Peritoneal Dialysis May Be Feasible, Safe Long-Term Treatment for Patients With CKD

Research published in Nephrology demonstrates that peritoneal dialysis may be a feasible and safe long-term renal replacement therapy (RRT) option for patients with chronic kidney disease (CKD) across the ascitic spectrum. Despite these findings, the authors noted that a broader consensus is needed to determine its expansion as a first-line therapy and to connect it to both palliation and transplantation.¹

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The number of patients who have end-stage kidney disease (ESKD) associated with chronic liver disease (CLD) and refractory chronic heart failure (CHF) and associated with advanced CKD complicated by ascites—or accumulating fluid in the peritoneal cavity—is growing, according to the investigators. Oftentimes, hemodialysis can be poorly tolerated, resulting in an increased hemodynamic instability, bleeding, and encephalopathy risks. This presents serious RRT challenges.¹

When treating CKD, it is significant for the disease to be managed properly, along with other comorbidities (eg, high blood pressure, immunoglobulin A nephropathy, diabetes). Additionally, treatment recommendations can vary depending on the patient’s stage of CKD; therefore, health care professionals will need to tailor treatment to each specific patient. Untreated or unmanaged CKD can result in other complications, including cardiovascular disease, high blood pressure, anemia, metabolic acidosis, and kidney failure.²

Peritoneal dialysis is a treatment for kidney failure that utilizes the patient’s lining of their abdomen to filter blood inside their body. A few weeks prior to treatment, a catheter is inserted in the belly. Treatment is initiated with a dialysis solution—that consists of water with salt and other additives—which flows from a bag and into the catheter. Once empty, the bag is disconnected and a cap is placed on the catheter, allowing patients to continue their usual routine and activities. After receiving training from a health care professional, patients are able to self-administer their peritoneal dialysis regimen.³

For these reasons, peritoneal dialysis has emerged as a promising alternative; however, its implementation and efficacy are not consistently supported by existing literature. Therefore, it lacks guideline consensus. The investigators of this review aimed to accurately map the current literature on peritoneal dialysis practice and outcomes within the CKD spectrum. A total of 18 observational studies were selected and evaluated.¹

Across the included studies, there were 627 patients who had ESKD with CLD or ascites and 222 patients with advanced CKD with CHF or ascites. The literature presented that practice patterns demonstrated a higher implementation of peritoneal dialysis for patients with CLD or ascites in Asian countries, suggesting a heavier regional peritoneal dialysis and viral hepatitis penetration. In Western settings, the usage of peritoneal dialysis was considered more unique and was seen more often in patients with CHF. Across different contexts, the treatment showed adaptability among diverse patient profiles.¹

When used as an urgent-start and incremental therapy, peritoneal dialysis enabled both long-term controlled paracentesis and dialysis while maintaining hemodynamic stability, optimal nutritional status, and—notably in CHF—improved symptom control, reduced hospitalizations, and lowered diuretic reliance. The investigators noted that mechanical complications were rare, and when they occurred, they were considered to be manageable, whereas peritonitis rates were comparable without impacting technique failure. Survival outcomes were also comparable or superior.¹

REFERENCES

1. Renaud CJ, Wong TM, and Hussein MSJ. Practice and Outcome Trends of Peritoneal Dialysis in Chronic Kidney Disease Patients With Liver Cirrhosis and Chronic Heart Failure Complicated by Symptomatic Ascites—A Scoping Review. Nephrology. 2025;30:e70013. doi:10.1111/nep.70013

2. National Kidney Foundation. Chronic Kidney Disease (CKD). Accessed March 28, 2025. https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd

3. National Institute of Diabetes and Digestive and Kidney Diseases. Peritoneal Dialysis. Accessed March 27, 2025. https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/peritoneal-dialysis