available on the NHS?
Does peritoneal dialysis cure kidney failure?
Is it painful?
Can I do it myself at home?
What is peritonitis and how serious is it?
Can I work and travel on PD?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Dialysis NHS — Dialysis: how it is performed UK Kidney Association — clinical guidelines (peritoneal dialysis) ISPD peritonitis guideline recommendations: 2022 update
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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