The primary advantage of peritoneal dialysis (PD) is the extension of life. People whose kidneys no longer work can die within weeks without dialysis or a kidney transplant. Individuals may have a choice between peritoneal dialysis, which can be performed at home, and hemodialysis, which usually takes place in a clinic.

Some research has found PD to have certain advantages over hemodialysis:

• Higher quality of life. There is greater independence and freedom due to flexible scheduling.  
  
  
• Less-restrictive diet. Because PD does not have the two- and three-day buildup of wastes seen with hemodialysis, it allows more choices of food. The prescribed eating plan, though, must still be followed.
  
  
• Increased ability to stay in the workforce. Studies have shown people using peritoneal dialysis are more likely to remain employed than those using hemodialysis.
  
  
• Lower expense. Peritoneal dialysis costs thousands of dollars less a year.

However, some research has found that people on hemodialysis tend to live longer than those using PD. In addition, some dialysis patients are not candidates for PD. Several factors may prevent patients from carrying out peritoneal dialysis, such as:

• Abdominal scarring (peritoneal sclerosis)
• Inadequate eyesight due to diabetic retinopathy, glaucoma or other conditions
• Confusion
• Inability to follow infection-control procedures
• Danger of hyperglycemia (high blood glucose)

Peritoneal dialysis carries its own risks as well as some it has in common with hemodialysis. Potential risks of PD include:

• Peritonitis. Infection and inflammation of the peritoneum. A major risk of peritoneal dialysis, peritonitis has symptoms including stomach pain, fever and a cloudy dialysis bag. Keeping the area around the catheter clean and following the peritoneal dialysis procedures are essential to prevent this painful complication, which needs prompt medical attention and can require hospitalization. Peritonitis is treated with antibiotics.
  
  
• Peritoneal sclerosis. Scarring or adhesions of the peritoneum, such as from surgery. This can reduce or end the abdominal membrane’s ability to filter out wastes. Longtime use of peritoneal dialysis can thicken the membrane. Peritoneal sclerosis is the main reason people on peritoneal dialysis must sometimes switch to hemodialysis.
  
  
• Hyperglycemia. Because peritoneal dialysis involves long dwell times in which the body can draw glucose from the dialysate (dialysis solution), high blood glucose can result. The physician can adjust the prescribed formula, but some people with diabetes might not have peritoneal dialysis as an option. Researchers are working on nonglucose PD dialysates.
  
  
• Hyperosmolar hyperglycemic nonketonic syndrome (HHNS). A condition involving severe hyperglycemia and dehydration. If HHNS goes untreated, seizures, diabetic coma and death can follow.
  
  
• Noncompliance.  The individual’s failure to carry out all prescribed exchanges. Noncompliance is a major problem with peritoneal dialysis, according to the National Institutes of Health (NIH). Risk of hospitalization and death increase when treatments are skipped.
  
  
• Underdialysis. Inadequate use of the treatment. Research shows that many PD patients might not be getting enough dialysis to prevent undesired weight loss, nausea, serious medical complications and even premature death, according to the American Association of Kidney Patients.
  
  
• Weight gain. The PD solution contains glucose to chemically bond with the body’s wastes. The extra calories in the sugar can add unwanted pounds and the associated health risks of obesity.

Other risks of peritoneal dialysis reflect the risks of dialysis in general. These include:

• Bacterial infections
  
  
• Blood clotting
  
  
• Renal osteodystrophy (bones weakened by kidney disease), a condition with some similarities to osteoporosis
  
  
• Amyloidosis (accumulation of protein in the organs and tissues)
  
  
• Anemia
  
  
• Abnormal heart rhythm (arrhythmia)
  
  
• High blood pressure (hypertension)
  
  
• Itching (pruritus)
  
  
• Sleep disorders