Five Tips for Working While on Peritoneal Dialysis

Dialysis can be a significant time commitment, with many people dialyzing for hours at a time, several times a week. It’s natural to wonder if you’ll be able to maintain your work on dialysis. Thankfully there are many different treatment options available, including peritoneal dialysis (PD).

Peritoneal dialysis (PD) is a flexible dialysis treatment option that allows you to dialyze at home and on the go. There are two kinds of PD available, automated peritoneal dialysis (APD), and continuous ambulatory peritoneal dialysis (CAPD). Both types of PD use the lining of your abdominal wall—your peritoneum—and a fluid called dialysate to filter toxins and excess fluids from your blood. Understanding the different types of PD can help you decide what will be best for your lifestyle.

APD uses a cycler machine and is usually done at night while you sleep. The cycler will pump dialysate fluid into your abdomen through a peritoneal dialysis (PD) catheter, where it stays—or “dwells”—for a set amount of time as prescribed by your doctor. When fluid is done dwelling, the cycler will pump it out. This process is called an exchange. Most people on APD will have three to four exchanges each night.

Unlike APD, CAPD doesn’t use a machine to do exchanges. Instead, you’ll attach a bag of dialysate to your PD catheter, then raise it to shoulder height and attach to an IV pole so that gravity pulls the fluid into your abdomen to dwell. This is called filling. Once the fluid is in your body, you can unhook your PD catheter from the IV pole and tubing and go about your day. After dwelling, you’ll drain the dialysate and dispose of it, then start the process of filling again. Filling and draining takes about 20 minutes and must be done in a clean environment. Each cycle is an exchange. Similar to APD, most people do three to four CAPD exchanges daily.

Since CAPD exchanges happen throughout the day, it’s likely you’ll need to do exchanges while working. You can perform your CAPD exchanges in any clean environment where you can shut doors and windows and prevent others from entering while completing your exchange. You’ll also need to carve out time to submit flowsheets to your care team.

APD is usually done at night, so be aware that you’ll need a little extra time in the morning to disconnect from your cycler and submit necessary treatment flowsheets to your care team. If your job requires an early start, be sure to plan your sleep schedule accordingly.

Both types of PD are done through a PD catheter. You’ll need a minor surgery to place the catheter. Most people on dialysis have their PD catheter placed in their lower abdomen. If your job requires frequent bending and lifting, such as working in a factory or as a mechanic, you may opt to have your PD catheter’s exit site in your chest instead.

Before you can start PD, you’ll need to train on how to do your daily exchanges on your own. Training takes about one week but is broken into different sections so you can go at your own pace. Plan to take some time off work and coordinate with your care team to create the best training experience. In addition to training, you’ll have one or two appointments with your care team per month.

Whether you choose APD or CAPD, it’s important to plan your day in advance to make sure you get the exchanges you need. Your social worker can help with accommodations, such as finding transportation to required medical appointments, or other needs that may arise. Make sure you have a plan for when and where you will do exchanges—throughout the workday with CAPD, or enough time to complete the nightly cycler exchanges with APD—to set yourself up for success.

Infections, especially in your peritoneal cavity or abdomen, can cause you to miss work. The best way to avoid infections is to prevent them. Inspect your access site daily and look for signs of redness, drainage, tenderness, or swelling. If you notice changes to your access site or your drained PD fluid is cloudy, be sure to alert your care team right away. Also be sure to keep your PD catheter close to your body and practice good hygiene. Wash your hands for 40–60 seconds and wear a mask before touching your PD catheter and keep your access site clean and dry. Your home dialysis nurse can also share resources on identifying infections.

Dialysis doesn’t have to define your life. PD is a convenient treatment option with a flexible schedule that allows you to maintain your lifestyle and continue to work. If you’re interested in working while on PD, be sure to talk to your care team.