Peritoneal Dialysis at Home: CAPD vs. APD - What You Need to Know

Peritoneal Dialysis at Home: CAPD vs. APD - What You Need to Know

If you’re living with kidney failure, dialysis isn’t just a medical procedure-it’s a daily reality. For many, choosing peritoneal dialysis at home means regaining control over your schedule, your body, and your life. But not all home dialysis is the same. Two main options exist: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). One doesn’t need a machine. The other runs while you sleep. Which one fits your life? The answer isn’t one-size-fits-all.

Peritoneal dialysis uses the lining of your abdomen-the peritoneum-as a natural filter. A soft tube, called a catheter, is placed in your belly during a simple surgery. Dialysis fluid flows in, pulls out waste and extra fluid, then drains out. It’s clean, quiet, and done mostly at home. Unlike hemodialysis, which requires trips to a clinic three times a week, peritoneal dialysis lets you manage your treatment on your terms. But the way you do it makes all the difference.

CAPD: Manual Exchanges, Total Freedom

CAPD has been around since the 1970s. It’s simple: you do 3 to 5 fluid exchanges every day, using gravity. No machine. No electricity. Just bags of dialysis solution, a clean space, and your hands. Each exchange takes about 30 to 40 minutes. You drain the old fluid, fill your belly with fresh fluid, and let it sit for 4 to 6 hours before draining again. You can do it anywhere-at home, at work, even while traveling.

People who choose CAPD often say it gives them the most flexibility. A teacher might do an exchange during planning period. A retiree might do theirs after breakfast. You carry your bags in a small backpack-usually 4 to 6 pounds total per exchange. No setup. No alarms. No power outlets needed. That’s why CAPD is still the top choice for older adults, especially those over 75, and for people in areas with unreliable electricity.

But it’s not without trade-offs. Doing exchanges manually means your day is broken up. You can’t just forget about it. If you miss an exchange, fluid and waste build up. And because you’re handling the tubing and bags multiple times a day, the risk of infection-specifically peritonitis-is higher. USRDS data shows CAPD users average 0.68 infections per year, compared to 0.52 for APD users. Poor hand hygiene or a dusty room can lead to trouble. Training takes 10 to 14 days, and you have to be comfortable with fine motor skills. If your hands shake, or you have arthritis, CAPD can become a burden.

APD: Let the Machine Work While You Sleep

APD, introduced in the 1980s and widely used since the 1990s, flips the script. Instead of doing exchanges during the day, you hook up to a small machine-called a cycler-before bed. It runs automatically for 8 to 10 hours while you sleep, doing 8 to 12 exchanges on its own. You wake up with your belly drained and your blood cleaned. No daytime interruptions.

This is why APD is so popular with working adults, parents, and people who want to sleep through the night without being woken up by dialysis. Mayo Clinic data shows APD users get an average of 3.2 more hours of sleep per night than CAPD users. Better sleep means better energy, better mood, and fewer crashes during the day.

The machines are compact-about the size of a small suitcase, weighing 15 to 25 pounds. Brands like Baxter Amia, Fresenius Sleep-Safe, and HomeChoice are common. They come with safety features: air bubble detectors, pressure sensors, and even ultraviolet disinfection to reduce contamination. Some newer models, like the Baxter Amia with Balance® software, use AI to adjust fluid removal based on your daily weight and blood pressure. In clinical trials, that cut fluid overload events by 31%.

But APD isn’t magic. You need electricity. You need space. You need to set up the machine every night and disconnect in the morning. If the power goes out, or the machine glitches-which happens in about 12% of users per year-you’re stuck. One ER nurse on a patient forum said she had three cycler malfunctions in two years, each requiring an emergency service call. And while APD reduces manual errors, it introduces new ones: forgetting to connect the lines, misloading the fluid bags, or not cleaning the machine properly.

Costs, Coverage, and Hidden Expenses

Medicare covers 80% of home dialysis costs in the U.S. The rest? That’s where things get tricky.

CAPD supplies-bags, tubing, disinfectant-cost about $50 to $75 a month out of pocket. APD? You’re looking at $75 to $100 monthly, because you’re renting the cycler. That rental fee adds up. Some insurance plans cover it fully. Others don’t. And if you live in a rural area, getting a technician to fix a broken cycler might mean a two-hour drive.

But here’s the twist: APD might save you money long-term. Better fluid control means fewer hospital visits for high blood pressure, heart strain, or lung fluid. Medicare claims data shows APD users have 18% fewer hospitalizations for fluid-related issues. That’s a real savings-both for you and the system.

Also, APD users often need fewer phosphate binders and blood pressure meds. One 2021 study found APD cut long-term medication costs by 15 to 20%. That’s not just about money-it’s about fewer pills, fewer side effects, and simpler routines.

Who Benefits Most from Each Option?

There’s no “better” option. Only the right one for you.

CAPD is ideal if:

• You’re over 65 and prefer simple, no-tech routines
• You travel often or live somewhere with unreliable power
• You have good hand coordination and don’t mind daily interruptions
• You want to avoid machine noise or dependence on electronics

APD is ideal if:

• You work, go to school, or care for kids during the day
• You value uninterrupted sleep and consistent fluid removal
• You have reliable electricity and space for a small machine
• You’re comfortable learning tech-based systems and troubleshooting minor issues

There are exceptions. Some older adults with dementia do better on APD because they can’t remember manual exchanges. Some younger people with hand tremors can’t manage CAPD but handle APD fine. The key isn’t age-it’s your lifestyle, your body, and your support system.

Training, Space, and Daily Life

Both modalities require training. CAPD training takes 10 to 14 days. You learn sterile technique, how to hang bags, how to spot infection signs, and how to handle emergencies. APD training is longer-14 to 21 days-because you also learn how to operate the cycler, change tubing, reset alarms, and manage power failures.

You’ll need storage space. For CAPD, a 4x4 foot closet for dialysis supplies is enough. For APD, you need that same space, plus a dedicated outlet, and room for the machine. Noise isn’t a dealbreaker-cyclers run at 35 to 45 decibels, like a quiet library-but if you’re a light sleeper, it can take time to adjust. Some users use white noise machines or earplugs.

Support matters. APD programs now offer 24/7 technical help. CAPD programs usually don’t. And here’s something new: 78% of APD systems now connect remotely to your care team. If your fluid levels drop too low or your catheter gets blocked, your nurse gets an alert before you even feel sick. That’s saved lives.

What the Experts Say

Dr. Michael J. Germain, a nephrologist and former president of the American Society of Nephrology, says CAPD remains the gold standard for patients over 75. “It’s simple. No machines. No tech to fail. For someone with memory issues or limited mobility, it’s the safest bet.”

But Dr. Beth Piraino from UPMC argues the opposite: “We should offer APD first to anyone under 65. The technology is reliable now. The benefits in sleep, energy, and hospital avoidance are too big to ignore.”

And there’s a warning from Dr. Rajnish Mehrotra: “Pushing home dialysis without support infrastructure hurts the most vulnerable. Not everyone has a quiet room, a working outlet, or someone to help them set up a machine.”

The American Society of Nephrology’s 2023 guidelines say it plainly: individualize the choice. Don’t assume. Don’t default. Test your dexterity. Ask about your sleep. Consider your job. Talk about your fears.

The Future of Home Dialysis

APD adoption is growing. In 2023, it made up 55% of home peritoneal dialysis. By 2030, experts predict it’ll be 65%. Why? Because the machines are getting smarter. New models can adjust prescriptions automatically. Some can be controlled via smartphone. The FDA is reviewing the first smartphone-connected cycler-expected in 2025-which could reduce setup errors by 40%.

Meanwhile, CAPD isn’t disappearing. It’s still vital for low-resource settings, elderly patients, and those who simply don’t want to rely on electronics. The next big thing? Wearable artificial kidneys. UCSF is already in Phase II trials. That could blur the line between CAPD and hemodialysis entirely.

But for now, the choice is yours. And it’s not just about medical outcomes. It’s about your life. Can you handle a daily routine that breaks your day? Or do you want to wake up clean, without a single exchange behind you?

Frequently Asked Questions