Peritoneal Dialysis in the Modern Era: A Comprehensive Review of Clinical Practice, Evolving Challenges, and Technological Advancements

Elmukhtar Habas¹, Amnna Rayani², Ala Habas³, Khaled Alarbi⁴, Aml Habas⁵, Mohamed Baghi⁴, Eshrak Habas⁶, Almehdi Errayes⁷

Keywords: Peritoneal dialysis, ESKD, biocompatible dialysis fluids, PD complications, wearableartificial kidney, infection prevention in PD, peritoneal membrane fibrosis

DOI: 10.63475/yjm.v5i1.0345

DOI URL: https://doi.org/10.63475/yjm.v5i1.0345

Publish Date: 30-04-2026

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Pages: 57 - 76

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Author Affiliation:

1 Professor, Senior Consultant, Department of Medicine, Hamad General Hospital, Doha, Qatar
2 Professor, Department of Pediatrics, University of Tripoli, Tripoli, Libya
3 Resident, Department of Medicine, Tripoli Central Hospital, University of Tripoli, Tripoli, Libya
4 Associate Consultant, Department of Medicine, Hamad General Hospital, Doha, Qatar
5 Specialist, Department of Pediatrics, Open Libyan University, Tripoli, Libya
6 Specialist, Department of Radiology, Tripoli University Hospital, University of Tripoli, Tripoli, Libya
7 Senior Consultant, Department of Medicine, Hamad General Hospital, Doha, Qatar

Abstract

Peritoneal dialysis (PD) is a recognized renal replacement therapy (RRT) for individuals withend-stage kidney disease (ESKD), leveraging the peritoneal membrane’s ability to clear toxins and excess fluid efficiently. Since its clinical adoption in 1959, the percentage has increasedfrom approximately 12% in the United States to 73.6% in Hong Kong. PD has undergone substantial developments, including refined catheter placement techniques and effective fluid ultrafiltration, thereby increasing its accessibility and enhancing patient quality of life. PD is particularly suitable for individuals with challenging vascular access or those who want homebased treatment options. However, its benefits must be weighed against contraindications, which include current infections and insufficient patient support, which must be carefully evaluated. Frequent complications include infections such as peritonitis, catheter-associated problems, fluid overload, and metabolic disturbances. This review presents a comprehensive examination of peritoneal anatomy and physiology, indications and contraindications for PD, associated difficulties, and new advancements in biocompatible PD solutions, wearable artificial kidneys, and infection prevention methodologies. Despite advancements in treatment choices, obstacles remain in patient selection, technique survival, and psychosocial support, contributing to PD’s global underutilization (e.g., approximately 12% in the United States to 73.6% in Hong Kong). Future efforts must prioritize adopting biocompatible solutions, integrating AI and wearable technologies, and implementing personalized strategies to enhance technique survival and global accessibility.

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