Peritoneal dialysis (PD) uses the inside lining of your child’s abdomen (the peritoneum) to clean their blood inside their body. A special fluid called dialysate is sent from a bag into your child’s abdomen through a catheter. Dialysate is made up of water, salts and other additives. The dialysate absorbs waste, extra salts and water from your child’s body. It is then drained out of their body, taking the waste, extra salts and water with it.

How often will my child have peritoneal dialysis?

Most children have peritoneal dialysis every day. Your healthcare team will discuss the right treatment schedule for your child. Although children are connected to the machine, they can read, do school work, play with toys or sleep while they are having dialysis.

Where will my child have peritoneal dialysis?

Most of the time, peritoneal dialysis is done at home. It can also be done in other places, such as school or other family members’ homes. You will be trained how to manage your child’s dialysis at home and a team of healthcare professionals will be available to call if you have any questions or problems. If your child is old enough, they will also be shown what to do.

You will be provided with all of the equipment and supplies you need. This includes bags of special fluid, medicines and cleaning equipment.

What needs to happen before my child can start peritoneal dialysis?

Your child will need a procedure to place a peritoneal dialysis catheter (PD catheter) into their abdomen. The PD catheter is a soft, plastic tube that is about 30–40 cm long. Part of it sits inside your child’s abdomen, and part of it outside. The catheter is soft and should feel comfortable.

The place where the catheter comes out of the skin is called the exit site. It needs to be kept clean to avoid infection.

The PD catheter should ideally be placed several weeks before dialysis starts, to give it time to heal.

What happens during peritoneal dialysis?

• A special fluid called dialysate is sent from a bag into your child’s abdomen through their catheter. Dialysate is made up of water, salts and other additives.
• The dialysate absorbs waste, extra salts and water from your child’s body. It is then drained out of their body, taking the waste, extra salts and water with it.
• Each time your child uses a bag of dialysate and then drains it out is called an exchange. Each exchange takes around 30 to 40 minutes.

There are two main ways of doing peritoneal dialysis

Continuous ambulatory peritoneal dialysis (CAPD) - exchanges usually take place four times a day, which you or your child will need to do.

Automated peritoneal dialysis (APD) - a machine does your child’s exchanges overnight while they sleep. Your child will normally have between 3 and 5 exchanges a night over 9-12 hours.

Your kidney team will talk to you about which way of having peritoneal dialysis would work best for you and your child.

Will my child need any other medication while on peritoneal dialysis?

Your child will need to take laxatives to soften their poo. This will help their dialysis to work well and avoid your child becoming constipated.

Your child may also need to take vitamin tablets because dialysis can remove some vitamins from the body. They might also be given a water tablet to help them wee.

Are there any risks or side effects to peritoneal dialysis?

Your child’s healthcare team will train you how to manage peritoneal dialysis and care for your child at home. They will also give you information about what to look for, so any complications can be treated quickly.

Poor drainage

One common complication is when fluid (liquid) does not properly drain out of the peritoneal cavity. This may happen for different reasons.

• The catheter may become kinked or blocked, if your child lies on it (for example, rolling over at night). This can usually be easily corrected.
• Blood or fibrin (a protein) from the body can get stuck in or around the catheter. A medicine called heparin can be added to the dialysate (dialysis fluid) to help prevent this.
• Occasionally, the poor drainage keeps happening. This may be because the catheter gets displaced, or omentum (a fold of tissue in the abdomen) gets wrapped around the catheter. The catheter will usually need to be replaced if this occurs. Some children who have previously had surgery in their abdomen may have adhesions (internal scar tissue). If this happens, peritoneal dialysis may need to be stopped, and haemodialysis considered as an alternative.

Other risks

• Infections due to germs entering the body, especially peritonitis, which is an infection of the peritoneum. Keeping the exit site clean will reduce the risk. Most infections can be treated with antibiotic medicines, which kill the germs. If the infection is more serious, the catheter will need to be removed, and a new catheter placed after the infection is gone.
• Hernias happen when an internal part of the body pushes through the wall around it and a lump in the tummy or groin can be seen.

Side effects

When your child first starts peritoneal dialysis they may feel bloated. Most children quickly get used to this but if it remains a problem, the amount of fluid drained into their abdomen can be reduced.

Some children feel 'drain pain' when the fluid is draining out of their body or towards the end of the drain. Tell your child’s dialysis team if this happens so that they can make changes to your child’s treatment.

For more information see Peritoneal dialysis (PD) | Kidney Care UK

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