I’m glad you were able to evaluate both in-center and home dialysis and then able to select the therapy which best suits your lifestyle. With PD it is true you must have a catheter placed in your abdomen, but of course if you chose hemodialysis you would need an access (where dialysis can be delivered to you) in your arm or sometimes a catheter in your neck temporarily. So there is always some “access” in your body for dialysis. The catheter for PD is hidden from the view of others by your clothing as it is in the lower abdomen, below your belly button, usually. You should be able to discuss with the surgeon before it is placed about where it is best placed for you.
As for fluid in the abdomen, it is true that most patients on PD have fluid at all times, but sometimes, especially when first on PD, you may be able to have very little fluid in the daytime and larger volumes in the night on the cycler (CCPD). If you still make urine, that is, still have some kidney function, then it is easier to have smaller volumes during the day. But eventually, after a few years usually, your kidneys may stop making any urine and then it is very important to have fluid during the day. Most people find that they feel very full at first with the fluid, but this changes within days or weeks of starting PD and soon they find they have no idea how much (or how little) fluid is actually in the abdomen. At our center, we once did a study of this and had patients receive different amounts of fluid blindly (that is the actual volume was hidden from them), then asked them to guess how much fluid was used. They were right only half the time, about as good as the flip of a coin, which means they often were just guessing. In fact most said just that—they were just guessing as they could not tell. In some circumstances, you will be told to empty your abdomen of fluid, for example when you are going to exercise. So there are times when fluid can be reduced, but to get the fulll prescription of dialysis ordered, you need to use the volume prescribed every day unless otherwise told to do so.
As for a night off the cycler, this can be done on special occasions and you need to discuss this with your nurse and doctor. It is important not to just decide not to do dialysis on your own. Remember that PD is usually done 24 hours a day, 7 days a week, and that is why sometimes it can be interrupted without much difficulty for the patient.
And lastly, as to how long your are on the cycler, that depends upon how much kidney function you still have and what prescription is written for you. At our center, we often asked patients how long they slept and tried to work around that, but generally you need to be on the cycler about 8 hours a night. You do not need to sleep all that time, and on the other hand, you do not need to get up when the cycler is finished with the treatment. So you may hook up to the cycler and read or watch TV, or you may sleep a couple of hours after the cycler is done. And you may start the cycler at different times each night, so long as you get all the prescribed hours once on the machine. It is flexible and you do not need to call and ask about these times, you just decide on your own and manage your treatments with your life.
I wish you luck and would be glad to answer more questions if you have them.