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

Choosing between CAPD and APD for home dialysis isn’t about which is better - it’s about which fits your life.

If you’re living with kidney failure and considering dialysis at home, you’ve probably heard about peritoneal dialysis. It’s a treatment that uses the lining of your belly - the peritoneum - as a filter to clean your blood. No needles. No trips to a clinic three times a week. Just a catheter in your abdomen and a routine you can manage yourself. The two main types are CAPD (Continuous Ambulatory Peritoneal Dialysis) and APD (Automated Peritoneal Dialysis). One is done by hand, the other by machine. Both work. But they change your life in very different ways.

Let’s cut through the noise. This isn’t a medical lecture. This is what actually matters when you’re deciding: how much time it takes, how it affects your sleep, what happens if the machine breaks, and whether you can still go on vacation or keep working. Real people live with this every day. Here’s what they’ve learned.

CAPD: Manual exchanges, total freedom - but constant interruptions

CAPD has been around since the 1970s. It doesn’t need a machine. You do the exchanges yourself, four to five times a day, using gravity to fill and drain your belly with dialysis fluid. Each exchange takes about 30 to 40 minutes. You can do it anywhere - at home, at work, in a quiet corner of a coffee shop. No electricity. No cords. Just clean hands, sterile supplies, and a routine.

That freedom is real. A 58-year-old teacher in Ohio who’s been on CAPD for seven years says he does his exchanges during his planning period between classes. He keeps bags in a closet. No setup. No noise. Just grab, connect, wait, drain. For people who hate being tied down, this is gold.

But here’s the trade-off: you’re interrupted four to five times a day. That’s not just time - it’s mental energy. You can’t just walk out the door without planning where you’ll do your next exchange. You need a clean surface. You need to wash your hands. You need to be careful. One slip-up, and you risk peritonitis - a serious belly infection. The data shows CAPD users have a slightly higher risk: 0.68 episodes per patient per year, compared to 0.52 for APD.

And yes, you’re carrying bags. Four to six pounds of fluid each time. If you’re older or have arthritis, lifting and handling those bags can be hard. Nearly 38% of dialysis patients over 65 have trouble with fine motor skills, according to USRDS data. For them, CAPD can become a daily struggle.

APD: Sleep while your machine works - but it’s not silent

APD flips the script. Instead of doing exchanges during the day, you hook up to a machine at night while you sleep. The cycler - a small box about the size of a laptop - automatically fills your belly with fluid, lets it sit, then drains it out. You get 8 to 10 hours of treatment while you’re unconscious. That’s why many working adults choose it.

An ER nurse in Texas, 42, says APD lets her work 12-hour shifts without missing a beat. She connects before bed, disconnects in the morning. No daytime interruptions. She gets 3.2 more hours of sleep per night than CAPD users, according to Mayo Clinic data. That’s huge for energy, mood, and overall quality of life.

But APD isn’t magic. It needs electricity. If the power goes out, you have to switch to manual exchanges - and not everyone knows how. Cyclers can break. About 12% of users face a malfunction each year. One woman on Reddit said she’s had three emergency service calls in two years because the machine stopped mid-cycle. That’s stressful.

And yes, the machine makes noise. Around 35 to 45 decibels - like a quiet library. For some, that’s fine. For others, it’s enough to wake them up. Fifteen percent of APD users stop the treatment because of sleep disruption. Modern cyclers like the Baxter Amia have quieter settings and even AI that adjusts fluid removal based on your weight and blood pressure. But it’s still a machine in your bedroom.

Which one is safer? The numbers don’t lie

Safety isn’t just about infections. It’s about how well your body handles the treatment.

APD gives you more consistent fluid removal. That means less swelling, less strain on your heart, and fewer trips to the ER for fluid overload. A 2021 meta-analysis found APD users had 22% fewer hypertension emergencies. Medicare data shows APD patients are 18% less likely to be hospitalized for fluid-related issues.

CAPD, on the other hand, is better if you still have some kidney function left - more than 2 mL per minute. The continuous, gentle filtering helps preserve what’s left. That’s why doctors often recommend CAPD for older patients with residual function.

Both methods have similar survival rates: about 52-58% after five years. That’s better than in-center hemodialysis, which hovers around 45-50%. So either way, you’re choosing a treatment that can extend your life - and let you live it on your terms.

Costs aren’t what you think

Medicare covers 80% of home dialysis costs in the U.S. That means you’re paying for the rest. For CAPD, monthly supply costs average $50 to $75. For APD, it’s $75 to $100 - because you’re renting the machine. But here’s the twist: APD can save you money long-term. Better fluid control means fewer blood pressure meds, less need for phosphate binders, and fewer hospital visits. One study showed APD users cut medication costs by 15-20% over time.

And if you live in a rural area, access matters. Only 32% of rural clinics offer full APD training. CAPD is easier to teach remotely. Some patients in remote regions get trained via video calls and then manage on their own. That’s not always possible with APD, where hands-on troubleshooting is critical.

Who’s it for? Real-life scenarios

Let’s say you’re 76, retired, and have mild arthritis. You don’t work. You live alone. You want something simple. CAPD might be your best bet. It doesn’t rely on technology. You control every step. No machine to fix. No power outage worries.

Now imagine you’re 48, work full-time, have a family, and want to keep your weekends free. APD lets you do your dialysis while you sleep. You can go to your kid’s soccer game without rushing home to do an exchange. You can travel - just pack the cycler and a power adapter.

What if you’re 62, live with your adult child, and they’re willing to help? Medicare now covers training for family members as care partners. That opens up APD for more people. If you can’t lift the bags or handle the tubing, your child can do it for you - without needing to be a nurse.

There’s no one-size-fits-all. But there is a best fit - for you.

Training and support: What to expect

Training for CAPD takes 10 to 14 days. You’ll learn sterile technique, how to connect the tubing, how to spot signs of infection, and how to manage your fluid balance. It’s intense. You’ll practice on a dummy before you touch your own catheter.

APD training is longer - 14 to 21 days. You’ll learn the machine inside and out: how to load the bags, how to troubleshoot alarms, how to switch to manual mode if needed. You’ll also learn about remote monitoring. Most modern APD systems now send data to your care team every night. If your fluid removal drops or your weight spikes, your nurse gets an alert. That’s how they catch problems before you end up in the hospital.

Support is better for APD. About 95% of APD programs offer 24/7 technical support. For CAPD, it’s 82%. That gap matters. When you’re scared, confused, or in pain - you need someone to answer the phone. Fast.

The future is automated - but CAPD isn’t going away

APD adoption is growing fast. It’s rising 7.3% per year. CAPD? Just 2.1%. Why? Technology. New cyclers like Baxter’s Amia use AI to adjust treatment based on your real-time data. In trials, they reduced fluid overload by 31%. By 2030, APD will likely make up 65% of home peritoneal dialysis.

But CAPD still has its place. It’s cheaper. It’s simpler. It doesn’t need power. In places with unreliable electricity - or for patients with dementia or severe cognitive decline - CAPD is often the only option.

The goal isn’t to replace CAPD. It’s to give you choices. And the best choice isn’t the most advanced. It’s the one you can stick with - day after day, year after year.

What to ask your doctor

Don’t just accept the first option they suggest. Ask these questions:

• Do I still have any kidney function left? That affects which dialysis type is better for me.
• Can I handle lifting and connecting tubing? If not, APD might be easier.
• Do I have a reliable power source at home? What if the power goes out?
• Is there 24/7 support for the machine I’d be using?
• Can my family be trained to help if I need it?
• What’s the backup plan if the machine breaks or I get sick?

And if your clinic doesn’t offer both options - ask why. Only 68% of nephrology practices in the U.S. offer both CAPD and APD. You deserve to know all your choices.

Final thought: It’s not about the machine - it’s about your life

Peritoneal dialysis gives you back control. That’s rare in kidney care. CAPD lets you move freely. APD lets you sleep peacefully. One is manual. One is automated. Both are life-changing.

The right choice isn’t the one that looks best on paper. It’s the one you can live with - without resentment, without fear, without constant stress. Talk to people who’ve been there. Try the training. See how it feels. Your body will tell you what works. Listen to it.

Next steps: What to do right now

If you’re considering home dialysis, here’s your action plan:

1. Ask your nephrologist if you’re a candidate for peritoneal dialysis. Not everyone is - but many more people could be than realize.
2. Request a demonstration of both CAPD and APD. See the supplies. Touch the machine. Try the tubing.
3. Ask to speak with someone currently on each modality. Real stories beat brochures.
4. Check your insurance coverage. Know what’s included and what you’ll pay monthly.
5. Do a home assessment. Do you have space for supplies? A clean area for exchanges? A reliable outlet for APD?
6. Start training early. It takes weeks to feel confident. Don’t wait until you’re in crisis.

This isn’t a one-time decision. It’s a lifestyle adjustment. And you don’t have to get it perfect on the first try. Many people try one method, switch to the other, and find their rhythm. The goal isn’t perfection. It’s control. And with either CAPD or APD, you still get to live - on your terms.