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

Peritoneal dialysis lets you treat kidney failure at home - no hospital visits needed

If you’re living with kidney failure, dialysis isn’t just a medical procedure - it’s a lifestyle. And for many, doing it at home changes everything. Two main types of peritoneal dialysis (PD) are used this way: CAPD (Continuous Ambulatory Peritoneal Dialysis) and APD (Automated Peritoneal Dialysis). Both use your abdominal lining to clean your blood, but how you do it, when you do it, and what you need to make it work are totally different.

There’s no one-size-fits-all answer. Choosing between CAPD and APD depends on your daily routine, your health, your home setup, and even how you sleep. Let’s break down what each one really means in practice - not just the clinical details, but the real-life trade-offs.

CAPD: Do it yourself, anytime, anywhere

CAPD doesn’t need a machine. You do the exchanges manually - usually 3 to 5 times a day, every day. Each exchange takes about 30 to 40 minutes. You drain the old fluid out of your belly, then fill it with fresh dialysis solution using gravity. You can do it sitting, standing, or even lying down. No electricity. No noise. Just clean hands, a clean space, and the right supplies.

People who choose CAPD often say it gives them freedom. You can swap bags during your lunch break, while watching TV, or before bed. One teacher in Wisconsin did his exchanges during planning periods between classes. A retired nurse in Florida does hers while walking her dog. The flexibility is real.

But that freedom comes with a cost. You’re carrying around 4 to 6 pounds of fluid bags every day. You have to be careful not to contaminate the tubing. One small mistake - a dirty surface, a missed handwash - can lead to peritonitis, a serious belly infection. About 0.68 episodes happen per patient per year with CAPD, according to U.S. data. That’s higher than APD.

Training takes 10 to 14 days. You learn sterile technique, how to connect the bags, how to spot signs of infection, and how to handle problems like slow drainage. It’s not hard, but it’s repetitive. And if your hands shake from arthritis or nerve damage, it can be tough.

APD: Let the machine work while you sleep

APD uses a small machine - a cycler - that does the exchanges for you, usually overnight while you sleep. You hook up to the machine before bed, and it automatically fills your belly with fluid, lets it sit, then drains it out. Most people get 8 to 10 hours of treatment while they’re dreaming.

The big win? You’re free during the day. No more stopping your day for dialysis. An ER nurse in Ohio told her story on a patient forum: “I work 12-hour shifts. With APD, I sleep, I work, I live. The machine handles it.”

Modern cyclers like the Baxter Amia or Fresenius Sleep-Safe are quiet - about 35 to 45 decibels, like a library. They have safety features: air bubble detectors, pressure sensors, and even remote monitoring. Your clinic can see if something’s wrong while you’re asleep.

But APD has its own challenges. You need electricity. You need space - about 2x2 feet for the machine. You need to set it up every night and take it apart every morning. If the machine breaks - and about 12% do each year - you’re stuck. You might need emergency service calls. Some people say the noise still wakes them up, even if it’s quiet.

Training takes longer - 14 to 21 days. You learn how to connect tubing, troubleshoot error codes, replace parts, and handle power outages. If you’re not tech-savvy, it can feel overwhelming. But for many, the trade-off is worth it.

Who does better with CAPD?

CAPD is often the go-to for older adults - especially those over 75. Why? Simplicity. No machines to fix. No power to worry about. If you have trouble remembering complex routines, CAPD’s manual steps are easier to stick with.

It’s also better if you have good residual kidney function - meaning your kidneys still do a little work. CAPD’s constant, gentle filtering works well with that. People with diabetes or heart issues also benefit because CAPD removes fluid slowly, which is easier on the heart than the sudden shifts from in-center hemodialysis.

And if you travel a lot? CAPD wins. You can pack your supplies in a cooler. Do exchanges in hotel rooms, airport bathrooms, or even in a car if you have to. No need to find an outlet. No need to explain your machine to strangers.

But CAPD isn’t ideal if you have limited hand strength, tremors, or vision problems. If you’re living alone and can’t ask for help, the risk of infection rises.

Who does better with APD?

APD shines for working adults, especially those between 18 and 64. It fits into a schedule. You don’t miss work. You don’t interrupt your day. You don’t have to carry bags around.

It’s also better for fluid control. Studies show APD users have 22% fewer episodes of dangerous fluid overload - which means fewer hospital trips for heart strain or lung issues. It’s also linked to better blood pressure control and lower phosphorus levels, which reduces the need for extra medications.

And here’s something surprising: APD users sleep an average of 3.2 hours more per night than CAPD users. Why? Because they’re not waking up to do exchanges. They’re not stressed about timing their day around dialysis.

But APD needs a stable home. You need a quiet, clean space for the machine. You need reliable electricity. You need to be able to manage the equipment. If you live in a small apartment or have unstable power, APD might not be practical.

Cost and insurance: What you’ll actually pay

In the U.S., Medicare covers 80% of home dialysis costs. The rest depends on your plan and state.

CAPD supplies - bags, tubing, gloves - cost about $50 to $75 a month out-of-pocket. APD runs $75 to $100 because you’re renting the cycler. That’s more, but some patients save money long-term. Better fluid control means fewer hospital visits. Less need for blood pressure meds. Lower phosphate binder costs. One study found APD users cut those drug costs by 15-20%.

Some insurance plans now cover home modifications - like installing a dedicated outlet or a storage shelf - for APD users. Medicare started covering family training in 2024, so if your spouse or adult child helps, they can learn without extra fees.

Outside the U.S., things vary. In Germany and France, APD gets higher reimbursement. In rural areas, CAPD is still more common simply because clinics don’t have the equipment or staff to train for APD.

Real people, real choices

On patient forums, CAPD users say: “I love that I can do it anywhere.” But they also say: “I’m tired of doing it every day.” APD users say: “I sleep through my treatment.” But they also say: “I hate when the machine beeps at 3 a.m.”

One man in Florida switched from CAPD to APD after three peritonitis infections. “I was scared every time I touched a bag,” he said. Another woman in Texas switched from APD to CAPD after her cycler broke three times in six months. “I didn’t want to wait for a repair crew,” she said. “I just wanted to do it myself.”

There’s no right or wrong. Only what works for you.

What happens if things go wrong?

Both modalities carry risks - but different ones.

With CAPD, the biggest danger is infection. About 34% of people who switch off PD do so because of repeated peritonitis. That’s why training is so strict. You must wash your hands. You must clean your work area. You must never touch the end of the tubing.

With APD, the biggest danger is machine failure. About 1 in 10 cyclers break down each year. If it happens overnight, you may need to do a manual exchange until it’s fixed. That’s why every APD patient gets backup supplies and a 24/7 support line. Most programs now offer remote monitoring - your clinic gets an alert if your treatment is interrupted.

Other issues? Some people can’t tolerate the fluid solution - it causes belly pain or weight gain. Others struggle with catheter problems. Both need regular check-ups with their nephrologist and a home visit from a PD nurse every month.

How to decide - a practical checklist

Ask yourself these questions:

• Do I have steady hands and good vision? (If no, CAPD might be harder.)
• Do I have a quiet, clean space for a machine? (If no, CAPD is simpler.)
• Do I work nights or irregular hours? (If yes, APD might not fit.)
• Do I travel often? (If yes, CAPD is easier to pack.)
• Do I have someone who can help me if I get sick? (If no, CAPD’s simplicity helps.)
• Am I comfortable with technology? (If no, APD’s complexity might stress you out.)
• Do I sleep poorly? (If yes, APD might give you back those lost hours.)

There’s no rush. Most clinics offer trial periods. You can try CAPD for a month, then switch to APD if it doesn’t feel right. Or start with APD and switch if the machine feels like a burden.

The future of home dialysis

APD adoption is growing - about 7.3% a year. CAPD is rising only 2.1%. Why? Technology. New cyclers like Baxter’s Amia use AI to adjust fluid removal based on your weight and blood pressure. They connect to apps. They send alerts. They reduce errors.

By 2030, APD is expected to be the most common form of home PD. But CAPD won’t disappear. It’s still the only option for people without power, without space, or without tech access. It’s also the most affordable choice in low-resource settings.

For now, the best choice is the one you can stick with. Not the fanciest. Not the newest. The one that lets you live your life - without dialysis running it.