The current guideline recommendations from the National Kidney Foundation for suitable patients for PD are as follows:

Patients who cannot tolerate HD may include patients with congestive or ischemic heart disease, those with limited vascular options for access, and patients who cannot
be anticoagulated. Advantages of PD in patients with cardiovascular disease include better hemodynamic control, less acute hypokalemia, and better control of anemia. PD has even been proposed as a method of managing refractory heart failure in patients without renal failure. Another advantage to this mode of therapy is that a number of methods exist to accommodate patients’ schedules. The volumes, exchanges, and dwell times of the dialysate can all be varied. With these adjustments the balance of a patient’s volume and solute status can be fine-tuned while at home.

The vascular options for access may become limited over time after the use of multiple sites in the extremities. Even when suitable veins for fistula creation or target vessels for arteriovenous venous graft creation are present, coexistent central venous stenosis often dooms the access to ultimate failure. Prior to failure, a poorly functioning access will limit the efficiency of HD. The concurrence of arterial occlusive disease in the patient with end-stage renal disease (ESRD) limits the use of affected extremities given the often excessive risk of limb loss due to access-related arterial steal. Pediatric patients have smaller vessels; therefore functioning access can be difficult to achieve and maintain in this group. Patients less than 20 kg in weight are generally considered for PD due to the prohibitively small size of their vessels as well as the large extracorporeal blood volumes required for HD.

For a number of reasons, a patient may prefer to have dialysis at home. Remote locations, transportation limitations, or busy work schedules are all issues that can be resolved with home-based PD. Children are more easily able to attend school with the schedule of PD, particularly when automated peritoneal dialysis (APD) rather than CAPD is chosen, as the schedule of exchanges gives greater freedom during the day.

The decision to proceed with PD is a complex one that involves a thorough review of the patient and their home environment, social support, psychological and physical condition, as well as economic factors.

Based on current standard practice, a number of conditions may benefit from placement of a PD catheter:

Based on the National Kidney Foundation current guideline recommendations, the contraindications to PD include the following:

Since PD relies on the satisfactory function of the peritoneal membrane, a disturbance of this mechanism will limit the ability to receive effective dialysis. Measurement of Kt/Vurea is performed to assess adequacy. Previous abdominal surgery itself should
not be a contraindication for PD, as the formation of intra-abdominal adhesions is variable and unpredictable from one patient to another.

The ability to perform PD requires some degree of intellectual functioning to manage the procedure as well as troubleshoot problems as they arise. In addition, some degree of manual dexterity is required if a patient is to perform treatments independently. A patient who, based on evaluation of multiple psychosocial factors, is not likely to reliably perform PD, should not be placed on this dialysis modality without a reliable assistant.

A number of physical defects will limit the ability to perform PD, including surgically irreparable hernia, omphalocele, gastroschisis, diaphragmatic hernia, and bladder exstrophy. Acute worsening of these conditions can be expected to occur with the use of PD.

The increase in intra-abdominal pressure associated with PD will likely lead to the worsening of any structural defect or hernia, as well as the exacerbation of the symptoms of gastroesophageal reflux, chronic back pain, and other conditions.

The challenges of PD with morbid obesity include commercially available catheter lengths, providing adequate dialysate exchanges, difficulty with recognition of peritonitis, as well as worsening of hyperglycemia, hypertriglyceridemia, and weight gain.

Any recent intra-abdominal infection would naturally increase the chance for infectious complications related to PD. In addition, the existence of an intra-abdominal vascular foreign body, for example an aortoiliac bypass graft, would make PD a less attractive option, as the risk of prosthetic infection is associated with extremely high mortality rates.

PD is associated with protein loss which may be difficult to control, thus the patient with protein malnutrition may not tolerate PD. In addition, the dialysate solution uses glucose for osmosis, and absorption of glucose during PD may be difficult to control, particularly for the diabetic patient. Furthermore, hypertriglyceridemia occurs with PD, which again may be troublesome to manage.