Spatial burden and self-managed safety in peritoneal dialysis: a qualitative study based on semi-structured interviews.

BACKGROUND

Peritoneal dialysis is promoted for its spatial flexibility compared to in-center hemodialysis. However, this flexibility entails a significant relocation of clinical responsibility, requiring patients to manage infection control and medical logistics within non-institutional settings. While spatial factors-including housing conditions, storage capacity, and environmental cleanliness-are critical to modality sustainability, they are often reduced to logistical metrics in clinical consultations. This study investigates the concrete mechanisms through which patients evaluate and manage their physical environments to ensure clinical safety.

METHODS

A qualitative study was conducted using semi-structured interviews with 43 adult patients receiving peritoneal dialysis at a tertiary university hospital in South Korea. Interviews explored how participants experienced and evaluated different spaces in relation to peritoneal dialysis. Data were analyzed inductively using thematic analysis.

RESULTS

Participants perceived space not as a static setting but as a managed clinical site, categorized into three domains. Hospitals represented delegated safety, where clinical rigor was entrusted to professionals. Homes functioned as sites of internalized safety, where patients exercised hygienic control by reconfiguring domestic routines to accommodate medical inventories. Spaces beyond the home revealed a paradox of spatial liberation: while peritoneal dialysis theoretically enables flexibility, the unpredictability of external environments often triggered rigorous risk assessments, leading to self-imposed spatial narrowing. Across all domains, the patient's capacity for environmental control was the primary determinant of whether a space was deemed safe.

CONCLUSIONS

This study highlights that space is not a neutral backdrop to treatment, but a central dimension of the PD experience. Understanding how patients perceive and manage their environment is essential for meaningful modality discussions, realistic education, and patient-centered communication. Without addressing these spatial dynamics, PD risks being presented as flexible in principle while remaining constraining in practice.