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Peritoneal dialysis requires the surgical placement of a plastic catheter into the abdomen to create an access. The most common type is called a Tenckhoff catheter. The peritoneal cavity is the space in the abdomen that houses the organs and is lined by two special membrane layers called the peritoneum. During the dialysis treatment, the peritoneal cavity is slowly filled with a fluid called dialysate through the catheter. The dialysate is a solution comprised of a known amount of a glucose dissolved in water. The strength of this solution determines the osmotic gradient, and , therefore, the amount of water that diffuses out of the bloodstream. Common strengths of glucose are 0.5%, 1.5%, 2.5% and 4.25%.The dialysate fluid absorbs the water and waste products and toxins through the peritoneum. The fluid is then drained from the abdomen, measured, and discarded. The length of time that the dialysate is left in the peritoneal cavity is determined by the physician.

There are several kinds of peritoneal dialysis but the two major ones are: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD).

• Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines and is the most common type of peritoneal dialysis. CAPD can be performed at home and/or at work. Dialysate is instilled into the peritoneal cavity through the catheter. The dialysate remains for several hours (called the "dwell", during which time the person can perform their normal activities at work, school, or home) before it is drained back into the bag and discarded. This is called an exchange or pass. CAPD usually involves four daily exchanges of 2-2.5 liters in 4-8 hours durations.

• Continuous Cycling Peritoneal Dialysis (CCPD) usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2 hours and exchanges are done throughout the night during sleep.

Possible complications of peritoneal dialysis include an infection of the peritoneum (peritonitis), hernias, fluid leaks, constipation, dislodgement of the catheter, and weight gain.

In the event that renal function continues to worsen, peritoneal dialysis may eventually become less effective, requiring increasing exchanges and differing types and amount of solution to achieve adequate removal of fluids and wastes. Hemodialysis may eventually become necessary. A switch to hemodialysis may also become necessary in the event of peritoneal infection, catheter malfunction, or inability of the person to adequately perform the peritoneal dialysis procedure.

Occasionally, a combination of peritoneal and hemodialysis can be used (complementary dialysis therapy). This usually entails performing peritoneal dialysis 6 days per week, then undergoing hemodialysis once weekly to ensure adequate removal of remaining fluid and wastes.

Kidney Transplantation

A kidney transplant is a surgical procedure to implant a healthy kidney into a patient with kidney failure. Kidney transplants are second only to corneal transplant as the most common transplant operation in the United States. There are over 9,000 kidney transplants performed each year.