Peritoneal Dialysis (PD) at Home

The idea of performing peritoneal dialysis (PD) at home may make you feel anxious, but it is quite a manageable process. Almost everybody can perform peritoneal dialysis (PD) with proper training. This will usually require between 2 and 5 days of training, depending on what type of PD therapy you choose. 

Your clinician will schedule training for you that will include: 

• Setting up your treatment area 
• Caring for your catheter exit-site 
• Performing PD exchanges 
• Handwashing techniques to ensure safe handling of PD solutions 
• Storing and ordering supplies for treatment 
• Keeping manual treatment logs (if necessary) 
• Measuring your own blood pressure, pulse, temperature, and weight 
• Recognising and reporting problems with your treatment 
• Managing your diet and fluid intake 

You will not have to perform at-home peritoneal dialysis (PD) by yourself until you and your clinician feel that you are ready. Even after this, you will not be alone with your treatment – always remember that your healthcare team is ready to support you at any time. 

While performing peritoneal dialysis (PD) at home, you will still have regular appointments with your nursing team and will be able to ask questions about your treatment or about how to find other resources that can help. 

Based on a budget impact analysis, PD cost is about RM2508/month taking into account the situation in Malaysia that the Public Service Department and the Social Security Organization cover both APD and CAPD.¹ CAPD treatment supplies will include PD solution and disposable items; APD treatment supplies will include monthly machine rental, PD solution and disposable items. Both CAPD and APD have different costs and could be fully or partially subsidized based on your reimbursement entitlement. All the required items will be delivered to your home as per prescription by doctor.

Please consult your kidney care team to explore access to PD treatment including cost and subsidy. Your doctor or nurse may assess your financial need and suggest the next step to assist you in embarking on PD at home.

There are few agencies supporting kidney dialysis treatment, especially PD:²

1. Ministry of Health
2. Department of Public Service
3. Department of MAF Veteran Affairs
4. Ministry of Education
5. Ministry of Defense
6. Social Security Organisation
7. Zakat institutions

Some NGOs such as National Kidney Foundation, statutory corporations and employers may provide financial support for your dialysis treatment. You can speak about your condition to gain the support you need to cope and start PD therapy.

Slight discomfort during exchange 

Even though no needles are involved in the PD process, the dialysis solution inside your abdomen may sometimes cause discomfort during your exchanges. To relieve the discomfort, your clinician can suggest simple solutions such as the use of laxatives or by employing a drainage technique.

Some patients who are sensitive to the dialysis solution may also feel some stinging when the fluid enters the abdomen. To address this, your nephrologist may add sodium bicarbonate or lidocaine.³

Before starting dialysis, your clinician will discuss various ways to ensure your treatment is as comfortable as possible for you.

Weight gain 

Sugar molecules are present in the dialysate used during peritoneal dialysis, and some of them are absorbed by your body during dialysis. The absorbed sugar may cause weight gain in some PD patients. 

If you are concerned about gaining weight, you will need to keep track of what you eat and engage in regular exercise. You can consult your doctor for professional advice on how to maintain a sustainable diet and exercise routine. Avoid following any extreme diet to lose weight in a brief time as it may disrupt your body's metabolism and cause you to fall very ill. 

Bloating 

As peritoneal dialysis patients need to carry fluid in their peritoneal cavity throughout the day, you can have a noticeable abdominal bulge and may experience some bloating. The side effect of bloating may be more evident for patients who are prescribed higher fill volumes, as they will need to carry more fluid in their peritoneal cavity per exchange. Adhering to the daily fluid restriction recommended by your doctor can help to reduce the dialysate volume and make you feel less bloated when dialyzing.  

If the bloating persists, you can consult your doctor to modify your PD prescription. 

Peritonitis 

Peritonitis happens when your peritoneum, a thin layer of tissue that lines the inside of your abdomen, is infected, usually with bacteria or fungi. It is critical to practice proper hygiene during your dialysis treatment. These include washing hands before dialysis, wearing masks during treatments, applying antibiotic cream to the catheter exit site, and following other precautionary steps instructed by your doctor.  

Signs and symptoms of peritonitis can include: 

• Pain 
• Fever and chills 
• Cloudy dialysis fluid after draining 

Do consult your clinician immediately if you experience any of these symptoms. Early treatment of infection is vital. 

Antibiotic injections are usually used to treat peritonitis. If the infection becomes severe or recurrent, you may need to change to other dialysis options. 

Exit site infection

Exit site is the point on the abdomen where the PD catheter exits the skin. The exit site can get infected if you do not keep your exit site clean and dry. Therefore, you should always: 

• Practice proper change of dressing as taught by your clinician  
• Wash your hands thoroughly before exit site care 
• Keep your catheter taped securely 

Signs and symptoms of exit site infection can include: 

• Redness 
• Swelling 
• Presence of pus 
• Pain 

Do consult your clinician immediately if you experience any of these symptoms. Early treatment of infection is vital. 

Hernia  

A hernia occurs when an internal organ protrudes through the wall of the muscle or tissue that typically confines it. The presence of a lump in your abdomen is the most common symptom of a hernia. It is possible that the lump is painless and will only be noticed during a routine check-up. 

Peritoneal dialysis patients have a higher chance of getting a hernia. This is because keeping fluid in the peritoneal cavity for a long time can create a strain on the abdominal muscles.

Depending on each individual’s age, medical condition, and lifestyle habits, the life expectancy of dialysis patients can vary.  In some cases, patients have lived for well up to three decades while on dialysis, with an average life expectancy of 5-10 years.⁴