Peritoneal Dialysis at Home: How It Works and Who It Suits

Hearing that you need dialysis is a lot to take in, and being asked about a type you may never have heard of can make it feel like a test. It is not. Federal kidney experts at NIDDK say each treatment has pros and cons, that the choice is yours to make with your care team, and that you can change treatments later if one does not suit you. This page gives you what you need to have that conversation.

Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, called the peritoneum, to filter your blood inside your body. A cleaning fluid called dialysis solution (dialysate) flows through a soft tube, the catheter, into your belly, soaks up wastes and extra fluid for a few hours, then drains out and is replaced with fresh fluid.

Each drain and refill is called an exchange, and the time the fluid stays in your belly is the dwell time. NIDDK says the exchange is repeated four to six times every day, by hand or by a machine at night. Between exchanges you cap the catheter, tuck it inside your clothes and go about your day. You should not feel pain. Some people feel full or bloated, and some need a larger clothing size, but NIDDK says most people look and feel normal with fluid inside.

Like all dialysis, PD is not a cure. It takes over part of the work your kidneys did, and it works only if you do every exchange as prescribed. The fluid contains a sugar (dextrose) or a compound called icodextrin, plus minerals, and comes in bags of 1.5 to 3 liters. Your doctor prescribes the strength you need.

Medicare names two main types of dialysis. Hemodialysis pumps your blood through a filter outside your body, and it can be done at a dialysis center or at home. Peritoneal dialysis filters your blood inside your body, and it is done at home. Here is how PD compares with the most common choice, hemodialysis at a center.

Hemodialysis can also be done at home, which NIDDK says may take training of 4.5 to 6 hours a day, 5 days a week, for 3 to 8 weeks, and means learning to place your own needles. Our guide to dialysis and kidney failure in Black patients covers in-center care in more depth.

The two kinds differ in two ways: when the exchanges happen, and whether a machine does them. If one does not suit you, NIDDK says to ask your doctor about trying the other.

Continuous ambulatory peritoneal dialysis (CAPD) needs no machine. You drain and refill by hand, and NIDDK says each exchange takes about 30 to 40 minutes. The fluid usually dwells for 4 to 6 hours or more, most people do four exchanges a day, and you sleep with fluid in your belly without waking up for an exchange. You can read, talk or watch TV during an exchange. The tradeoff: you have to stop what you are doing several times a day, every day of the week.

With automated peritoneal dialysis (APD), sometimes called continuous cycling PD or CCPD, you set up a machine called a cycler each evening. It fills and drains your belly three to five times during the night. MedlinePlus says you are connected to it for 10 to 12 hours. You wake up with fresh fluid in your belly, and some people need one extra exchange by hand in the afternoon. The tradeoffs: the tubing limits how much you move around at night, and you have to bring the machine when you travel or switch to hand exchanges.

Some people need a mix of both. NIDDK says that may apply if you weigh more than 175 pounds or if your peritoneum filters wastes slowly.

MedlinePlus says PD may be a good option if you want more independence and can learn to treat yourself, and that you or your caregivers will have to learn to do the treatment, use the equipment, keep track of supplies and prevent infection. NIDDK lists what people tend to like about it: more control over treatment, no need for a helper once you are trained, and the freedom to do it at home, at work or while traveling.

It may be harder if you have no clean, private space to do exchanges or nowhere to store boxes of fluid, if you know you would skip exchanges, or if you would rather have trained staff do the work. Some health issues get raised too. A 2022 review in Seminars in Dialysis found few absolute medical reasons not to do PD, but said older age, diabetes, obesity, polycystic kidney disease, heart failure, past belly surgery and a failed kidney transplant are sometimes treated as reasons against it, rightly or wrongly. None of those is an automatic no. If you are told PD is not for you, ask for the specific reason.

A surgeon places the catheter through a small cut, often below and a little to the side of your belly button. You get general or local anesthesia, and most people go home the same day, though some stay overnight. NIDDK says planning the surgery at least 3 weeks before your first exchange can improve success, because the catheter works better with 10 to 20 days to heal. NIDDK says the catheter stays in your belly for as long as you do PD.

NIDDK says you will work with a dialysis nurse for 1 to 2 weeks to learn exchanges and how to avoid infection, and that most people bring a family member or friend so someone else can help on a sick day. If you choose a cycler, you also learn to do exchanges by hand, for a power outage or an extra daytime exchange.

Your care team arranges for fluid and supplies such as surgical masks to be delivered to your home, NIDDK says, usually once a month. You will need a cool, clean, dry place to store the boxes, and a clean, well-lit spot for exchanges. Used fluid goes down a toilet or tub. Medicare's booklet says your dialysis facility is responsible for giving you all the home dialysis equipment and supplies that are medically necessary.

Ask about a backup plan. When Hurricane Helene damaged Baxter's North Cove plant in North Carolina in September 2024, the plant made about half of the U.S. supply of PD fluid, and USRDS reports that new PD starts for adults came to a near halt for the rest of 2024 and into early 2025 while fluid was saved for people already on PD.

NIDDK names three main problems: infection, hernia and weight gain. Infection is one of the most serious.

Exit-site infection. Redness, pus, swelling or tenderness where the catheter leaves your skin is a sign of infection there. It is treated with antibiotics. Washing your hands, wearing a mask while you connect, cleaning the exit site every day and checking each bag for cloudiness before you use it all lower the risk.

Hernia. The catheter opening and the weight of the fluid put pressure on your belly muscles. Tell your care team about any new swelling or lump in your belly or groin.

Weight gain and blood sugar. The longer fluid sits in your belly, the more sugar your body absorbs from it, which can add weight over time. A shorter dwell, a different schedule or help from your dietitian can limit it. If you have diabetes, ask how the fluid will affect your numbers.

Infections are less common than they used to be. USRDS reports that, among adults on PD with traditional Medicare, hospital stays for peritonitis fell from 14.6 to 10.5 per 100 person-years between 2014 and 2024. Switching is common too: of people who began PD in 2022 and 2023, 31% had moved to in-center hemodialysis within 2 years.

Yes, if you qualify. You can get Medicare at any age for kidney failure that needs regular dialysis, as long as you (or your spouse or a parent) have worked long enough under Social Security, the Railroad Retirement Board or as a government employee, or already get those benefits. You need both Part A and Part B to get full coverage. Sign up through Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

Medicare Part B covers home dialysis training for you and the person helping you (only at a Medicare-certified training facility), home dialysis equipment and supplies, certain home support visits from your dialysis facility, and most drugs for home dialysis. Medicare does not pay for paid aides to help with home dialysis or for pay you or your helper lose during training.

For most people on dialysis, Medicare starts on the first day of the fourth month of treatment. Start in July, and coverage begins October 1. Home training is the exception. Medicare can start in your first month of dialysis if you take part in a home dialysis training program at a Medicare-certified facility during your first 3 months, your doctor expects you to finish training and do your own treatments, and you keep up regular dialysis. If you complete home training, Medicare says coverage starts the month you begin regular dialysis, and services to prepare for dialysis, like access surgery, could then be covered.

Costs: in 2026, after the Part B deductible of $283, you pay 20% of the Medicare-approved amount for outpatient dialysis and for home dialysis training. Medigap, Medicaid, a Medicare Advantage plan, a job-based plan or a state kidney program may cover some of that. If you have a job-based plan, it pays first for the first 30 months of Medicare eligibility (the coordination period). A dialysis social worker or your State Health Insurance Assistance Program (SHIP) can walk you through your options.

Not on dialysis yet? If you have stage 4 kidney disease, Medicare Part B covers up to 6 kidney disease education sessions with a referral from your doctor. They cover PD, hemodialysis and transplant, so you can learn your options before you have to choose in a hurry.

The latest USRDS report, the federal kidney data system, shows the gap at the start of treatment: in 2024, 85.7% of Black people starting kidney failure treatment began with in-center hemodialysis, compared with 80.4% of White people. The 2024 figures were pulled down for everyone by the PD fluid shortage after Hurricane Helene. USRDS also reports that PD use is lowest in the Southeast, that home dialysis is least common among people with both Medicare and Medicaid, and that Black, Hispanic and Native American people generally had the lowest chance of what CMS calls an optimal start: a transplant before dialysis, dialysis at home, or in-center dialysis with a permanent access.

The gap continues after the start. A study of more than 160,000 people who began dialysis between 2007 and 2011 at one large dialysis company found every racial and ethnic minority group was less likely to be treated with home dialysis than White patients, and that Black patients on PD were more likely to move to in-center hemodialysis. USRDS reports the same pattern in recent years. It also shows that people starting PD have become less likely to be White over the past decade (56.4% in 2014, 47.7% in 2024), so the mix of who gets PD can change.

Medicare tried paying for change. From 2021, the ESRD Treatment Choices Model tied payments for about 30% of dialysis facilities and kidney care clinicians, in randomly selected regions of the country, to their home dialysis and transplant rates. A 2024 study in JAMA Health Forum found no rise in home dialysis or transplants in its first 2 years and no change in racial or economic gaps, and CMS ended the model as of December 31, 2025. Medicare's voluntary Kidney Care Choices models are ongoing, but you do not have to wait for your center to raise PD with you.

Copy these into your phone or print them for your next visit. Bring someone with you if you can.

1. Am I a candidate for peritoneal dialysis? If not, what is the specific reason, and could it change?
2. Which type would fit my life better, CAPD or a cycler at night?
3. Can I visit the home training unit and talk with someone who is on PD now?
4. How long will training take, and can a family member train with me?
5. When should my catheter be placed, and who does the surgery?
6. Where will I store supplies, and what if my home is small?
7. Who do I call at 2 a.m. if my fluid is cloudy or my belly hurts?
8. What is the backup plan if there is a power outage or a fluid shortage?
9. How will PD affect my blood pressure, diabetes or other conditions?
10. Will Medicare start sooner if I begin home training in my first 3 months?
11. Can you refer me for a kidney transplant evaluation now, and can I stay on PD while I wait?

That last question matters. NIDDK says people who get a donated kidney have a greater chance of living longer than those who stay on dialysis, and that a transplant center can put you on the waiting list once your kidney function is 20 or less, even before dialysis starts. Read our guide to the kidney transplant access gap for Black patients before that appointment. If you are still trying to make sense of your lab results, our guide to eGFR, creatinine and other kidney numbers explains them, and our guide to kidney disease, Black adults and APOL1 covers the gene variant many families ask about.

Most people get dialysis where their kidney doctor works, but Medicare says you have the right to choose another facility at any time, though that could mean changing doctors. To compare centers:

• Use our dialysis center finder, which lists Medicare-certified dialysis centers by state. Each center's page shows whether CMS lists it as offering peritoneal dialysis, in-center hemodialysis and home hemodialysis training, along with its CMS star rating and the share of its patients on the transplant waitlist.
• Use Medicare's own Care Compare dialysis facility search, which shows the types of dialysis each facility offers, quality ratings and patient survey results.
• Call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for help comparing facilities, or ask your local ESRD Network.

When you call a center, ask: "Do you train patients for peritoneal dialysis at home, and how soon could I start training?" If a facility will not take you as a patient, Medicare says you have the right to file a complaint.