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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Peritoneal dialysis

In short

Peritoneal dialysis (PD) uses the lining of your belly as a filter. Fluid goes in through a soft tube (catheter), stays for some hours to draw out waste and water, and is then drained out (NIDDK). You do it at home, by hand during the day (CAPD) or with a machine at night (APD). The biggest risk is an infection of the belly lining, peritonitis: cloudy fluid, belly pain or fever means call your PD unit the same day and keep the bag (ISPD 2022). The sugar in PD fluid is absorbed, which adds calories and raises glucose (DaVita; NIDDK), so your diabetes plan needs review.

Your numbers

Starting points, not your prescription

These numbers are typical starting points from guidelines. Your nephrologist, diabetes team and renal dietitian set your own numbers from your blood tests, urine output and medicines, and change them as your labs change. If your lab report or your team says something different, they win.

What Typical number Source
CAPD at least 4 exchanges a day, about 30–40 minutes each; fluid stays in for 4–6 hours or more NIDDK
APD a cycler fills and drains 3–5 times during the night NIDDK
Training 1–2 weeks with a PD nurse NIDDK
Protein 1.0–1.2 g/kg a day (70–84 g at 70 kg), because protein is lost in the fluid KDOQI 2020; KDIGO 2022, practice point 3.1.2; DaVita
Calories from the fluid often 400 or more a day DaVita
Potassium often 3,000–4,000 mg a day; some people need more because their level runs low; the app starts at 3,500 mg DaVita
Phosphorus low, with binders at meals if prescribed; the app starts at 1,000 mg DaVita
Sodium the app starts at under 2,000 mg; some PD units allow more because PD removes sodium well KDIGO 2024; DaVita
Fluid often 2–3 L a day, depending on the urine you still make; the app starts at 2,000 mL DaVita

Tests to expect

Test How often
Calcium and phosphate every 1–3 months
PTH every 3–6 months
Hemoglobin and iron about every 3 months
Dialysis clearance (Kt/V), blood pressure, fluid and nutrition at clinic visits

There is no single clearance number that proves PD is enough. If your symptoms, nutrition and fluid are all controlled, the prescription does not need changing just to reach a clearance target, and a weekly Kt/V above 1.7 has shown no survival advantage (ISPD 2020). Sources for the table: KDIGO 2017; KDIGO 2026 anemia. See Dialysis adequacy.

What changes now

Your PD prescription is built around your goals. ISPD asks teams to agree realistic goals with you, to keep you feeling well and living your life, and to check blood pressure, fluid, nutrition and how you feel, not only lab numbers (ISPD 2020).

Preventing peritonitis.

  • Wash your hands every time you touch the catheter, and wear a mask during exchanges (NIDDK).
  • Clean the exit site every day, as your team showed you (NIDDK).
  • Ask for your technique to be checked again from time to time: ISPD recommends regular retraining (ISPD 2022).
  • If you have pets, ask your unit which extra precautions to take: ISPD recommends them (ISPD 2022).
  • Tell your PD unit before a colonoscopy or a gynecology procedure: ISPD suggests antibiotics beforehand (ISPD 2022).
  • Low blood potassium may raise the risk of peritonitis, so do not cut potassium unless your blood test says so (ISPD 2022).

Food. Protein goes up, because protein is lost in the fluid (DaVita). Potassium is often less limited than on hemodialysis. Phosphorus stays low, which is harder with more protein (DaVita). Choose fresh rather than processed meat: phosphate additives are almost fully absorbed (KDOQI 2020; Phosphate additives).

Diabetes. The longer the fluid stays in, the more sugar (dextrose) your body absorbs (NIDDK). That is often 400 calories or more a day (DaVita). Glucose patterns change when PD starts and when your prescription changes, and sugar-based fluids can mean you need more insulin, so tell your diabetes team every change. UK guidance asks for a specialist diabetes team to be involved for people with type 1 diabetes on PD (JBDS 2022, recommendations 6.6 and 6.10). A1c is less reliable on dialysis (KDIGO 2022, practice point 2.1.2); CGM data help (ADA–KDIGO 2022).

Icodextrin (Extraneal) and glucose meters

Icodextrin, a PD fluid used for one long dwell a day, makes some glucose meters read falsely high: meters and strips using GDH-PQQ, GDO and some GDH-FAD methods. False highs have led to lows being missed and to insulin being given wrongly, which can cause coma and death. Use only a glucose-specific meter your PD unit approves. The false readings can last up to two weeks after stopping icodextrin, and CGM systems "may or may not be compatible" (Extraneal label; MHRA; JBDS 2022, 6.4). Tell every hospital and paramedic that you use it.

What to do

  • Look at every drained bag. Cloudy? Call the unit the same day and bring the bag.
  • Clean the exit site daily and look for redness, pus or tenderness.
  • Check which glucose meter you have. If you use icodextrin, make sure it is glucose-specific.
  • Ask your diabetes team to review your insulin plan when PD starts and whenever the prescription changes. Do not change it yourself.
  • Weigh yourself daily; sugar from the fluid can add weight over time (NIDDK).
  • Eat protein at each meal, and take binders with meals if prescribed.
  • Ask your nurse what to do if the fluid drains slowly or you are constipated.
  • Keep a 5–7 day supply of PD supplies, as your unit directs. On APD, learn manual CAPD for power cuts (CMS).
  • Enter PD as your treatment in the app so it uses PD targets (First setup).

Examples

An exchange day on CAPD. For example: 7 a.m., noon, 5 p.m. and 10 p.m., each taking 30–40 minutes, with the night bag staying in while you sleep (NIDDK). Your unit sets your own times and fluids.

Calories you did not eat. A 70 kg person's starting energy target is about 2,100 kcal a day. If 400 kcal comes from the fluid, that is about one-fifth of the day. That is why weight can creep up, and why glucose can rise without a change in food (DaVita).

A protein top-up. Going from 56 g to 70–84 g a day means 14–28 g more. One large egg has about 6 g and 2 oz of roast chicken breast about 18 g (USDA).

A cloudy bag at 11 p.m. Call the PD unit's out-of-hours number now. Keep the bag for testing. ISPD says cloudy fluid should be treated as peritonitis until proven otherwise (ISPD 2022).

Ask your care team

  1. CAPD or APD: which fits my life and my urine output?
  2. What is my fluid allowance, and what weight gain should make me call?
  3. Do I need a potassium limit, or should I eat more potassium?
  4. Which glucose meter and CGM are safe with my PD fluids?
  5. How should my insulin plan change on PD? Can I have it in writing?
  6. What should I do if my fluid drains slowly?

Get help now if…

Call 911 (or your local emergency number)

Chest pain; severe breathlessness or not being able to lie flat; fainting; new confusion; a low the person cannot treat themselves (give glucagon, then call) (ADA 2026 §6); possible DKA: blood ketones of 3.0 mmol/L or more, or any ketones with vomiting, deep fast breathing or fruity breath. On dialysis these signs count even under 3.0 (2024 consensus). Full list: Get help now.

Call your PD unit the same day

Cloudy fluid, belly pain or fever: keep the bag (ISPD 2022). Also redness, pus or pain at the exit site; a new lump or swelling in the groin or belly (NIDDK); fluid that will not drain; weight gain or swelling above your limit.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.